Malignant triton tumor in the abdominal wall:A case report

BACKGROUND Malignant triton tumors(MTTs)comprise a subgroup of malignant peripheral nerve sheath tumors(MPNSTs)that exhibits rhabdomyosarcomatous differen-tiation and follow an aggressive course.MTTs are primarily located along peripheral nerves.Cases of MTTs in the abdominal wall have not been reported.MTT has a poorer prognosis than classic MPNSTs,and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis intricacies.Treatment for MTTs mirrors that for MPNSTs and is predominantly surgical.CASE SUMMARY A 49-year-old woman presented with a subcutaneous mass in her lower abdo-minal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the consultation.She had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the consultation.Abdominal computed tomography(CT)showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis muscle.There was no sign of metastasis(T1N0M0).An incisional biopsy identified sporadic MTT of the lower abdomen.A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was executed.Subse-quently,the general surgeon utilized an approach akin to the open peritoneal onlay mesh technique.The patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin defect.No complications arose,and annual follow-up CTs did not show signs of recurrence or metastasis.CONCLUSION An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction,eliminating the need for postoperative radiotherapy.

Removal of a guide-wire sliding into abdominal cavity via transgastric natural orifice transluminal endoscopic surgery: A case report

BACKGROUND Guidewire slippage into the peritoneal cavity during clinical operations is extremely rare.Therefore,this paper aims to report a successful case of guidewire removal using transgastric natural orifice transluminal endoscopic surgery(NOTES).The goal is to enhance physicians'understanding of the management plan for this unique scenario and provide a valuable reference for clinical practice.CASE SUMMARY A 64-year-old man presented with abdominal distension and was diagnosed with cirrhosis combined with massive ascites.To proceed with treatment,the patient underwent ultrasound-guided peritoneal puncture and underwent catheterization and drainage.Unfortunately,a 0.035-inch guidewire slipped into the abdominal cavity during the procedure.Following a comprehensive evaluation and consultation by a multidisciplinary team,the guidewire was successfully removed using NOTES.CONCLUSION This case highlights the potential consideration of transgastric NOTES removal when encountering a foreign body,such as a guidewire,within the abdominal cavity.

Meta-analysis of electrical stimulation promoting recovery of gastrointestinal function after gynecological abdominal surgery

BACKGROUND The effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery was not clear.AIM To systematically evaluate the effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery.METHODS The Cochrane Library,Web of Science,PubMed,ProQuest,and the Chinese bio-medical literature databases Wanfang,Weipu,and CNKI were used to search for relevant studies on controlled trials of electrical stimulation in gynecological abdominal surgery patients from self-established databases to May 2024.The RevMan software(version 5.3)was used to analyze the included literature and explore the heterogeneity of each study.RESULTS Seven controlled trials,involving 520 patients,were included.The results of meta-analysis showed that electrical stimulation could shorten the recovery time of intestinal sound after gynecological abdominal surgery[odds ratio(OR):-5.11,95%CI:-5.84 to-4.38,P<0.00001]and improve the time of first anal exhaust(OR:-1.19,95%CI:-1.38 to-0.99,P<0.00001),improved the time of first anal defecation(OR:-0.98,95%CI:-1.19 to-0.78,P<0.00001),The difference is significant.According to the funnel plot,if the scatter is symmetrical,it indicates that the funnel plot is unbiased.CONCLUSION Electrical stimulation can shorten this reduces the length of time it takes for the patient to recover from bowel sounds and also affects the time to first anal voiding and defecation to some extent,thereby promoting gas-trointestinal function recovery after gynecological abdominal surgery.The quality of the studies included in this review was poor,which may have affected the final results.It is necessary to conduct a randomized controlled study with higher quality and more samples to further confirm the promoting effect of electrical stimulation on gastrointestinal function recovery to guide clinical treatment.

Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

Incidence and Management of Early Postoperative Hypoxemia after Abdominal Surgery at Teaching Hospital

Background: Oxygen saturation refers to the quantity of oxygenated hemoglobin in the blood, that is to say the level of oxygen measurable in the red blood cells when they have passed through the lungs. The aim of this study was to describe the management of early postoperative hypoxemia after abdominal surgery at the Yaounde General Hospital (YGH). Method: This is a quantitative, observational study, with a descriptive aim, which took place in the anesthesiology department of the YGH, over a period of 2 months from August 1st to October 1st, 2023. The study included all the patients ≥18 years, of both sexes who had abdominal surgery under general anesthesia and were willing to participate during the time of data collection. The variables studied were the sociodemographic and clinical characteristics, risk factors for oxygen desaturation, postoperative variations in SPO2 and therapeutic tools. Results: We collected 30 patients among whom 11 presented with early postoperative hypoxemia i.e. a frequency of 36.7%. The age of the patients ranged from 18 to 63 years and the mean was 42.47 ± 13.5 years on average. The sex ratio was 0.5. Hysterectomy was the most commonly performed surgery (23.3%). The most common comorbidity was high blood pressure (30%). Half of the patients had midline incision. Supra-umbilical surgery predominated (56.7%), intraoperative blood loss ≥500 ml in 46.7% of cases. Upper abdominal surgery with, subcostal incision and blood loss ≥500 ml are statistically significant risk factors for the occurrence of early postoperative hypoxemia (P Conclusion: Hypoxemia is the result of impaired respiratory function favored by the conditions encountered during the early postoperative period.

Reinforced tissue matrix to strengthen the abdominal wall following reversal of temporary ostomies or to treat incisional hernias

BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence.Biologic meshes have also been used to enhance healing,particularly in contaminated conditions.Reinforced tissue matrices(R-TMs),which include a biologic scaffold of native extracellular matrix and a syn-thetic component for added strength/durability,are designed to take advantage of aspects of both synthetic and biologic materials.To date,RTMs have not been reported to reinforce the abdominal wall following stoma reversal.METHODS Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma.Following hernia repair and proximal stoma closure,RTM(OviTex®1S permanent or OviTex®LPR)was placed to reinforce the abdominal wall using a laparoscopic,robotic,or open surgical approach.Post-operative follow-up was performed at 1 month and 1 year.Hernia recurrence was determined by physical examination and,when necessary,via computed tomo-graphy scan.Secondary endpoints included length of hospital stay,time to return to work,and hospital readmissions.Evaluated complications of the wound/repair site included presence of surgical site infection,seroma,hematoma,wound dehiscence,or fistula formation.RESULTS The observational study cohort included 16 male and 12 female patients with average age of 58.5 years±16.3 years and average body mass index of 26.2 kg/m^(2)±4.1 kg/m^(2).Patients presented with a parastomal hernia(75.0%),in-cisional hernia(14.3%),or combined parastomal/incisional hernia(10.7%).Using a laparoscopic(53.6%),robotic(35.7%),or open(10.7%)technique,RTMs(OviTex®LPR:82.1%,OviTex®1S:17.9%)were placed using sublay(82.1%)or intraperitoneal onlay(IPOM;17.9%)mesh positioning.At 1-month and 1-year follow-ups,there were no hernia recurrences(0%).Average hospital stays were 2.1 d±1.2 d and return to work occurred at 8.3 post-operative days±3.0 post-operative days.Three patients(10.7%)were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues.Fistula and mesh infection were observed in two patients each(7.1%),leading to partial mesh removal in one patient(3.6%).There were no complications between 1 month and 1 year(0%).CONCLUSION RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal,with no hernia recurrences and favorable outcomes after 1-month and 1-year.

Perioperative management of postoperative sigmoid colon cancer complicated by a large abdominal wall defect:A case report

BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.

Effect of Continuous Double-Lumen Irrigation Drainage at Constant Temperature on the Control of Abdominal Infection After Surgery

Objective:To investigate the effect of continuous double-lumen irrigation drainage at constant temperature on the control of abdominal infection after surgery,providing a reference for clinical treatment.Methods:From December 2022 to August 2023,100 patients with abdominal infections after surgery were selected from Wendeng People's Hospital in Weihai.They were randomly divided into a control group(50 cases,using conventional single-hole rubber irrigation drainage)and an observation group(50 cases,using continuous double-lumen irrigation drainage at constant temperature).The inflammatory and immune indicators of the two groups were compared after different interventions,and the specific conditions of abdominal infection were statistically analyzed.Results:There was no significant difference in inflammatory indicators between the two groups before intervention(P>0.05).After the intervention,the inflammatory indicators of the observation group were significantly lower(P<0.05).There was no significant difference in immune function indicators between the two groups before intervention(P>0.05).After intervention,the immune function indicators of the observation group showed significant improvement(P<0.05).The control of abdominal infection in the observation group was better than in the control group(P<0.05).Conclusion:Continuous double-lumen rrigation drainage at constant temperature has a better effect on controlling abdominal infection after surgery,improving the infection condition,and enhancing the immune function of patients.

