What operation for recurrent rectal prolapse after previous Delorme's procedure? A practical reality

AIM: To report our experience with perineal repair(Delorme's procedure) of rectal prolapse with particular focus on treatment of the recurrence.METHODS: Clinical records of 40 patients who underwent Delorme's procedure between 2003 and 2014 were reviewed to obtain the following data: Gender; duration of symptoms, length of prolapse, operation time, ASA grade, length of post-operative stay, procedure-related complications, development and treatment of recurrent prolapse. Analysis of post-operative complications, rate and time of recurrence and factors influencing the choice of the procedure for recurrent disease was conducted. Continuous variables were expressed as the median with interquartile range(IQR). Statistical analysis was carried out using the Fisher exact test.RESULTS: Median age at the time of surgery was 76 years(IQR: 71-81.5) and there were 38 females and 2 males. The median duration of symptoms was 6 mo(IQR: 3.5-12) and majority of patients presented electively whereas four patients presented in the emergency department with irreducible rectal prolapse. The median length of prolapse was 5 cm(IQR: 5-7), median operative time was 100 min(IQR: 85-120) and median post-operative stay was 4 d(IQR: 3-6). Approximately16% of the patients suffered minor complications such as- urinary retention, delayed defaecation and infected haematoma. One patient died constituting postoperative mortality of 2.5%. Median follow-up was 6.5 mo(IQR: 2.15-16). Overall recurrence rate was 28%(n = 12). Recurrence rate for patients undergoing an urgent Delorme's procedure who presented as an emergency was higher(75.0%) compared to those treated electively(20.5%), P value 0.034. Median time interval from surgery to the development of recurrence was 16 mo(IQR: 5-30). There were three patients who developed an early recurrence, within two weeks of the initial procedure. The management of the recurrent prolapse was as follows: No further intervention(n = 1), repeat Delorme's procedure(n = 3), Altemeier's procedure(n = 5) and rectopexy with faecal diversion(n = 3). One patient was lost during follow up.CONCLUSION: Delorme's procedure is a suitable treatment for rectal prolapse due to low morbidity and mortality and acceptable rate of recurrence. The management of the recurrent rectal prolapse is often restricted to the pelvic approach by the same patientrelated factors that influenced the choice of the initial operation, i.e., Delorme's procedure. Early recurrence developing within days or weeks often represents a technical failure and may require abdominal rectopexy with faecal diversion.

Introduction of PIC/S Accession Procedure and Suggestions for Establishing a Unified Quality Management System in China

Objective To introduce the accession procedure and evaluation of PIC/S,and help relevant departments in China to understand the requirements of PIC/S in detail,and to promote the process of China’s entry into PIC/S.Methods The procedures and steps of joining PIC/S,the evaluation process of PIC/S,and the experience of several countries in joining PIC/S were introduced and analyzed,which could help the relevant personnel in China understand the specific contents.Results and Conclusion According to the requirements of PIC/S,it is necessary to establish a unified GMP quality management system.

基于S-Procedure的分段线性Delta算子系统的稳定性分析

本文研究了一类由Delta算子描述的分段线性系统的二次稳定性问题。基于Delta域的Lyapunov稳定性理论,利用S-procedure构造了分段Lyapunov函数,而且将分段线性Delta算子系统的二次稳定性判定问题转化为一组线性矩阵不等式的求解问题。

Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis(CP) and patient selection.METHODS: All consecutive patients undergoingduodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index(BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index(white blood cells, interleukin(IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data(postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients.RESULTS: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male(85%) and seven were female(16%). The etiology of CP was alcohol in 32 patients(70%) and idiopathic in 14 patients(30%). Stones were found in 38 patients(83%). An inflammatory mass was found in five patients(11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19(9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7(17.8-22.4) kg/m2 and was 20.6 ± 2.9(15.4-27.7) kg/m2 in the opengroup. Allpatientsrequired analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients(43%). Pre-operative complications due to pancreatitis were observed in 18 patients(39%). Pancreatic functional insufficiency was observed in 14 patients(30%). Two laparoscopic patients(2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29(290-370) min. Estimated intra-operativeblood loss was 57 ± 14(40-80) m L. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2(5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass(P < 0.001) and acute exacerbation(P < 0.001) were risk factors for intra-operative blood loss. CONCLUSION: The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.

