Clinical efficacy and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in gastrectomy

BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options.Each of these two surgical methods has advantages and disadvantages,so it is particularly important to compare and analyze their clinical efficacy and safety.AIM To compare the surgical safety,clinical efficacy,and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.METHODS The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study.According to the different anastomosis methods used,the patients were divided into a double-channel anastomosis group(50 patients)and a tubular gastroesophageal anastomosis group(49 patients).In the double-channel anastomosis,Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection,and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux.In the tubular gastroesophageal anastomosis group,after the proximal end of the stomach was cut,tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube.The main outcome measure was quality of life 1 year after surgery in both groups,and the evaluation criteria were based on the postgastrectomy syndrome assessment scale.The greater the changes in body mass,food intake per meal,meal quality subscale score,and total measures of physical and mental health score,the better the condition;the greater the other indicators,the worse the condition.The secondary outcome measures were intraoperative and postoperative conditions,the incidence of postoperative long-term complications,and changes in nutritional status at 1,3,6,and 12 months after surgery.RESULTS In the double-channel anastomosis cohort,there were 35 males(70%)and 15 females(30%),33(66.0%)were under 65 years of age,and 37(74.0%)had a body mass index ranging from 18 to 25 kg/m2.In the group undergoing tubular gastroesophageal anastomosis,there were eight females(16.3%),21(42.9%)individuals were under the age of 65 years,and 34(69.4%)had a body mass index ranging from 18 to 25 kg/m2.The baseline data did not significantly differ between the two groups(P>0.05 for all),with the exception of age(P=0.021).The duration of hospitalization,number of lymph nodes dissected,intraoperative blood loss,and perioperative complication rate did not differ significantly between the two groups(P>0.05 for all).Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group.Specifically,they had lower scores for esophageal reflux[2.8(2.3,4.0)vs 4.8(3.8,5.0),Z=3.489,P<0.001],eating discomfort[2.7(1.7,3.0)vs 3.3(2.7,4.0),Z=3.393,P=0.001],total symptoms[2.3(1.7,2.7)vs 2.5(2.2,2.9),Z=2.243,P=0.025],and other aspects of quality of life.The postoperative symptoms[2.0(1.0,3.0)vs 2.0(2.0,3.0),Z=2.127,P=0.033],meals[2.0(1.0,2.0)vs 2.0(2.0,3.0),Z=3.976,P<0.001],work[1.0(1.0,2.0)vs 2.0(1.0,2.0),Z=2.279,P=0.023],and daily life[1.7(1.3,2.0)vs 2.0(2.0,2.3),Z=3.950,P<0.001]were all better than those of the tubular gastroesophageal anastomosis group.The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score[3.0(2.0,4.0)vs 3.5(2.0,5.0),Z=2.345,P=0.019]compared to the dual-channel anastomosis group.Hemoglobin,serum albumin,total serum protein,and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups(P>0.05 for all).CONCLUSION The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery.Compared with tubular gastric surgery,double-channel anastomosis is a preferred surgical technique for proximal gastric cancer.It offers advantages such as less esophageal reflux and improved quality of life.

Ultrasound guiding the rapid diagnosis and treatment of perioperative pneumothorax:A case report

BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold standard for the diagnosis of pneumothorax,but is not suitable for rapid diagnosis of this complication.In contrast,lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax.CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned.Anesthesia was induced,and tracheal intubation was performed successfully with a video laryngoscope.About 2 min after tracheal intubation,the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%.According to the BLUE protocol,a recommended area of the chest was scanned by ultrasound.The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung.The boundary of pneumothorax(lung points)were rapidly confirmed by ultrasound.To avoid lung injury,a closed thoracic drainage tube was placed in the involved area.On day 9 after surgery,the patient was discharged from the hospital without any complications.CONCLUSION Perioperative pneumothorax is rare but dangerous.It can be rapidly diagnosed and treated with ultrasound guidance.

Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy

BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.

