World Journal of Gastrointestinal Surgery最新文献

The authors introduce a new magnetic resonance cholangiopancreatography (MRCP) radiologic feature, the "ice-breaking sign" (IBS), and present a retrospective case-control study comparing patients with common bile duct stones who exhibit the IBS with a control group without this sign. The two groups were matched using a propensity score based on patient age and sex. However, the matching process did not account for the size of the choledocholithiasis, which may represent a significant confounding factor. Both groups were not homogeneous. The authors advocate for the use of MRCP as the primary diagnostic tool to guide the decision. However, in clinical practice, MRCP availability is often limited, particularly when compared to endoscopic ultrasound, which may be more available. The authors compared the clinical course and therapeutic responses to cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) between the two groups. The results demonstrated a markedly low ERCP success rate in both the study and control, falling below international standards, whereas the success rate of LCBDE was only slightly reduced. Despite the study's limitations and potential biases, the authors conclude that IBS is a valuable predictor for treatment planning and suggest that LCBDE should be considered the first-line approach. Despite its growing acceptance, LCBDE remains infeasible in many hospitals due to the steep learning curve.

Background: Aging is associated with reduced physiological reserves, frailty, sarcopenia, and increases in other comorbidities. Existing studies on prehabilitation showed potential in improving postoperative outcomes but were heterogeneous. Recommendations are still weak for promoting multimodal prehabilitation before elective colorectal surgery. There is also no recommendation on the best criteria to select patients for prehabilitation.

Aim: To compare postoperative outcomes in patients with prehabilitation vs those without prior to elective colorectal surgery using propensity score matching (PSM).

Methods: This retrospective study was conducted from July 2010 to December 2021 on patients aged ≥ 75 years, or aged ≥ 65 years and frail, and/or had Charlson comorbidity index ≥ 4 who underwent elective colorectal surgery. Perioperative care included a specialized nurse, physiotherapist, dietician, and geriatrician review. Decision for the type of prehabilitation (inpatient, outpatient, or home-based) was made after a joint discussion considering patient's mobility, caregiver availability, and anticipated compliance to physiotherapy regime. A 2:1 PSM was performed to balance.

Results: There were 208 patients (prehabilitation: 148, no prehabilitation: 60) in the unmatched cohort. There were 43.8% who were aged ≥ 80 years, 31.7% who were frail, and 43.8% who underwent laparoscopic surgery. Duration of prehabilitation ranged from 2-4 weeks. The overall incidence of major morbidity, 30-day mortality, and 1-year mortality were 12.0%, 1.9%, and 6.7%, respectively. The PSM group had 144 patients. Prehabilitation was not an independent predictor of major morbidity [odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.30-2.33] and 1-year mortality (OR = 1.26, 95%CI: 0.30-5.28). Subgroup analysis of patients who were not frail (prehabilitation n = 79, no prehabilitation n = 40) similarly showed that prehabilitation was not an independent predictor of major morbidity (OR = 0.75, 95%CI: 0.26-2.14) and 1-year mortality (OR = 1.04, 95%CI: 0.24-4.55).

Conclusion: Older patients who were not frail did not benefit from prehabilitation. Selection criteria for prehabilitation may be modified to target patients who will better benefit from it.

Background: Peripherally inserted central catheter (PICC) is the preferred intravenous route for chemotherapy in patients with cancer, but its complications, especially deep vein thrombosis (DVT), are becoming increasingly prevalent. Medical staff proficient in intubation and maintenance techniques can reduce complications. The multivariate integration teaching model applies the integration of "teaching learning application" to medical training, which helps shift the prevention of complications from "passive management of complications" to "active construction of risk immunity", thereby ensuring foundational competency for PICC in patients with cancer.

Aim: To investigate the efficacy of the multivariate integration teaching model in patients with gastric cancer and concurrent DVT after PICC intubation and analyze its effect on patients' quality of life index (QLI) and satisfaction.