Delorme's operation plus sphincteroplasty for complete rectal prolapse associated with traumatic fecal incontinence

Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction.Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery.Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting.Primary resection with end colostomy(Hartmann's procedure) is considered the safer option.Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents(SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction.The authors concluded that the technical and clinical success rates for stenting were lower than expected.SEMS was associated with a high incidence of clinical and silent perforation.Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital.The goal of stenting,a decrease of the stoma rate,may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation.Until now,this was not demonstrated in a prospective randomized trial.

Khubchandani's procedure combined with stapled posterior rectal wall resection for rectocele

BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.

Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants: Lessons learned from single-balloon enteroscopy-assisted ERCP

Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.

Correction method for moderate and severe degrees of hallux valgus associated with transfer metatarsalgia

BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a deformity that is charac-terized by the involvement of lesser rays and requires complex surgical treatment.In this study,we attempted to develop a procedure for this condition.AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems.This method included a modified Lapidus procedure,M2M3 tarsometatarsal arthrodesis,intermetatarsal fusion of the M4 and M5 bases,and the use of an original external fixation apparatus to enhance correction power.Preoperative,postoperative,and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society(AOFAS)scores were compared,and P values<0.05 were considered to indicate statistical significance.RESULTS The study included 28 females(93.3%)and 2 males feet(6.7%),20(66.7%)of whom had a moderate degree of HV and 10(33.3%)of whom had severe deformity.M2 and M3 metatarsalgia was observed in 21 feet,and 9 feet experienced pain only at M2.The mean follow-up duration was 11 months.All patients had good correction of the HV angle[preoperative median,36.5 degrees,interquartile range(IQR):30-45;postoperative median,10 degrees,IQR:8.8-10;follow-up median,11.5 degrees,IQR:10-14;P<0.01].At follow-up,metatarsalgia was resolved in most patients(30 vs 5).There was a clinically negligible decrease in the corrected angles at the final follow-up,and the overall AOFAS score was significantly better(median,65 points,IQR:53.8-70;vs 80 points,IQR:75-85;P<0.01).CONCLUSION The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up.Randomized clinical trials with larger samples,as well as long-term outcome assessments,are needed in the future.

Strangulated ileal trans-coloanal-anastomotic hernia:A complication of Altemeier's procedure previously never reported

A postoperative complication after Altemeier operation, so far never reported,is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation.After 6 d from perineal rectosigmoidectomy, the patient,was discharged free of complications.Four days later he was readmitted in emergency for stran-gulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate.The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen,resection of the necrotic ileum,and end colostomy.The outcome of the second operation was free of complication and the patient was discharged on the 6th postoperative day.In conclusion,after Altemeier operation prolonged straining at defecation should be carefully

Single institution experience with the Ladd's procedure in patients with heterotaxy and stage Ⅰ palliated single-ventricle

AIM:To investigate and describe our current institutional management protocol for single-ventricle patients who must undergo a Ladd's procedure.METHODS:We retrospectively reviewed the charts of all patients from January 2005 to March 2014 who were diagnosed with heterotaxy syndrome and an associated intestinal rotation anomaly who carried a cardiac diagnosis of functional single ventricle and were status post stage I palliation.A total of 8 patients with a history of stage I single-ventricle palliation underwent Ladd's procedure during this time period.We reviewed each patients chart to determine if significant intraoperative or post-operative morbidity or mortality occurred.We also described our protocolized management of these patients in the cardiac intensive care unit,which included pre-operative labs,echocardiography,milrinone infusion,as well as protocolized fluid administration and anticoagulation regimines.We also reviewed the literature to determine the reported morbidity and mortality associated with the Ladd's procedure in this particular cardiac physiology and if other institutions have reported protocolized care of these patients.RESULTS:A total of 8 patients were identified to have heterotaxy with an intestinal rotation anomaly and single-ventricle heart disease that was status post single ventricle palliation.Six of these patients were palliated with a Blaylock-Taussig shunt,one of whom underwent a Norwood procedure.The two other patients were palliated with a stent,which was placed in the ductus arteriosus.These eight patients all underwent elective Ladd's procedure at the time of gastrostomy tube placement.Per our protocol,all patients remained on aspirin prior to surgery and had no period where they were without anticoagulation.All patients remained on milrinone during and after the procedure and received fluid administration upon arrival to the cardiac intensive care unit to account for losses.All 8 patients experienced no intraoperative or post-operative complications.All patients survived to discharge.One patient presented to the emergency room two months after discharge in cardiac arrest and died due to bowel obstruction and perforation.CONCLUSION:Protocolized intensive care management may have contributed to favorable outcomes following Ladd's procedure at our institution.

