Open surgery:Still a great option to treat patients with posttraumatic arteriovenous fistulas:A case report

BACKGROUND In the modern era of endovascular surgery percutaneous interventions are being widely used to treat a number of vascular disorders including arteriovenous fistulas(AVF).Still,patients with hostile anatomy or complicated cases such as large post-traumatic AVFs may be successfully treated using conventional vascular surgery.CASE SUMMARY This paper presents state-of-the-art treatment options in subjects with posttraumatic AVFs and a case-report of a successful open surgical approach in a patient with a 25 year old history of a post-traumatic AVF between the common femoral artery and common femoral vein.CONCLUSION Open surgery is still a great option to treat patients with post-traumatic arteriovenous fistulas with hostile anatomy or in complicated cases.Concomitant conditions and complications should be addressed promptly.

Evolving thoracic surgery: from open surgery to single port thoracoscopic surgery and future robotic

Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long recovery times after surgery. But he history of thoracic surgery changed since the begining of video-assisted thoracoscoDic surgery （VATg3

Open surgery in the era of minimally invasive surgery

The benefits and popularity of minimally invasive surgery are undeniable around the globe.However,open surgery is necessary and learning open surgery skills is still a necessity.Open surgery allows for better exposure to the surgical field and provides tactile sensation to facilitate the stereo visual assessment to precisely remove the lesion.Open surgery is still the key to surgical training,and the skills learned from open surgeries remain crucial for unforeseen circumstances and certain conditions like emergencies,challenge cases,or patients with compromised status.

Laparoscopic vs.open surgery for gastrointestinal stromal tumors of esophagogastric junction:A multicenter,retrospective cohort analysis with propensity score weighting

Objective:Laparoscopic resection is increasingly performed for gastrointestinal stromal tumors(GISTs).However,the laparoscopic approach for GISTs located in the esophagogastric junction(EGJ-GIST)is surgically challenging.This study compares the efficacy of laparoscopic surgery and the open procedure for EGJ-GIST through the propensity score weighting(PSW)method.Methods:Between April 2006 and April 2018,1,824 surgical patients were diagnosed with primary gastric GIST at four medical centers in South China.Of these patients,228 were identified as EGJ-GISTs and retrospectively reviewed clinicopathological characteristics,operative information,and long-term outcomes.PSW was used to create the balanced cohorts.Results:PSW was carried out in laparoscopic and open-surgery cohorts according to year of surgery,sex,age,body mass index(BMI),tumor size,mitotic rates and recurrence risk.After PSW,438 patients consisting of 213 laparoscopic(L group)and 225 open surgery(O group)patients were enrolled.After PSW,the following measures in the L group were superior to those in the O group:median operative time[interquartile range(IQR)]:100.0(64.5-141.5)vs.149.0(104.0-197.5)min,P<0.001;median blood loss(IQR):30.0(10.0-50.0)vs.50.0(20.0-100.0)mL,P=0.002;median time to liquid intake(IQR):3.0(2.0-4.0)vs.4.0(3.0-5.0)d,P<0.001;median hospital stay(IQR):6.0(4.0-8.0)vs.7.0(5.0-12.0)d,P<0.001;and postoperative complications(10.3%vs.22.7%,P=0.001).The median follow-up was 55(range,2-153)months in the entire cohort.No significant differences were detected in either relapse-free survival(RFS)[hazard ratio(HR):0.372,95%confidence interval(95%CI):0.072-1.910,P=0.236]or overall survival(OS)(HR:0.400,95%CI:0.119-1.343,P=0.138)between the two groups.Conclusions:Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time,reduced blood loss,shorter time to liquid intake,and shorter length of stay,all without compromising postoperative outcomes and long-term survival.

Clinical effect of laparoscopic radical resection of colorectal cancer based on propensity score matching