Methods: A retrospective analysis of medical records of 100 patients with gastric cancer and PICC treated at Zhejiang Provincial People's Hospital from May 2019 to November 2020 was conducted. According to the different treatment methods and teaching modes received by medical staff, they were divided into a control group and an experimental group, with 50 cases in each group. The routine clinical teaching model and the multivariate integration teaching model were administered to the medical staff for the control group and the experimental group, respectively, to compare the incidence rates of DVT and other adverse reactions, QLI scores, Karnofsky Performance Scale scores, Mental Status Scale in Non-Psychiatric Settings scores, patient satisfaction, medical staff's test marks, and satisfaction evaluation of the teaching model.

Results: Compared with the control group, the experimental group exhibited significantly lower incidence rates of DVT and other adverse reactions and MSSNS scores but significantly higher QLI scores, KPS scores, patient satisfaction, medical staff's test marks, and their satisfaction evaluations of the teaching model (P < 0.05).

Conclusion: In a single-center practice, performing the multivariate integration teaching model for medical staff may effectively improve the patients' QLI and satisfaction and may have certain application value in preventing DVT in patients with gastric cancer and PICC.

Background: Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis in children, offering reduced postoperative pain and quicker recovery compared to open surgery. A critical aspect of LA is the secure closure of the appendiceal stump to avoid complications such as leakage and abscess formation. Various closure techniques are employed, including endoloops (ELs), staplers, clips, and energy devices; however, the optimal method remains unclear due to inconsistent evidence.

Aim: To systematically evaluate and rank the effectiveness and safety of different appendiceal stump closure techniques used in pediatric LA. By assessing outcomes such as postoperative complications, operative time, and length of hospital stay, this analysis seeks to provide evidence-based guidance to clarify clinical decision-making and optimize patient care.

Methods: This systematic review and network meta-analysis, conducted according to PRISMA and Cochrane guidelines, compared the effectiveness and safety of stump closure methods in pediatric LA. Databases searched included PubMed, Cochrane Central, Web of Science, and Scopus up to May 1, 2025. Eligible studies included both randomized and non-randomized designs reporting surgical outcomes in pediatric patients. Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A frequentist network meta-analysis with a random-effects model was conducted using R software to evaluate total complications (primary outcome), as well as operative time and hospital stay (secondary outcomes). P-scores were used to rank the effectiveness of treatments.

Results: Fourteen studies comprising over 50000 pediatric patients were included in the network meta-analysis comparing appendiceal stump closure techniques in LA. No significant differences in total postoperative complications or hospital stay were observed among techniques, including EL, endostapler, polymer clip, LigaSure, harmonic scalpel (HS), and sutures. HS showed a statistically significant reduction in operative time compared to EL (mean difference: -13.5 minutes), while other methods did not demonstrate significant time savings. No technique was associated with a statistically significant increase or decrease in postoperative complications or length of stay. Publication bias was minimal, and the methodological quality of included studies was moderate to good.

Conclusion: While all closure techniques show similar safety profiles, HS offers shorter operating times. These findings support tailoring stump closure method selection based on operative efficiency and resource availability.

The largest multi-institutional cohort analysis of bile spillage in incidental gallbladder cancer was presented by van Dooren et al The study offers important insights, though certain methodological limitations and interpretative challenges temper the strength of its conclusions. We address these, clarify how statistical findings intersect with clinical relevance for bile spillage, propose a refined classification system, and provide global epidemiological context.

This letter presents a critical analysis of the study by Zhao et al, which proposed a therapeutic strategy for difficult common bile duct stones focusing on the "ice-breaking sign" as a pivotal radiological feature. Based on magnetic resonance cholangiopancreatography with three-dimensional reconstruction, the diagnostic criteria for this sign were established by identifying an abrupt narrowing at the distal bile duct caused by impacted stones, analogous to the morphology of an ice-breaking vessel. Specifically, the proximal bile duct (hepatic hilar side) exhibited significant dilatation upstream of the stenosis, while the distal segment (duodenal papillary side) presented with stricture or occlusion. This study was the first to introduce the radiological marker termed the "ice-breaking sign", providing a novel dimension for the evaluation of refractory common bile duct stones. However, notable limitations were also present in this study. The interpretation of the ice-breaking sign depended largely on subjective assessments by physicians, even though a multidisciplinary consensus approach was employed. Objective quantification criteria, such as specific thresholds for the degree of stenosis, were not established. Furthermore, being a single-center study, it might have influenced the reproducibility of findings across different centers. Future studies should explore the pathophysiological mechanisms of the "ice-breaking sign" in greater depth, increase the sample size, and conduct multicenter research to validate its clinical universality and guiding significance for treatment strategies.

