World Journal of Gastrointestinal Surgery最新文献

Background: Colostomy is important in the treatment of colorectal cancer. However, surgical site wound infections after colostomy seriously affect patients' physical recovery and quality of life.

Aim: To investigate the ability of high-quality nursing care to prevent surgical site wound infections and reduce post-colostomy complications in patients with colorectal cancer.

Methods: Eighty patients with colorectal cancer who underwent colostomy at our hospital between January 2023 and January 2024 were selected as research subjects. The random number table method was used to divide the participants into control and research groups (n = 40 each). The control group received routine nursing care, while the research group received high-quality nursing care. The differences in indicators were compared between groups.

Results: The baseline characteristics did not differ between the research (n = 40) and control (n = 40) groups (P > 0.05). The incidences of wound infection, inflammation, and delayed wound healing were significantly lower in the research (5.00%) vs control (25.00%) group (P = 0.028). The incidence of postoperative complications, including fistula stenosis, fistula hemorrhage, fistula prolapse, peristome dermatitis, urinary retention, pulmonary infection, and intestinal obstruction, was significantly lower in the research (5.00%) vs control (27.50%) group (P = 0.015). In addition, the time to first exhaust (51.40 ± 2.22 vs 63.80 ± 2.66, respectively; P < 0.001), time to first bowel movement (61.30 ± 2.21 vs 71.80 ± 2.74, respectively; P < 0.001), and average hospital stay (7.94 ± 0.77 vs 10.44 ± 0.63, respectively; P < 0.001) were significantly shorter in the research vs control group. The mean Newcastle satisfaction with nursing scale score was also significantly higher in the research (91.22 ± 0.96) vs control (71.13 ± 1.52) group (P < 0.001).

Conclusion: High-quality nursing interventions can effectively reduce the risk of wound infections and complications in patients undergoing colostomy, promote their postoperative recovery, and improve their satisfaction with the nursing care received.

The medical education system, particularly the fellowship training system, of China has been continuously developing and improving. China established the fellowship training system in 2016, with the period for general surgeons being 3 years. Among the various general surgery subspecialties, hepatopancreatobiliary (HPB) surgery has a specialized training period of approximately 6 months. However, owing to the intricate anatomical knowledge and sophisticated surgical skills involved in HPB surgery, training excellent HPB surgeons in such a short period has always been a major challenge in the field of surgical education. This editorial summarizes the current situation, existing problems that need to be implemented for improving HPB fellowship in China. Finally, we hope to build a qualified HPB fellowship system that continually adapts to social development.

This article discusses the article written by Tan et al. Transarterial chemoembolization (TACE) is one of the main treatment methods for advanced hepatocellular carcinoma (HCC). There are other vascular interventional therapies, including drug-eluting bead TACE, transarterial radioembolization, and hepatic arterial infusion chemotherapy. TACE combined with anti-angiogenesis therapy may improve tumor control and prolong progression free survival. The combination therapy of TACE and immunotherapy may improve the clinical efficacy of HCC. In future research, more basic and clinical studies are needed to explore the immunogenic intervention therapy.

After anorectal surgery, hemorrhoids frequently lead to chronic issues, particularly in patients with mixed hemorrhoids. Liu et al investigated the outcomes of staple removal at the 3- and 9-o'clock positions following modified stapled hemorrhoidopexy (SH) in patients with grade III or IV hemorrhoids. This study included patients who underwent standard or modified SH between January 1, 2015, and January 1, 2020. Key metrics assessed included hospital stay duration, blood loss, operation time, and the incidence of minor or major complications. The findings indicated that the modified SH technique is a safe option for advanced-grade hemorrhoids, resulting in a lower rate of postoperative anal stenosis compared to standard SH. Notably, this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments. While the modified SH demonstrates immediate benefits, further research is necessary to evaluate long-term effects. Despite its advantages, the study's limited sample size restricts the generalizability of the findings, underscoring the need for larger, long-term studies to validate these results. Clinically, the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis, a common concern following typical surgeries. If confirmed by larger trials, this procedure may become the preferred surgical approach for hemorrhoids. In conclusion, the work of Liu et al signifies a meaningful advancement in hemorrhoid surgery, enhancing patient safety and outcomes.

Background: Utilizing failure mode and effects analysis (FMEA) in operating room nursing provides valuable insights for the care of patients undergoing radical gastric cancer surgery.

Aim: To evaluate the impact of FMEA on the risk of adverse events and nursing-care quality in patients undergoing radical surgery.

Methods: Among 230 patients receiving radical cancer surgery between May 2019 and May 2024, 115 were assigned to a control group that received standard intraoperative thermoregulation, while the observation group benefited from FMEA-modeled operating room care. Clinical indicators, stress responses, postoperative gastrointestinal function recovery, nursing quality, and the incidence of adverse events were compared between the two groups.

Results: Significant differences were observed in bed and hospital stay durations between the groups (P < 0.05). There were no significant differences in intraoperative blood loss or postoperative body temperature (P > 0.05). Stress scores improved in both groups post-nursing (P < 0.05), with the observation group showing lower stress scores than the control group (P < 0.05). Gastrointestinal function recovery and nursing quality scores also differed significantly (P < 0.05). Additionally, the incidence of adverse events such as stress injuries and surgical infections varied notably between the groups (P < 0.05).