Risk factors and risk prediction model for mucocutaneous separation in enterostomy patients:A single center experience

BACKGROUND Mucocutaneous separation(MCS)is a common postoperative complication in enterostomy patients,potentially leading to significant morbidity.Early identification of risk factors is crucial for preventing this condition.However,predictive models for MCS remain underdeveloped.AIM To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy.METHODS A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study.Patients were divided into two groups,the MCS group(n=110),and the non-MCS(n=382)based on the occurrence of MCS within the first 3 weeks after surgery.Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed.Receiver operating characteristic curve analysis was used to assess the model’s performance.RESULTS The postoperative MCS incidence rate was 22.4%.Suture dislodgement(P<0.0001),serum albumin level(P<0.0001),body mass index(BMI)(P=0.0006),hemoglobin level(P=0.0409),intestinal rapture(P=0.0043),incision infection(P<0.0001),neoadjuvant therapy(P=0.0432),stoma site(P=0.0028)and elevated intra-abdominal pressure(P=0.0395)were potential predictive factors of MCS.Suture dislodgement[P<0.0001,OR:28.007595%CI:(11.0901-82.1751)],serum albumin level(P=0.0008,OR:0.3504,95%CI:[0.1902-0.6485]),BMI[P=0.0045,OR:2.1361,95%CI:(1.2660-3.6235)],hemoglobin level[P=0.0269,OR:0.5164,95%CI:(0.2881-0.9324)],intestinal rapture[P=0.0351,OR:3.0694,95%CI:(1.0482-8.5558)],incision infection[P=0.0179,OR:0.2885,95%CI:(0.0950-0.7624)]and neoadjuvant therapy[P=0.0112,OR:1.9769,95%CI:(1.1718-3.3690)]were independent predictive factors and included in the model.The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis.CONCLUSION The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.

Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery:Four case reports

BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.

Effect of temperature maintenance by forced-air warming blankets of different temperatures on changes in inflammatory factors in children undergoing congenital hip dislocation surgery

Background:Hypothermia is associated with many adverse clinical outcomes in pediatric patients,and thus,it is important to an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients.This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β(TGF-β),tumor necrosis factor(TNF)-α,interleukin(IL)-1β,and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip(DDH).Methods:The study included 123 children undergoing surgery for DDH under general anesthesia.The patients were randomly assigned to three groups,using a random number table:the 32,38,and 43°C groups according to the temperature setting of the forced-air warming blankets.For each patient,body temperature was recorded immediately after anesthesia induction and intubation(T0),at initial incision(T1),at 1 h after incision(T2),at2 h after incision(T3),at the end of surgery(T4),immediately upon return to the ward after surgery(T5),and then at 12 h(T6),24 h(T7),36 h(T8),and 48 h(T9)after the surgery.The serum levels of TGF-β,TNF-α,IL-1β,and IL-10 were measured at To and T4 for all groups.Results:The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups(x^2=6.630,P=0.036).At To,the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group(F=17.992,P<0.001).At T2,the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups(F=12.776,P<0.001).Moreover,at T4,the serum levels of TGF-β(F=3286.548,P<0.001)and IL-10(F=4628.983,P<0.001)were significantly increased in the 38°C group,and the serum levels of TNF-α(F=911.415,P<0.001)and IL-10(F=322.191,P<0.001)were significantly decreased in the 38°C group,compared with the levels in the 32 and 43°C groups.Conclusion:Force-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.

Safety and efficacy of three-dimensional printed patient-specific drilling templates for expansive open-door laminoplasty

To the Editor:Expansive open-door laminoplasty(EOLP)is commonly performed for patients with multi-level cervical myelopathy of various causes.Nevertheless,there are still several complications.Among them,displaced complete fracture of the hinge side and lamina re-closure could result in neurological function deterioration.Chen et a A1*reported that the use of the mini-plate could significantly reduce the incidence of lamina re-closure compared with the traditional suture technique.Nevertheless,the complete fracture rates were around 56.8%for both the mini-plate group and the suture suspension group.Accurately locating the trough position has been reported to lower the incidence of hinge side complete fractures.121 In this study,threedimensional(3D)printed patient-specific drilling templates were fabricated to guide the trough position in EOLP,131 to validate the safety and efficacy of the 3D printed templates.

Legacy of Hongxi Su:Pioneer of Chinese Cardiosurgery

Prof.Hongxi Su(苏鸿熙)was born in Tongshan,Jiangsu Province,in January of 1915(Fig.1).He is the pioneer of Chinese cardiosurgery and one of the most renowned Chinese cardiothoracic surgeons,performing the first successful intracardiac surgery under extracorporeal circulation,as well as applying artificial blood vessels in aortic-carotid artery bypass surgery,shaping the cardiosurgery landscape of China.