BACKGROUND The incidence of colorectal cancer(CRC)is increasing annually.Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice.AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching(PSM).METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital,Xiangya School of Medicine,Central South University(The First People’s Hospital of Changde City)were analyzed retrospectively.The control group included patients who underwent open surgery(n=43),and those who underwent laparoscopic surgery formed the observation group(n=57).The baseline information of both groups was equipoised using 1×1 PSM.Differences in the perioperative parameters,inflammatory response,immune function,degree of pain,and physical status between the groups were analyzed.RESULTS Thirty patients from both groups were successfully matched.After PSM,baseline data showed no statistically significant differences between the groups:(1)Periop-erative parameters:The observation group had a longer surgery time,less intra-operative blood loss,earlier first ambulation and first anal exhaust times,and shorter gastric tube indwelling time than the control group;(2)Inflammatory response:24 h after surgery,the levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)between groups were higher than preoperatively.IL-6,CRP,and TNF-αlevels in the observation group were lower than in the control group;(3)Immune function:At 24 h after surgery,counts of CD4-positive T-lymphocytes(CD4+)and CD4+/CD8-positive T-lymphocytes(CD8+)in both groups were lower than those before surgery,whereas CD8+was higher than that before surgery.At 24 h after surgery,both CD4+counts and CD4+/CD8+in the observation group were higher than those in the control group,whereas CD8+counts were lower;(4)Degree of pain:The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery;and(5)Physical status:One month after surgery,the Karnofsky performance score in the observation group was higher than that in the control group.CONCLUSION Laparoscopic radical resection of CRC has significant benefits,such as reducing postoperative pain and postoperative inflammatory response,avoiding excessive immune inhibition,and contributing to postoperative recovery.

Postoperative ileus in colorectal surgery:is there any difference between laparoscopic and open surgery?

Background:Postoperative ileus is a major complication of patients undergoing abdominal surgery.The purpose of this study was to determine the effects of operative time and the method of surgery on postoperative ileus.Methods:After institutional review board approval,121 patients were studied in two groups.Group 1 consisted of 86 patients with colorectal cancers and Group 2 included 35 patients with diverticulitis.Various surgical procedures were performed in both groups.In all patients,the nasogastric(NG)tube was removed after termination of surgery.Clear liquids were offered commencing on the first postoperative day,followed by a regular diet as tolerated.GI-1 was the postoperative time to toleration of clear liquids,whereas GI-2 was the postoperative time to first bowel movement or flatus and toleration of a regular diet.Statistical analysis was performed using a linear regression model by disease with the first bowel movement or flatus as the dependent variable and operative time and category as explanatory variables.Results:Vomiting after oral feeding occurred in 18(20.9%)patients with cancer and in 7(20.0%)patients with diverticular disease.An NG tube was reinserted in 13(15.1%)patients in the cancer group and in 3(8.6%)patients in the diverticular disease group.In patients with cancer,the duration of operation was associated with GI-2(P=0.011),whereas in patients with diverticulitis,the duration of operation was associated with GI-1(P=0.001)and GI-2(P=0.044).In the diverticulitis group,a significant relationship was found between GI-2 and operative category(P=0.03).Conclusion:Longer operations led to more prolonged postoperative ileus after both laparoscopy and laparotomy,regardless of malignant or benign pathology.In anticipation of and/or following longer operations,surgeons should consider measures to shorten postoperative ileus.

Survival outcomes following laparoscopic vs open surgery for non-metastatic rectal cancer:a two-center cohort study with propensity score matching

Background:Laparoscopic surgery for rectal cancer is commonly performed in China.However,compared with open surgery,the effectiveness of laparoscopic surgery,especially the long-term survival,has not been sufficiently proved.Methods:Data of eligible patients with non-metastatic rectal cancer at Nanfang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese Medicine between 2012 and 2014 were retrospectively reviewed.Long-termsurvival outcomes and short-termsurgical safety were analysed with propensity score matching between groups.Results:Of 430 cases collated from two institutes,103 matched pairs were analysed after propensity score matching.The estimated blood loss during laparoscopic surgerywas significantly less than that during open surgery(P=0.019)and the operative time and hospital staywere shorter in the laparoscopic group(both P<0.001).The post-operative complications ratewas 9.7%in the laparoscopic group and 10.7%in the open group(P=0.818).No significant differencewas observed between the laparoscopic group and the open group in the 5-year overall survival rate(75.7%vs 80.6%,P=0.346),5-year relapse-free survival rate(74.8%vs 76.7%,P=0.527),or 5-year cancer-specific survival rate(79.6%vs 87.4%,P=0.219).An elevated carcinoembryonic antigen,<12 harvested lymph nodes,and perineural invasion were independent prognostic factors affecting overall survival and relapse-free survival.Conclusions:Our findings suggest that open surgery should still be the priority recommendation,but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer.