Analysis of Risk Factors of Postoperative Neurological Complications in Patients with Stanford Type A Aortic Dissection Undergoing Sun’s Procedure

Objective:This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects.Methods:From January 2019 to December 2020,the clinical data of 480 patients with Stanford type A aortic dissection,who were treated by Sun’s procedure in our center were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the risk factors of postoperative neurological complications.According to whether there were neurological complications after surgery,they were divided into two groups:the group with complications(n=70)and the group without complications(n=410).The clinical data of the two groups were collected and compared.Results:There were 70 cases of patients with postoperative neurological complications in 480 cases.The incidence rates of temporary neurological dysfunction(TND)and permanent neurological dysfunction(PND)was 11.5%(55/480)and 3.1%(15/480),respectively.Univariate analysis showed that the age(≥70 years),stroke history,femoral artery intubation and cardiopulmonary bypass(CPB)time were associated with postoperative PND(p<0.05).Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and assisted time of suction influenced the occurrence of postoperative TND(p<0.05).Multivariate logistic regression analysis showed that age(≥70 years),stroke history,femoral artery intubation and CPB time were independent risk factors for PND.Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and aspiration time were independent risk factors for TND.Compared with the two groups,the hospitalization time and ICU time of the patients in the neurological complications group were significantly prolonged,and the mortality rate was significantly increased(p<0.05).Conclusion:There are many risk factors for neurological complications in patients with Stanford type A aortic dissection after surgery.With the improvement of surgical techniques,optimization of cerebral perfusion,and interventions for risk factors,Sun’s procedure remains the preferred treatment for Stanford type A aortic dissection.

Delorme手术治疗21例完全性直肠脱垂的效果观察

目的本研究旨在观察Delorme术式对完全性直肠脱垂的治疗效果,以探讨Delorme术用于治疗完全性直肠脱垂的可行性。方法选取新疆维吾尔自治区人民医院胃肠外科2006-2010年间行Delorme手术的完全性直肠脱垂患者21例,其中女性14例,男性7例。采用Wexner排便失禁评分以及肛门压力检测法对患者术前和术后的排便情况进行比较。结果21例患者在手术前均存在对稀水便、固体便以及排气失禁的情况。术后4例患者分别于第6,8,12,18个月时出现病情复发,占总人数的19.0%。术后失访患者2例,在余下的19例患者中,15例(78.9%)排便失禁有不同程度的改善,其中8例(42.1%)明显改善,7例(36.8%)完全治愈,其余4例(21.1%)效果不明显;有1例(5.3%)术前未诉便秘,但术后却出现便秘。结论 Delorme手术用于治疗完全性直肠脱垂具有疗效确切、并发症少、术后便秘发生率低等特点,其在直肠脱垂的治疗中具有重要价值。

S-引理及其进展

S-引理是运筹学领域和控制论领域中一个十分重要的定理。本文首先从一个非线性控制系统的全局渐近稳定性分析出发,引出S-过程和S-引理,以及两者之间的联系与区别。接着我们介绍了S-引理的基本内容和最新进展,以及它在复数域和四元数集合上的推广。最后,我们介绍了将齐次型S-引理推广到任意多个对称(或厄米特)矩阵时的一些基本结果。

Delorme术式治疗完全性直肠脱垂的临床观察

目的探讨Delorme术式治疗直肠脱垂的临床效果。方法对2004年1月至2010年10月26例完全性直肠脱垂患者采用Delorme手术治疗的临床资料作回顾性分析。结果零死亡率,复发率为7.69%(2/26)。80%(16/20)肛门失禁患者肛门控便能力提升(最大肛管静息压、最大肛管自主收缩压、最大耐受容积明显增加)。平均住院时间7d(6～10d)。术后无疼痛16例(61.5%),中度7例(26.9%),高度3例(11.5%)。手术满意度高18例(69.2%),中5例(19.2%),低3例(11.5%)。结论 Delorme术式治疗完全性直肠脱垂有术后疼痛轻、复发率低、手术满意度高、肛门控便能力提升等特点。