Conclusion: Incorporating FMEA into operating room nursing significantly enhances patient care by improving safety, expediting recovery, and reducing healthcare-associated risks.

Background: Intestinal ischemia-reperfusion (I/R) injury (II/RI) is a critical condition that results in oxidative stress, inflammation, and damage to multiple organs. Zinc, an essential trace element, offers protective benefits in several tissues during I/R injury, but its effects on intestinal II/RI remain unclear.

Aim: To investigate the effects of zinc pretreatment on II/RI and associated multiorgan damage.

Methods: C57BL/6 mice were pretreated with zinc sulfate (ZnSO₄, 10 mg/kg) daily for three days before I/R injury was induced via superior mesenteric artery occlusion (SMAO) and abdominal aortic occlusion (AAO) models. Tissue and serum samples were collected to evaluate intestinal, liver, and kidney damage using Chiu's score, Suzuki score, and histopathological analysis. Caco-2 cells and intestinal organoids were used for in vitro hypoxia-reoxygenation injury models to measure reactive oxygen species (ROS) and superoxide dismutase (SOD) levels.

Results: Zinc pretreatment significantly reduced intestinal damage in the SMAO and AAO models (P < 0.001). The serum levels of liver enzymes (alanine aminotransferase, aspartate aminotransferase) and kidney markers (creatinine and urea) were lower in the zinc-treated mice than in the control mice, indicating reduced hepatic and renal injury. In vitro, zinc decreased ROS levels and increased SOD activity in Caco-2 cells subject to hypoxia-reoxygenation injury. Intestinal organoids pretreated with zinc exhibited enhanced resilience to hypoxic injury compared to controls.

Conclusion: Zinc pretreatment mitigates II/RI and reduces associated multiorgan damage. These findings suggest that zinc has potential clinical applications in protecting against I/R injuries.

Background: Previous studies suggest that appendectomy has a protective effect against ulcerative colitis (UC); however, relatively few studies focusing on this topic have been reported in China.

Aim: To explore the correlation between appendectomy and the onset of UC.

Methods: A total of 313 patients with newly diagnosed UC and 313 healthy individuals were selected for this study. According to whether their appendix was removed before the diagnosis of UC, patients were divided into appendectomized and non-appendectomized groups. Their general clinical data, appendectomy history, disease severity, extent of involvement, and blood routine test results were collected to evaluate the relationship between appendectomy and the onset of UC.

Results: The study revealed that the average time interval for the diagnosis of UC after appendectomy was 14.72 ± 13.87 years. 55.81% patients were diagnosed with UC five years after appendectomy. Among them, eight patients underwent appendectomy before the age of 20 years and were diagnosed with UC five years later. In the appendectomized group, the onset age of UC was higher, and the degree of disease activity was significantly lower. This group had a higher proportion of patients in clinical remission or with mild disease and a lower proportion of patients with severe disease. The extent of lesions in the appendectomized group was limited, with a higher proportion of E1 and E2, whereas a lower proportion of E3 lesions.

Conclusion: Appendectomy may delay the onset of UC, reduce disease severity, and lessen the scope of involvement.

The number of lymph nodes (LNs) dissected during surgery has become an interesting topic. Simple intuition always leads us to believe that dissecting more LNs will result in more accurate pathological staging and assurance of surgical quality. However, when the number of LNs dissected reaches a certain threshold, the patient's prognosis does not continue to improve as the number of dissected nodes increases. Instead, an increase in the number of dissected LNs may be accompanied by a higher incidence of complications. Currently, there are only less than 40% of colorectal cancer patients undergoing adequate LN evaluation. Therefore, obtaining a sufficient number of LNs in clinical practice is extremely challenging. How to further address the insufficiency of LN dissection due to various reasons, which results in concerns of surgeons about patient prognosis, is currently a critical focus.

Background: Endoscopic resection (ER) and laparoscopic resection (LR) have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors (gGISTs) (2-5 cm), but there are no selection criteria for their application.

Aim: To provide a reference for the development of standardized treatment strategies for gGISTs.

Methods: Clinical baseline characteristics, histopathological results, and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed. Propensity score matching (PSM) was employed to achieve balance in baseline characteristics of the two groups.

Results: Among 206 patients, 135 were in the ER group and 71 in the LR group. The ER group had significantly smaller tumors [3.5 cm (3.0-4.0 cm) vs 4.2 cm (3.3-5.0 cm), P < 0.001] and different tumor locations (P = 0.048). After PSM, 59 pairs of patients were balanced. After matching, the baseline characteristics of the ER and LR groups did not differ significantly from each other. Compared with LR, ER had faster recovery of diet (P = 0.046) and fewer postoperative symptoms (P = 0.040). LR achieved a higher complete resection rate (P < 0.001) and shorter operation time (P < 0.001). No significant differences were observed in postoperative hospital stay (P = 0.478), hospital costs (P = 0.469), complication rates (P > 0.999), pathological features (mitosis, P = 0.262; National Institutes of Health risk classification, P = 0.145), recurrence rates (P = 0.476), or mortality rates (P = 0.611).

Conclusion: Both ER and LR are safe and effective treatments for gGISTs. ER has less postoperative pain and faster recovery, while LR has a higher rate of complete resection.