Application of laparoscopic surgery in gallbladder carcinoma

Gallbladder carcinoma(GC)is a rare type of cancer of the digestive system,with an incidence that varies by region.Surgery plays a primary role in the comprehensive treatment of GC and is the only known cure.Compared with traditional open surgery,laparoscopic surgery has the advantages of convenient operation and magnified field of view.Laparoscopic surgery has been successful in many fields,including gastrointestinal medicine and gynecology.The gallbladder was one of the first organs to be treated by laparoscopic surgery,and laparoscopic cholecystectomy has become the gold standard surgical treatment for benign gallbladder diseases.However,the safety and feasibility of laparoscopic surgery for patients with GC remain controversial.Over the past several decades,research has focused on laparoscopic surgery for GC.The disadvantages of laparoscopic surgery include a high incidence of gallbladder perforation,possible port site metastasis,and potential tumor seeding.The advantages of laparoscopic surgery include less intraoperative blood loss,shorter postoperative hospital stay,and fewer complications.Nevertheless,studies have provided contrasting conclusions over time.In general,recent research has tended to support laparoscopic surgery.However,the application of laparoscopic surgery in GC is still in the exploratory stage.Here,we provide an overview of previous studies,with the aim of introducing the application of laparoscopy in GC.

Medium-term surgical outcomes and health-related quality of life after laparoscopic vs open colorectal cancer resection: SF-36 health survey questionnaire

BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.

Progression of Minimally Invasive Urological Surgery at Hôpital Général Idrissa Pouye in Dakar in 20 Years of Practice

Introduction: Open surgery is gradually being supplanted by minimally invasive surgical techniques worldwide. Our study aimed to describe the place of minimally invasive surgery at the Hôpital Général Idrissa Pouye (HOGIP) in Dakar. Materials and Methods: This is a descriptive cross-sectional study over a 20-years period from 1st June 2000 to 31st December 2021 in the urology department of HOGIP in Dakar. The list of all surgical procedures performed was computed. We evaluated the distribution of minimally invasive procedures (endoscopy, PCNL, laparoscopy) overall and over the years. We made calculations of proportions and statistical significance was considered for alpha = 0.05. Results: In 20 years, 14,855 surgical procedures were performed, of which 5344 (36%) were minimally invasive surgeries. The average age of men was 53.19 years (standard deviation: 21.77) vs 47.32 years (standard deviation: 18.43) for women. Minimally invasive procedures in the lower urinary tract accounted for 71.93% and involved 1033 cystoscopies (26.87%), 1020 Trans Urethral Resection of Prostate (TURP) (26.53%), 931 Direct Vision Internal Urethrotomy (DVIU) (24.21%, and 612 Trans Urethral Resection of the Bladder (TURB) (15.92%). In the upper urinary tract, 1461 (28.07%) minimally invasive procedures were performed, including PCNL in 193 cases (3.61%), laser endopyelotomy in 104 cases (1.95%), ureteroscopy in 486 cases (1.7%) and laparoscopy in 39 cases (0.46%). The proportion of minimally invasive surgery has gradually increased. Among the 5344 minimally invasive procedures, 333 (5.23%) were performed in 2000-2004 and 2332 (43.63%) in 2015-2019. Conclusion: Minimally invasive surgery represents an important part of the activity of the HOGIP urology department. Its development has improved over the years offering its advantages to the patients.

Psychosocial Factors Associated with Transfer Anxiety among Open Heart Surgery Patients Transferred from the Intensive Care Unit to the General Ward

Introduction: Patient’s transfer from the intensive care unit (ICU) to the general ward indicates their improving health status. However, the transfer produces anxiety when patients enter an unfamiliar environment with different care protocols and circumstances. Objectives: This study aimed to examine the level of ICU transfer anxiety among open heart surgery patients and determine the psychosocial factors associated with ICU transfer anxiety among open heart surgery patients. Methods: Data were collected in a cardiac center in Kathmandu City, Nepal among 95 open heart surgery patients within 24 hours of their transfer from an ICU to a general ward. The study used four self-reported questionnaires, namely the modified Mishel Uncertainty in Illness Scale for Adults, modified Brief COPE Inventory, Nurses’ Support Questionnaire, and State Anxiety Inventory. Results: Fifty-two patients (54.7%) had a high level of transfer anxiety. Spearman’s rank correlation showed that uncertainty in illness, coping, and nurses’ support were significantly related to transfer anxiety (p < 0.001). Conclusion: The results of this study suggest nurses to address uncertainty in illness of the patients, improve their coping abilities, and provide need-based nursing support to them during the transitional phase. Besides, clinicians and governmental agencies should contribute to implication of transitional guidelines, which can reduce transfer anxiety and promote health and recovery of the patients.