Delorme术治疗老年完全性直肠脱垂(15例临床分析)

目的探讨Delorme术治疗老年完全性直肠脱垂的疗效。方法回顾性分析2017年12月至2018年12月在我院行Delorme术的15例完全性直肠脱垂老年患者的临床资料,平均年龄(75.5±7.6)岁,平均病程(20.2±15.8)年,平均脱垂长度(6.1±2.2)cm。结果15例患者均顺利完成手术,手术时间45~90 min,平均(57.5±12.5)min;出血量10~50 ml,平均(30.0±20.0)ml;住院时间6~9 d,平均(7.5±1.5)d。本组无一例围手术期死亡,均未发生吻合口感染、直肠穿孔、直肠血肿、腹膜炎、直肠阴道瘘、泌尿生殖功能障碍等并发症。所有患者均获得随访,随访时间3~10个月,平均(6.3±3.7)个月。合并肛门失禁的11例患者Wexner评分由术前(14.4±2.4)分降至术后(5.5±1.5)分,差异有统计学意义(t=10.175,P<0.01),术后肛门失禁明显改善。无直肠脱垂复发病例。结论Delorme术创伤小,并发症少,操作难度小,术后肛门功能改善明显,是治疗老年人完全性直肠脱垂安全可靠的术式。

Procedural learning changes in patients with Wilson's disease

In the present study, we compared explicit memory performance, using the Wechsler Memory Scale and implicit memory performance, using the Nissen software version of the serial reaction time task, in patients with Wilson＇s disease to normal controls. The Wilson＇s disease patients exhibited deficits in explicit memory tasks, such as figure recall and understanding memory. Moreover, the Wilson＇s disease patients exhibited deficits in implicit memory tasks, including significantly prolonged response times. These findings indicate that Wilson＇s disease patients have explicit and implicit partial memory impairments.

CLINICAL REPORT OF MODIFIED MAZE PROCEDURE

ＣＬＩＮＩＣＡＬＲＥＰＯＲＴＯＦＭＯＤＩＦＩＥＤＭＡＺＥＰＲＯＣＥＤＵＲＥＣＬＩＮＩＣＡＬＲＥＰＯＲＴＯＦＭＯＤＩＦＩＥＤＭＡＺＥＰＲＯＣＥＤＵＲＥＺｈｕＪｉａＧｕａｎｇ；ＨｅＺｈｏｎｇＬｉａｎｇ；ＬｕｏＷｅｉ；ＤｏｎｇＡｉＱｉａｎｇ；ＸｕＳｈｉＷｅ...

“Parenchyma transection-first”strategy is superior to“tunnel-first”strategy in robotic spleen-preserving distal pancreatectomy with conservation of splenic vessels

Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with splenic vessel preservation(Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura’s procedure. Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy(P-F) group and a “tunnel-first” strategy(T-F) group and analyzed. Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time(146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0(20.0–55.0) m L vs. 50.0(20.0–100.0) m L, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the TF group and 2.4% in the P-F group( P = 0.14). The grade 3/4 complications were similar between the two groups( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. Conclusions: The pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura’s procedure.

Enhancing Operational Efficiency: Exploring the Integration of SOPs Using Virtual Reality and Smart Glasses Technology in Food Manufacturing

This paper explores the integration of Standard Operating Procedures (SOPs) using virtual reality and smart glasses technology in food manufacturing. The study employs a thorough methodology, combining observational insights to develop a comprehensive SOP. Implementation at different firms resulted in significant improvements, reducing product waste and enhancing overall efficiency. The use of virtual reality further augments SOP adoption. The findings underscore SOPs’ transformative influence, offering a tangible solution to challenges in the food production sector. Recommendations include regular SOP reviews and ongoing training for sustained success. Different firms exemplify SOPs as indispensable tools for operational excellence.