Evaluation of the Clinical Advantages of Laparoscopic Transverse Abdominal Wall Suspension in the Treatment of Pelvic Organ Prolapse

Objective:To evaluate the clinical advantages of laparoscopic transverse abdominal wall suspension in treating pelvic organ prolapse.Methods:Sixty patients diagnosed with moderate to severe pelvic organ prolapse and underwent surgical treatment in our hospital between January 2022 and December 2023 were selected.According to different surgical methods,they were divided into an observation group(given laparoscopic transverse abdominal wall suspension)and a control group(given transvaginal mesh implantation),with 30 subjects/group.The data on perioperative-related indicators,quality of life scores,postoperative recurrence,and complications of the two groups of patients were collected.Results:The postoperative hospitalization days and intraoperative bleeding volume of the observation group were significantly lower than those of the control group,but had longer operation time than that of the control group(P<0.05).The differences between the two groups were statistically significant 6 months after surgery,and the Pelvic Floor Disease Quality of Life Impact Questionnaire(PFIQ-7)score of the observation group was significantly higher than the control group(P<0.05).Both groups of patients completed 12 months of follow-up without any postoperative recurrence.The number of complications in the observation group was slightly lower than that of the control group(P>0.05).Conclusion:Laparoscopic transverse abdominal wall suspension was more effective in treating pelvic organ prolapse and is an ideal surgical procedure.

Gasless Laparoscopic Surgery plus Abdominal Wall Lifting for Giant Hiatal Hernia——Our Single-center Experience

Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is characteristic of more invasion and more complications.Although laparoscopic repair as a minimally invasive surgery is accepted,a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation.The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia.We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution.The GHH was defined as greater than one-third of the stomach in the chest.Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients.Mean age was 67 years.The results showed that there were no conversions to open surgery and no intraoperative deaths.The mean duration of operation was 100 min（range：90–130 min）.One-side pleura was injured in 4 cases（14.8%）.The mean postoperative length of stay was 4 days（range：3–7 days）.Median follow-up was 26 months（range：6–38 months）.Transient dysphagia for solid food occurred in three patients（11.1%）,and this symptom disappeared within three months.There was one patient with recurrent hiatal hernia who was reoperated on.Two patients still complained of heartburn three months after surgery.Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient.Totally,satisfactory outcome was reported in 88.9% patients.It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible,safe,and effective for the patients who cannot tolerate the pneumoperitoneum.

Abdominal cocoon syndrome-a rare culprit behind small bowel ischemia and obstruction:Three case reports

BACKGROUND Abdominal cocoon syndrome(ACS)represents a category within sclerosing encapsulating peritonitis,characterized by the encapsulation of internal organs with a fibrous,cocoon-like membrane of unknown origin,resulting in bowel obstruction and ischemia.Diagnosing this condition before surgery poses a cha-llenge,often requiring confirmation during laparotomy.In this context,we depict three instances of ACS:One linked to intestinal obstruction,the second exclu-sively manifesting as intestinal ischemia without any obstruction,and the final case involving a discrepancy between the radiologist and the surgeon.CASE SUMMARY Three male patients,aged 53,58,and 61 originating from Northern Thailand,arrived at our medical facility complaining of abdominal pain without any prior surgeries.Their vital signs remained stable during the assessment.The diagnosis of abdominal cocoon was confirmed through abdominal computed tomography(CT)before surgery.In the first case,the CT scan revealed capsules around the small bowel loops,showing no enhancement,along with mesenteric congestion affecting both small and large bowel loops,without a clear obstruction.The second case showed intestinal obstruction due to an encapsulated capsule on the CT scan.In the final case,a patient presented with recurring abdominal pain.Initially,the radiologist suspected enteritis as the cause after the CT scan.However,a detailed review led the surgeon to suspect encapsulating peritoneal sclerosis(ACS)and subsequently perform surgery.The surgical procedure involved complete removal of the encapsulating structure,resection of a portion of the small bowel,and end-to-end anastomosis.No complications occurred during surgery,and the patients had a smooth recovery after surgery,eventually discharged in good health.The histopathological examination of the fibrous membrane(cocoon)across all cases consistently revealed the presence of fibro-collagenous tissue,without any indications of malignancy.CONCLUSION Individuals diagnosed with abdominal cocoons commonly manifest vague symptoms of abdominal discomfort.An elevated degree of clinical suspicion,combined with the application of appropriate radiological evaluations,markedly improves the probability of identifying the abdominal cocoon before surgical intervention.In cases of complete bowel obstruction or ischemia,the established norm is the comprehensive removal of the peritoneal sac as part of standard care.Resection with intestinal anastomosis is advised solely when ischemia and gangrene have been confirmed.

Peptide-based enteral formula improves tolerance and clinical outcomes in abdominal surgery patients relative to a whole protein enteral formula

AIM To compare a dipeptide- and tripeptide-based enteral formula with a standard enteral formula for tolerance and nutritional outcomes in abdominal surgery patients.METHODS A retrospective study was performed to assess the differences between a whole-protein formula(WPF) and a dipeptide- and tripeptide-based formula(PEF) in clinical outcomes.Seventy-two adult intensive care unit(ICU) patients with serum albumin concentrations less than 3.0 g/d L were enrolled in this study.Patients were divided into two groups(WPF group = 40 patients,PEF group = 32 patients).The study patients were fed for at least 7 d,with ≥ 1000 m L of enteral formula infused on at least 3 of the days.RESULTS The mean serum albumin level on postoperative day(POD) 10,prealbumin levels on POD-5 and POD-10,and total lymphocyte count on POD-5 were significantly higher in the PEF group compared to those in the WPF group(P < 0.05).The average maximum gastric residual volume of the PEF patients during their ICU stays was significantly lower than that for WPF patients.CONCLUSION Dipeptide- and tripeptide-based enteral formulas are more efficacious and better tolerated than wholeprotein formulas.

Low-pressure pneumoperitoneum with abdominal wall lift in laparoscopic total mesorectal excision for rectal cancer:initial experience

AIM To evaluate the safety and feasibility of a new technology combining low-pressure pneumoperitoneum(LPP) and abdominal wall lift(AWL) in laparoscopic total mesorectal excision(TME) for rectal cancer.METHODS From November 2015 to July 2017,26 patients underwent laparoscopic TME for rectal cancer using LPP(6-8 mm Hg) with subcutaneous AWL in Qilu Hospital of Shandong University,Jinan,China.Clinical data regarding patients' demographics,intraoperative monitoring indices,operation-related indices andpathological outcomes were prospectively collected.RESULTS Laparoscopic TME was performed in 26 cases(14 anterior resection and 12 abdominoperineal resection) successfully,without conversion to open or laparoscopic surgery with standard-pressure pneumoperitoneum.Intraoperative monitoring showed stable heart rate,blood pressure and paw airway pressure.The mean operative time was 194.29 ± 41.27 min(range:125-270 min) and 200.41 ± 20.56 min(range:170-230 min) for anterior resection and abdominoperineal resection,respectively.The mean number of lymph nodes harvested was 16.71 ± 5.06(range:7-27).There was no positive circumferential or distal resection margin.No local recurrence was observed during a median follow-up period of 11.96 ± 5.55 mo(range:5-23 mo).CONCLUSION LPP combined with AWL is safe and feasible for laparoscopic TME.The technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.

Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.

Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix implant and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm: A preliminary result

AIM： To present our trial using a combination of the human acellular dermal matrix （HADM） implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS： Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADN and omentum flap. Postoperative morbidities and signs of herniation were monitored. RESULTS： The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period. CONCLUSION： The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.

Glutamine dipeptide for parenteral nutrition in abdominal surgery:A meta-analysis of randomized controlled trials

AIM: To assess the clinical and economical validity of glutamine dipeptide supplemented to parenteral nutrition (PN) in patients undergoing abdominal surgery. METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. The trials compared the standard PN and PN supplemented with glutamine dipeptide in abdominal surgery. RCTs were identified from the following electronic databases: the Cochrane Library, MEDLINE, EMBASE and ISI web of knowledge (SCI). The search was undertaken in April 2006. Literature references were checked by computer or hand at the same time. Clinical trials were extracted and evaluated by two reviewers independently. Statistical analysis was performed by RevMan4.2 software from Cochrane Collaboration. A P value of < 0.05 was considered statistically significant. RESULTS: Nine RCTs involving 373 patients were included. The combined results showed that glutamine dipeptide has a positive effect in improving postoperative cumulative nitrogen balance (weighted mean difference (WMD = 8.35, 95% CI [2.98, 13.71], P = 0.002), decreasing postoperative infectious morbidity (OR = 0.24, 95% CI [0.06, 0.93], P = 0.04), shortening the length of hospital stay (WMD= -3.55, 95% CI [-5.26, -1.84], P < 0.00001). No serious adverse effects were found. CONCLUSION: Postoperative PN supplemented with glutamine dipeptide is effective and safe to decrease the infectious rate, reduce the length of hospital stay and improve nitrogen balance in patients undergoing abdominal surgery. Further high quality trials in children and severe patients are required, and mortality and hospital cost should be considered in future RCTs with sufficient size and rigorous design.

Giant nonfunctional ectopic adrenocortical carcinoma on the anterior abdominal wall: A case report

BACKGROUND Adrenocortical cancer(ACC) is an infrequent and often aggressive malignancy with a very poor prognosis. It can be classified as functional or nonfunctional.Nonfunctional ACC is hampered by the absence of specific signs or symptoms;only abdominal pain with or without incidental adrenal occupation is typically present.CASE SUMMARY We report a rare case of a patient with a 30 cm × 15 cm × 8 cm ectopic ACC on the anterior abdominal wall without organ adhesion. A 77-year-old male was admitted to our hospital because of a huge abdominal mass, which, by ultrasonography, had an unclear border with the liver. Computed tomography showed that the mass was not associated with any organ but was adherent to the anterior abdominal wall. The patient underwent tumor resection, and a postoperative pathology examination showed a neuroendocrine tumor, which was diagnosed as ACC. The patient was disease-free at the 9-mo follow up.CONCLUSION The anterior abdominal wall is a rare site of ACC growth.

Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome

BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.

Clinical evidence of growth hormone for patients undergoing abdominal surgery: Meta-analysis of randomized controlled trials

AIM: To assess the effectiveness and safety of perioperative growth hormone (GH) in patients undergoing abdominal surgery.METHODS: We searched the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in February 2003. No language restrictions were applied. Randomized controlled trials (RCT) comparing GH with placebo in patients undergoing abdominal surgery were extracted and evaluated.Methodological quality was evaluated using the Jadad scale.RESULTS: Eighteen trials involving 646 patients were included. The combined results showed that GH had a positive effect on improving postoperative nitrogen balance (standardized mean difference [SMD] = 3.37, 95%CI [2.46, 4.27], P＜0.00001), and decreasing the length of hospital stay (weighted mean difference [WMD] = -2.07,95%CI [-3.03, -1.11], P = 0.00002), and reducing the duration of postoperative fatigue syndrome (SMD = -1.83,95%CI [-2.37, -1.30], P＜0.00001), but it could increase blood glucose levels (WMD = 0.91, 95%CI [0.56, 1.25],P＜0.00001).CONCLUSION: GH for patients undergoing abdominal surgery is effective and safe, if blood glucose can be controlled well. Further trials are required with a sufficient size to account for clinical heterogeneity and to measure other important outcomes such as infection, morbidity,mortality, fluid retention, immunomodulatory effects, and tumor recurrence.

Influence of the abdominal wall on the nonlinear propagation of focused therapeutic ultrasound

This article theoretically studies the influence of inhomogeneous abdominal walls on focused therapeutic ultrasound based on the phase screen model. An inhomogeneous tissue is considered as a combination of a homogeneous medium and a phase aberration screen. Variations of acoustic parameters such as peak positive pressure, peak negative pressure, and acoustic intensity are discussed with respect to the phase screen statistics of human abdominal walls. Results indicate that the abdominal wall can result in energy loss of the sound in the focal plane. For a typical human abdominal wall with correlation length of 7.9 mm and variance of 0.36, the peak acoustic intensity radiated from a 1MHz transmitter with a radius of 30 mm can be reduced by about 14% at the focal plane.