Role of laparoscopic and robotic liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis

Aim:This study aimed to compare mini-invasive liver resection(MILR)(laparoscopic/robotic approach)and open liver resection(OLR)for hepatocellular carcinoma(HCC)in elderly patients with regard to clinical and oncological outcomes through a comprehensive systematic review.Methods:The MEDLINE and Cochrane Library electronic databases were systematically searched from 2009 to December 2019 to identify relevant English written studies comparing MILR and OLR.The main endpoints were Child-Pugh score,serum total bilirubin level,comorbidity,presence/absence of cirrhosis,minor/major resection,challenge segment approach,operative time,estimated intraoperative blood loss,liver failure rate,morbidity according to the Clavien-Dindo classification,length of hospital stay(LOS),postoperative mortality,number of lesions,tumor size,readmission rate,recurrence rate and survival at 1,3 and 5 years after operation.Meta-analyses provided pooled relative risks and mean differences for these outcomes.Cut-off for"elderly age"was set at 65 years old.Results:Eight studies that evaluated 3051 patients who underwent liver resection for HCC,with 950 undergoing MILR and 2101 OLR,were included after the screening process.Blood loss,morbidity,and LOS showed statistical significance in favor of MILR.In particular,with respect to OLR,MILR decreased on average blood loss by 161.43 mL(95%CI:250.24-72.61),risk of morbidity by 42%(P<0.01),LOS by 4 days(95%CI:7-2),postoperative mortality risk by 47%(although not significantly,P=0.06).Major resections were significantly more common in the OLR group(P<0.0001).Recurrence,although not significant(P=0.06),must also be emphasized.The two surgical approaches were comparable with regard to the other outcomes investigated.Conclusion:Meta-analyses confirmed the advantages of MILR in terms of short perioperative outcomes,where it may promote the extension of liver resection to HCC patients with borderline liver function.MILR may be considered an important treatment option with significant benefits in the elderly and fragile patients.However,large well-designed prospective comparative studies or randomized controlled trials would be necessary to further confirm our conclusions.

Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma

AIM： To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma.METHODS： We performed a systematic search of the related literature in the Cochrane Library, PubM ed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction（IOPR%） from baseline to end-point, the percentage of number of glaucoma medications reduction from pre-to post-operation, and the secondary efficacy evaluations were performed by odds ratio（OR） and 95% confidence interval（CI） for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using Rev Man software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi^2 test and the I^2 measure.RESULTS： Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification.CONCLUSION： Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.

RELEASE OF SERUM TROPONIN I AND ITS RELATIONSHIP TO MULTIFACTORS FOLLOWING OPEN HEART SURGERY IN CHILDREN

Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A （ TOF, n =31 ） and group B （ VSD, n =26）. Blood sampies were drawn preoperatively, 5min（ T0 ） , 6h（ T6 ） , 12h（ T12 ） , 24h（ T24 ） , 48h（ T48 ） , 72h（ T72 ） after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia （ 30℃- 32℃ ）, cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass （ CPBT） , cross-clamping time （ CCT） , clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 （ P 〈 0. 01 ）, and fell to normal level at T72 （ P 〉 0. 05 ）. Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B. There was a positive correlation between peak CTnI and CPBT, CCT （ r = 0. 51 ; P 〈 0. 01 ）, myocardial operative injury after ventriculotomy and muscle resection （ r = 0. 35, P 〈0. 01 ）. Also the peak CTnl value was correlated to the clinical score for cardiac function （r = -0. 52; P 〈0. 01）. 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support. Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.

CHANGES ON RECEPTOR EXPRESSIONAND PRODUCTION OF INTERLEUKIN-2 IN CIRCULATING LYMPHOCYTE POPULATION AFTER OPEN HEART SURGERY

To evaluate the change of perioperative cell mediated immunity after cardiac operation with cardiopul-monary bypass (CPB), so as to provide some information for timely prevention and treatment against post-operative immunological disorder, 40 patients were studied. By searching for the effects of CPB and anes-thesia, interleukln-2 receptor (IL-2R) expression upon the surface of peripheral blood mononuclear cells(PBMC), as well as interleukin-2 (IL-2) production in vitro was traced 55 min after anesthesia, at end ofCPB, on postoperative 1, 7, and 14 day versus preanesthesia control. Our data demonstrated that expres-sion of IL-2R on PBMC was significantly suppressed in all comparing with the baseline value, meanwhile,IL-2 production in vitro also statistically dropped. However,no statistical difference was found on perioper-ative IL 2R expression and IL-2 synthesis in the cholecystectomy group. We conclude that postoperativeimmunological disorder seems to be the main factor, which could be denoted as reduced IL 2R expressionon PBMC and lL-2 synthesis in vitro for sepsis, even multiple system organ failure developed after cardiacsurgery.