Background: Recent studies have revealed that endoscopic minimally invasive treatment of early esophageal cancer and precancerous lesions is as effective as traditional surgery and offer considerable advantages, such as minimal invasiveness, enhanced safety, lower costs, and improved quality of life after surgery.

Aim: To analyze factors affecting postoperative fever in patients with early esophageal squamous cell carcinoma and precancerous lesions who underwent endoscopic radiofrequency ablation (ERFA).

Methods: Clinical data of 29 patients with esophageal lesions admitted to The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University between March 2022 and June 2024 were retrospectively analyzed. All patients underwent ERFA and were divided into a fever group and a non-fever group based on whether they experienced fever after surgery. The general characteristics of both groups were analyzed, and univariate analysis of variance and multivariate logistic regression were conducted to examine the factors that influence the incidence of fever in patients with early esophageal squamous cell carcinoma and precancerous lesions treated with ERFA.

Results: Among the 29 patients with esophageal lesions treated with ERFA, 11 did not experience fever, whereas 18 (62.07%) experienced it. Univariate analysis of variance showed that the ablation length and duration of postoperative fasting were significantly different between the fever and non-fever groups (P < 0.05), whereas the operation time, postoperative use of hormones, postoperative use of antibiotics, and pathological type were not significantly different between these groups (P > 0.05). Multivariate logistic regression indicated that the ablation length and duration of postoperative fasting were independent factors influencing the occurrence of post-ERFA fever.

Conclusion: The incidence of fever is high in patients with early esophageal lesions treated with ERFA, which is related to the ablation length and duration of postoperative fasting. The results can guide modifications in the treatment and nursing plans for patients with esophageal lesions to reduce the risk of postoperative fever.

In order to evaluate emerging imaging strategies for optimizing cholangiocarcinoma (CCA) assessment in liver transplantation (LT) candidates, addressing gaps in standardization, diagnostic ambiguity, and equitable access. Critical analysis of current evidence and innovations in CCA imaging, focusing on three pillars: (1) Adaptation of Liver Imaging Reporting and Data System for standardized reporting; (2) Integration of artificial intelligence (AI)-driven radiomics for risk stratification; and (3) Expanded utilization of contrast-enhanced ultrasound (CEUS) in resource-limited settings. Current imaging criteria for LT eligibility in CCA rely heavily on tumor size and vascular invasion, but lack standardized protocols for lesion characterization in cirrhotic livers. Liver Imaging Reporting and Data System, validated for hepatocellular carcinoma, shows promise in reducing interobserver variability when adapted to CCA-specific features (e.g., targetoid appearance on magnetic resonance imaging). AI-driven radiomics can predict microvascular invasion and post-LT recurrence risk with 85% accuracy in preliminary studies, while CEUS demonstrates 92% specificity for differentiating intrahepatic CCA from dysplastic nodules in cirrhosis. A harmonized approach combining standardized reporting systems, AI-powered analytics, and accessible imaging modalities like CEUS could redefine LT pathways for CCA. Collaborative efforts between radiologists and transplant teams are essential to translate these innovations into equitable, precision-driven care.

Background: Gastritis cystica profunda (GCP) is a rare submucosal gastric lesion characterized by the extension of cystically dilated gastric mucosal glands into or below the muscularis mucosa, often due to various underlying causes. Typically, asymptomatic or associated with mild symptoms, GCP is most commonly discovered incidentally during surgery or endoscopy. To the best of our knowledge, this is the first documented case of GCP accompanied by acute inflammation and abscess formation.

Case summary: A 37-year-old woman presented with upper abdominal pain. Laboratory tests showed elevated inflammatory markers and carbohydrate antigen 19-9 levels. Gastroscopy revealed a submucosal bulge. Based on enhanced computed tomography findings, an ectopic pancreas with cyst was suspected. Clinically, we decided to perform distal gastrectomy. Postoperative pathology confirmed that the patient had GCP complicated by acute inflammation and abscess formation. The patient had an uneventful postoperative recovery.

Conclusion: This case provides information on new complications of GCP and emphasizes the diagnostic value of enhanced computed tomography.