Effect of screening colonoscopy frequency on colorectal cancer mortality in patients with a family history of colorectal cancer

BACKGROUND Colorectal cancer is a common malignant tumor in China,and its incidence in the elderly is increasing annually.Inflammatory bowel disease is a group of chronic non-specific intestinal inflammatory diseases,including ulcerative colitis and Crohn’s disease.We included the clinicopathological and follow-up data of patients with colorectal cancer who underwent laparoscopic colectomy or open colectomy at our Gastrointestinal Department between January 2019 and December 2022.Surgical indicators,oncological indicators,and survival rates were compared between the groups.The results of 104 patients who met the above criteria were extracted from the database(laparoscopic colectomy group=63,open colectomy group=41),and there were no statistically significant differences in the baseline data or follow-up time between the two groups.RESULTS Intraoperative blood loss,time to first ambulation,and time to first fluid intake were significantly lower in the laparoscopic colectomy group than in the open colectomy group.The differences in overall mortality,tumor-related mortality,and recurrence rates between the two groups were not statistically significant,and survival analysis showed that the differences in the cumulative overall survival,tumor-related survival,and cumulative recurrence-free rates between the two groups were not statistically significant.CONCLUSION In elderly patients with colorectal cancer,laparoscopic colectomy has better short-term outcomes than open colectomy,and laparoscopic colectomy has superior long-term survival outcomes compared with open colectomy.

Surgical Treatment of the Upper Urinary Tract Lithiasis at the Urology Department of the Hopital General Idrissa Pouye

Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.

Clinical Application Analysis of Laparoscopic-Assisted Total Gastrectomy in the Surgical Treatment of Gastric Cancer

Objective:To investigate the clinical application effect of laparoscopic-assisted total gastrectomy in the surgical treatment of gastric cancer.Methods:The clinical data of 86 COPD patients included in the study were collected and divided into 43 cases each in Groups A and B using the randomization method,with open total gastrectomy in Group A and laparoscopic-assisted total gastrectomy in Group B.The clinical indexes,pain levels,and complications of patients in the two groups were observed in combination with the indexes.Results:The baseline data of the two groups of patients were not statistically significant(all P>0.05);the operation time,incision length,first flatulence time,and hospitalization time of patients in Group B were shorter than those in Group A(all P=0.000);the NRS scores of patients in Group B on the 1st postoperative day and the 2nd postoperative day were significantly lower than those in Group A(t=23.443,t=28.784,all P=0.000);the total complication rate of patients in Group B(1;2.33%)was significantly lower than that of Group A(9;20.94%)(χ^(2)=7.242,P=0.007).Conclusion:In the surgical treatment of gastric cancer,laparoscopic-assisted total gastrectomy can promote patients’recovery,reduce patients’pain,and lower the probability of complications.

Fast-track program vs traditional care in surgery for gastric cancer

AIM:To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.METHODS:PubMed,Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013,and only randomized trials were included.The references of relevant studies were manually searched for further studies that may have been missed.Search terms included"gastric cancer","fast track"and"enhanced recovery".Five outcome variables were considered most suitable for analysis:postoperative hospital stay,medical cost,duration to first flatus,C-reactive protein(CRP)level and complications.Postoperative hospital stay was calculated from the date of operation to the date of discharge.Fixed effects model was used for meta-analysis.RESULTS:Compared with traditional care,fasttrack program could significantly decrease the postoperative hospital stay[weighted mean difference(WMD)=-1.19,95%CI:-1.79--0.60,P=0.0001,fixed model],duration to first flatus(WMD=-6.82,95%CI:-11.51--2.13,P=0.004),medical costs(WMD=-2590,95%CI:-4054--1126,P=0.001),and the level of CRP(WMD=-17.78,95%CI:-32.22--3.35,P=0.0001)in laparoscopic surgery for gastric cancer.In open surgery for gastric cancer,fast-track program could also significantly decrease the postoperative hospital stay(WMD=-1.99,95%CI:-2.09--1.89,P=0.0001),duration to first flatus(WMD=-12.0,95%CI:-18.89--5.11,P=0.001),medical cost(WMD=-3674,95%CI:-5025--2323,P=0.0001),and the level of CRP(WMD=-27.34,95%CI:-35.42--19.26,P=0.0001).Furthermore,fast-track program did not significantly increase the incidence of complication(RR=1.39,95%CI:0.77-2.51,P=0.27,for laparoscopic surgery;and RR=1.52,95%CI:0.90-2.56,P=0.12,for open surgery).CONCLUSION:Our overall results suggested that compared with traditional care,fast-track program could result in shorter postoperative hospital stay,less medical costs,and lower level of CRP,with no more complications occurring in both laparoscopic and open surgery for gastric cancer.

Safety of fast-track rehabilitation after gastrointestinal surgery:Systematic review and meta-analysis

AIM: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery.