BACKGROUND Hepatic colon carcinoma invading the duodenum is not common in clinical practice.Surgical treatment of colonic hepatic cancer that invades the duodenum is difficult,and the surgical risk is high.AIM To disc...BACKGROUND Hepatic colon carcinoma invading the duodenum is not common in clinical practice.Surgical treatment of colonic hepatic cancer that invades the duodenum is difficult,and the surgical risk is high.AIM To discuss the efficacy and safety of duodenum-jejunum Roux-en-Y anastomosis for the treatment of hepatic colon carcinoma invading the duodenum.METHODS From 2016 to 2020,11 patients from Panzhihua Central Hospital diagnosed with hepatic colon carcinoma were enrolled in this study.Clinical and therapeutic effects and prognostic indicators were retrospectively analyzed to determine the efficacy and safety of our surgical procedures.All patients underwent radical resection of right colon cancer combined with duodenum-jejunum Roux-en-Y anastomosis.RESULTS The median tumor size was 65 mm(r50-90).Major complications(ClavienDindoI-II)occurred in 3 patients(27.3%);the average length of hospital stay was 18.09±4.21 d;and only 1 patient(9.1%)was readmitted during the 1st mo after the surgery.The 30-d mortality rate was 0%.After a median follow-up of 41 m(r7-58),the disease-free survival at 1,2,and 3 years was 90.9%,90.9%and 75.8%,respectively;the overall survival at 1,2,and 3 years was 90.9%.CONCLUSION In selected patients,radical resection of right colon cancer combined with duodenum-jejunum Roux-en-Y anastomosis is clinically effective,and the complications are manageable.The surgical procedure also has an acceptable morbidity rate and mid-term survival.展开更多
AIM:To evaluate short-type-single-balloon enteroscope(SBE) with passive-bending,high-force transmission functions for endoscopic retrograde cholangiopancreatography(ERCP) in patients with Roux-en-Y anastomosis.METHODS...AIM:To evaluate short-type-single-balloon enteroscope(SBE) with passive-bending,high-force transmission functions for endoscopic retrograde cholangiopancreatography(ERCP) in patients with Roux-en-Y anastomosis.METHODS:Short-type SBE with this technology(SIF-Y0004-V01; working length,1520 mm; channel diameter,3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y anastomosis.The rate of reaching the blind end,time required to reach the blind end,diagnostic and therapeutic success rates,and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology(SIF-Y0004; working length,1520 mm; channel diameter,3.2 mm) in 25 patients.RESULTS:The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004(P = 0.59).The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004(16 min vs 24 min,P = 0.04).The diagnostic success rate was 93% with SIFY0004-V01 and 84% with SIF-Y0004(P = 0.17).The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004(P = 0.68).The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004(P = 0.50).The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group(P = 0.723).The incidence of pancreatitis was 0% in the SIFY0004-V01 group and 5.9% in the SIF-Y0004 group(P > 0.999).The incidence of gastrointestinal perforation was 2.0%(1/50) in the SIF-Y0004-V01 group and 2.9%(1/34) in the SIF-Y0004 group(P > 0.999).CONCLUSION:SIF-Y0004-V01 is useful for ERCP inpatients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.展开更多
BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasi...BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.展开更多
To the Editor:Biliary stricture formation at the bilioenteric anastomosis is an infrequent complication(2%-3%)after pancreaticoduodenectomy;the average presentation is within 13-14 months(range from 1 month to 9 years...To the Editor:Biliary stricture formation at the bilioenteric anastomosis is an infrequent complication(2%-3%)after pancreaticoduodenectomy;the average presentation is within 13-14 months(range from 1 month to 9 years)after surgery[1,2].While the etiology is unknown,development of biliary stricture has shown to be more likely if a bile leak occurs in the postoperative period[3,4]and with younger patients[5].展开更多
Infectious pancreatic necrosis causes external pancreatic fistula in some patients.Generally,external pancreatic fistula requires fistula-gastric and/or intestinal anastomosis,and digestive endoscopic interventional t...Infectious pancreatic necrosis causes external pancreatic fistula in some patients.Generally,external pancreatic fistula requires fistula-gastric and/or intestinal anastomosis,and digestive endoscopic interventional treatment[1–3].It is especially difficult to treat external pancreatic fistulas with small fistulas where the external fistula is located in the lower back.The common treatment is to remove the body and tail of the pancreas and the spleen.This operation is very traumatic.A new pancreatic fistula may still occur at the pancreatic stump.The above operations may lead to unnecessary resection of the spleen,colon injury and other complications.In order to solve this problem,we innovatively used T-tube bridging fistula jejunal anastomosis plus continuous negative pressure suction to treat three cases of external pancreatic fistulas in the lower back,and all of them achieved good results.展开更多
BACKGROUND Despite much work having been conducted on magnetic compression anastomo-sis(MCA)in the digestive tract,there are no reports on the influence of magnetic force on the anastomosis.AIM To investigate the effe...BACKGROUND Despite much work having been conducted on magnetic compression anastomo-sis(MCA)in the digestive tract,there are no reports on the influence of magnetic force on the anastomosis.AIM To investigate the effect of different magnetic force magnets on the MCA of the digestive tract.METHODS Two groups of magnets of the same sizes but different magnetic forces were designed and produced.A total of 24 Sprague-Dawley rats were randomly assigned into two groups(powerful magnet group and common magnet group),with 12 rats in each group.Two types of magnets were used to complete the colonic side-to-side anastomosis of the rats.The operation time and magnet discharge time were recorded.The anastomotic specimens were obtained 4 wk after the operation and then the burst pressure and diameter of the anastomosis were measured,and the anastomosis was observed via the naked eye and subjected to histological examination.RESULTS The magnetic forces of the powerful and common magnet groups at zero distance were 8.26 N and 4.10 N,respectively.The colonic side-to-side anastomosis was completed in all 24 rats,and the operation success rate and postoperative survival rate were 100%.No significant difference was noted in the operation time between the two groups.The magnet discharge time of the powerful magnet group was slightly longer than that of the common magnet group,but the difference was not statistically significant(P=0.513).Furthermore,there was no statistical difference in the burst pressure(P=0.266)or diameter of magnetic anastomosis(P=0.095)between the two groups.The gross specimens of the two groups showed good anastomotic healing,and histological observation indicated good mucosal continuity without differences on healing.CONCLUSION In the rat colonic side-to-side MCA model,both the powerful magnet with 8.26 N and the common magnet with 4.10 N showed no significant impact on the anastomosis establishment process or its effect.展开更多
BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to ...BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to solve this problem,several methods of digestive tract reconstruction have emerged,but the most satisfying method remains to be discussed.Therefore,we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparo-scopic proximal gastrectomy.All the patients were successfully operated on without conversion to laparotomy.The duration of operation and digestive tract reconstruction were 203.500(150-224)min and 87.500(73-111)min,respectively.The intraoperative amount of bleeding was 20.500 mL±0.696 mL.The time of postoperative first flatus,the first postoperative fluid intake,and the postoperative length of stay were 2(1-3)d,4(3-5)d,and 9(8-10)d,respectively.All the patients were followed up for 12-23 months.The body mass index at 6 and 12 months after surgery were 22.577 kg/m2±3.098 kg/m2 and 22.594 kg/m2±3.207 kg/m2,respectively.The nutrition risk screening 2002 score,the patient-generated subjective global assessment score,and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery.Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits.All the patients exhibited no tumor recurrence or metastasis.CONCLUSION The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.展开更多
BACKGROUND Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic c...BACKGROUND Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD.Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate.However,the results remain controversial.Therefore,evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.METHODS PubMed,Scopus,and Cochrane Library were searched until October 8,2023.Patients who underwent intestinal resection due to CD were included.The intervention measures included Kono-S anastomosis,whereas the control group received traditional anastomosis such as end-to-end,end-to-side,and side-to-side anastomosis.Only randomized clinical trials and observational studies were included.The primary outcome measures were hospital stay post-surgery,overall postoperative complication incidence,the proportion of Clavien-Dindo grade IIIa or higher,overall postoperative recurrence rate,and Rutgeerts score.RESULTS From 2011 to 2023,six articles met the inclusion and exclusion criteria.The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD[MD=-0.26,95%CI:-0.42 to-0.10,P=0.002]than other traditional anastomosis methods.Compared to other traditional anastomosis methods,Kono-S anastomosis can significantly reduce the total recurrence rate[MD=0.40,95%CI:0.17 to 0.98,P=0.05]and postoperative Rutgeerts score[MD=-0.81,95%CI:-0.96 to-0.66,P<0.001]in patients with CD.However,there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo≥IIIa.CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards;however,additional larger trials are necessary to authenticate its effectiveness.展开更多
BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have ...BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or better.As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells.However,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.abdominal cavity in IA.METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological responses.RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two groups.In addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA group.CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.展开更多
Background: Prostate cancer ranks as the second most prevalent malignancy in men, with treatment strategies ranging from observation to various interventions. Radical prostatectomy is a common approach, aiming for a c...Background: Prostate cancer ranks as the second most prevalent malignancy in men, with treatment strategies ranging from observation to various interventions. Radical prostatectomy is a common approach, aiming for a cure, and the technique for vesico-urethral anastomosis varies, employing separate or continuous stitches. However, a consensus on the optimal technique is lacking. This study aims to compare vesico-urethral anastomosis techniques (separate vs. continuous stitches) in laparotomy-based radical prostatectomies, evaluating peri and postoperative outcomes. Materials and Method: A retrospective analysis of 140 patients’ medical records yielded 86 eligible cases, divided into two groups based on anastomosis technique. Both groups underwent surgery at the same urology center between 2016 and 2019, with a follow-up period exceeding 12 months. Pre-operative characteristics were statistically similar between groups. Results: Perioperative complication rates did not significantly differ between the two techniques (p > 0.99). However, the continuous stitch group experienced a 20-minute longer procedure time (p 0.05), patients with continuous stitches had 2.5 times higher diaper usage at twelve months (p Conclusion: This research suggests that vesico-urethral anastomosis with separate stitches yields superior results in laparotomy-based radical prostatectomies compared to continuous stitches, demonstrating benefits in surgical time, hospital stay, sentinel drain duration, stenosis rates, and long-term urinary incontinence outcomes.展开更多
BACKGROUND Anastomotic leaks remain one of the most dreaded complications in gastrointestinal surgery causing significant morbidity,that negatively affect the patients’quality of life.Experimental studies play an imp...BACKGROUND Anastomotic leaks remain one of the most dreaded complications in gastrointestinal surgery causing significant morbidity,that negatively affect the patients’quality of life.Experimental studies play an important role in understanding the pathophysiological background of anastomotic healing and there are still many fields that require further investigation.Knowledge drawn from these studies can lead to interventions or techniques that can reduce the risk of anastomotic leak in patients with high-risk features.Despite the advances in experimental protocols and techniques,designing a high-quality study is still challenging for the investigators as there is a plethora of different models used.AIM To review current state of the art for experimental protocols in high-risk anastomosis in rats.METHODS This systematic review was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.To identify eligible studies,a comprehensive literature search was performed in the electronic databases PubMed(MEDLINE)and Scopus,covering the period from conception until 18 October 2023.RESULTS From our search strategy 102 studies were included and were categorized based on the mechanism used to create a high-risk anastomosis.Methods of assessing anastomotic healing were extracted and were individually appraised.CONCLUSION Anastomotic healing studies have evolved over the last decades,but the findings are yet to be translated into human studies.There is a need for high-quality,well-designed studies that will help to the better understanding of the pathophysiology of anastomotic healing and the effects of various interventions.展开更多
BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To in...BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To investigate the feasibility of MCA for simultaneous esophagojejunostomy and jejunojejunostomy after total gastrectomy using beagle dogs.METHODS Sixteen beagles were randomly divided into an MCA group(study group,n=8)and a manual-suture anastomosis group(control group,n=8).Two different magnetic anastomosis devices were used in the study group for esophagojejunal and jejunojejunal anastomoses.Both devices included a pair of circular daughter and parent magnets each.The time of esophagojejunostomy and jejunojejunostomy,postoperative complications,and survival rate of the two groups were compared.The dogs were sacrificed one month after the operation and their anastomotic specimens were obtained.Healing was observed by the naked eye and a light microscope.RESULTS Digestive-tract reconstruction after total gastrectomy was successfully completed in both groups(survival rate=100%).In the study group,esophagojejunal and jejunojejunal anastomoses took 6.13±0.58 and 4.06±0.42 min,respectively,significantly lower than those in the control group(15.63±1.53 min,P<0.001 and 10.31±1.07 min,P<0.001,respectively).Complications such as bleeding,anastomotic leakage,and anastomotic stenosis were not observed.In the study group,the magnets did not interfere with each other.Discharge time of the jejunojejunal magnetic anastomosis device was 10.75±1.28 d,while that of the esophagojejunal magnetic anastomosis device was 12.25±1.49 d.Residual silk was found in the control group.The study group showed a greater smoothness of the anastomosis than that of the control group.All layers of anastomosis healed well in both groups.CONCLUSION MCA is a safe and feasible procedure for digestive-tract reconstruction after total gastrectomy in this animal model.展开更多
BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challengi...BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.展开更多
AIM:To compare the efficacy of double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) in therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y entero-enteric anastomosis.MET...AIM:To compare the efficacy of double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) in therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y entero-enteric anastomosis.METHODS:Retrospective analysis of our patient cohort revealed 4 patients with enterobiliary anastomosis and Roux-en-Y entero-enteric anastomosis who underwent repeated ERC with DBE and SBE because of recurrent cholangitis.RESULTS:A total of 38 endoscopic retrograde cholangiopancreatography procedures were performed in 25 patients with Roux-en-Y entero-enteric anastomosis.DBE was used in 29 procedures and SBE in 9.The 4 patients who underwent repeated ERC with DBE and SBE suffered from recurrent cholangitis due to stenosis of the enterobiliary anastomosis.ERC was performed repeatedly to achieve balloon dilation with/without biliary stone extraction and multiple stent placement at the level of the enterobiliary anastomosis.In all 4 patients DBE and SBE were equally successful.Compared to DBE,SBE was equally effective in passing the Roux-en-Y entero-enteric anastomosis,reaching the enterobiliary anastomosis and performing therapeutic ERC.CONCLUSION:This retrospective comparison shows that DBE and SBE are equally successful in the performance of therapeutic ERC at the level of the enterobiliary anastomosis after Roux-en-Y entero-enteric anastomosis.展开更多
In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-pron...In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-prone locations and RCAVF anastomosis angle is studied during maturation by developing two sets of RCAVF models for early (non-mature) and mature RCAVFs at five anastomosis angles. The impact of hemodynamics and wall shear stress (WSS) is examined to determine optimal anastomotic angles. Results indicate that acute angles produce more physiological WSS distributions and fewer disturbed regions, with early stenosis-prone regions located near the anastomosis that shift to the bending venous segment during remodeling. A pilot study comparing clinical and numerical results is conducted for validation.展开更多
文摘BACKGROUND Hepatic colon carcinoma invading the duodenum is not common in clinical practice.Surgical treatment of colonic hepatic cancer that invades the duodenum is difficult,and the surgical risk is high.AIM To discuss the efficacy and safety of duodenum-jejunum Roux-en-Y anastomosis for the treatment of hepatic colon carcinoma invading the duodenum.METHODS From 2016 to 2020,11 patients from Panzhihua Central Hospital diagnosed with hepatic colon carcinoma were enrolled in this study.Clinical and therapeutic effects and prognostic indicators were retrospectively analyzed to determine the efficacy and safety of our surgical procedures.All patients underwent radical resection of right colon cancer combined with duodenum-jejunum Roux-en-Y anastomosis.RESULTS The median tumor size was 65 mm(r50-90).Major complications(ClavienDindoI-II)occurred in 3 patients(27.3%);the average length of hospital stay was 18.09±4.21 d;and only 1 patient(9.1%)was readmitted during the 1st mo after the surgery.The 30-d mortality rate was 0%.After a median follow-up of 41 m(r7-58),the disease-free survival at 1,2,and 3 years was 90.9%,90.9%and 75.8%,respectively;the overall survival at 1,2,and 3 years was 90.9%.CONCLUSION In selected patients,radical resection of right colon cancer combined with duodenum-jejunum Roux-en-Y anastomosis is clinically effective,and the complications are manageable.The surgical procedure also has an acceptable morbidity rate and mid-term survival.
文摘AIM:To evaluate short-type-single-balloon enteroscope(SBE) with passive-bending,high-force transmission functions for endoscopic retrograde cholangiopancreatography(ERCP) in patients with Roux-en-Y anastomosis.METHODS:Short-type SBE with this technology(SIF-Y0004-V01; working length,1520 mm; channel diameter,3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y anastomosis.The rate of reaching the blind end,time required to reach the blind end,diagnostic and therapeutic success rates,and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology(SIF-Y0004; working length,1520 mm; channel diameter,3.2 mm) in 25 patients.RESULTS:The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004(P = 0.59).The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004(16 min vs 24 min,P = 0.04).The diagnostic success rate was 93% with SIFY0004-V01 and 84% with SIF-Y0004(P = 0.17).The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004(P = 0.68).The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004(P = 0.50).The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group(P = 0.723).The incidence of pancreatitis was 0% in the SIFY0004-V01 group and 5.9% in the SIF-Y0004 group(P > 0.999).The incidence of gastrointestinal perforation was 2.0%(1/50) in the SIF-Y0004-V01 group and 2.9%(1/34) in the SIF-Y0004 group(P > 0.999).CONCLUSION:SIF-Y0004-V01 is useful for ERCP inpatients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.
基金Supported by Natural Science Foundation of Gansu Province,China,No.18JR3RA052National Scientific Research Project Cultivation Plan of Gansu Provincial People’s Hospital,No.19SYPYA-1+1 种基金National Key Research and Development Program,No.2018YFC1311506Gansu Province Da Vinci Robot High End Diagnosis and Treatment Personnel Training Project,No.2020RCXM076.
文摘BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.
文摘To the Editor:Biliary stricture formation at the bilioenteric anastomosis is an infrequent complication(2%-3%)after pancreaticoduodenectomy;the average presentation is within 13-14 months(range from 1 month to 9 years)after surgery[1,2].While the etiology is unknown,development of biliary stricture has shown to be more likely if a bile leak occurs in the postoperative period[3,4]and with younger patients[5].
基金the National Natural Science Foundation of China(81902017).
文摘Infectious pancreatic necrosis causes external pancreatic fistula in some patients.Generally,external pancreatic fistula requires fistula-gastric and/or intestinal anastomosis,and digestive endoscopic interventional treatment[1–3].It is especially difficult to treat external pancreatic fistulas with small fistulas where the external fistula is located in the lower back.The common treatment is to remove the body and tail of the pancreas and the spleen.This operation is very traumatic.A new pancreatic fistula may still occur at the pancreatic stump.The above operations may lead to unnecessary resection of the spleen,colon injury and other complications.In order to solve this problem,we innovatively used T-tube bridging fistula jejunal anastomosis plus continuous negative pressure suction to treat three cases of external pancreatic fistulas in the lower back,and all of them achieved good results.
基金Supported by the Key Research and Development Program of Shaanxi,No.2022SF-036the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07the Fundamental Research Funds for the Central Universities,No.xzy022023068.
文摘BACKGROUND Despite much work having been conducted on magnetic compression anastomo-sis(MCA)in the digestive tract,there are no reports on the influence of magnetic force on the anastomosis.AIM To investigate the effect of different magnetic force magnets on the MCA of the digestive tract.METHODS Two groups of magnets of the same sizes but different magnetic forces were designed and produced.A total of 24 Sprague-Dawley rats were randomly assigned into two groups(powerful magnet group and common magnet group),with 12 rats in each group.Two types of magnets were used to complete the colonic side-to-side anastomosis of the rats.The operation time and magnet discharge time were recorded.The anastomotic specimens were obtained 4 wk after the operation and then the burst pressure and diameter of the anastomosis were measured,and the anastomosis was observed via the naked eye and subjected to histological examination.RESULTS The magnetic forces of the powerful and common magnet groups at zero distance were 8.26 N and 4.10 N,respectively.The colonic side-to-side anastomosis was completed in all 24 rats,and the operation success rate and postoperative survival rate were 100%.No significant difference was noted in the operation time between the two groups.The magnet discharge time of the powerful magnet group was slightly longer than that of the common magnet group,but the difference was not statistically significant(P=0.513).Furthermore,there was no statistical difference in the burst pressure(P=0.266)or diameter of magnetic anastomosis(P=0.095)between the two groups.The gross specimens of the two groups showed good anastomotic healing,and histological observation indicated good mucosal continuity without differences on healing.CONCLUSION In the rat colonic side-to-side MCA model,both the powerful magnet with 8.26 N and the common magnet with 4.10 N showed no significant impact on the anastomosis establishment process or its effect.
基金Supported by the Fujian Medical University Sailing Fund General Project,No.2022QH1117Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to solve this problem,several methods of digestive tract reconstruction have emerged,but the most satisfying method remains to be discussed.Therefore,we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparo-scopic proximal gastrectomy.All the patients were successfully operated on without conversion to laparotomy.The duration of operation and digestive tract reconstruction were 203.500(150-224)min and 87.500(73-111)min,respectively.The intraoperative amount of bleeding was 20.500 mL±0.696 mL.The time of postoperative first flatus,the first postoperative fluid intake,and the postoperative length of stay were 2(1-3)d,4(3-5)d,and 9(8-10)d,respectively.All the patients were followed up for 12-23 months.The body mass index at 6 and 12 months after surgery were 22.577 kg/m2±3.098 kg/m2 and 22.594 kg/m2±3.207 kg/m2,respectively.The nutrition risk screening 2002 score,the patient-generated subjective global assessment score,and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery.Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits.All the patients exhibited no tumor recurrence or metastasis.CONCLUSION The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.
文摘BACKGROUND Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD.Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate.However,the results remain controversial.Therefore,evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.METHODS PubMed,Scopus,and Cochrane Library were searched until October 8,2023.Patients who underwent intestinal resection due to CD were included.The intervention measures included Kono-S anastomosis,whereas the control group received traditional anastomosis such as end-to-end,end-to-side,and side-to-side anastomosis.Only randomized clinical trials and observational studies were included.The primary outcome measures were hospital stay post-surgery,overall postoperative complication incidence,the proportion of Clavien-Dindo grade IIIa or higher,overall postoperative recurrence rate,and Rutgeerts score.RESULTS From 2011 to 2023,six articles met the inclusion and exclusion criteria.The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD[MD=-0.26,95%CI:-0.42 to-0.10,P=0.002]than other traditional anastomosis methods.Compared to other traditional anastomosis methods,Kono-S anastomosis can significantly reduce the total recurrence rate[MD=0.40,95%CI:0.17 to 0.98,P=0.05]and postoperative Rutgeerts score[MD=-0.81,95%CI:-0.96 to-0.66,P<0.001]in patients with CD.However,there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo≥IIIa.CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards;however,additional larger trials are necessary to authenticate its effectiveness.
基金This study was reviewed and approved by the Ethics Review Committee of the Research Ethics Committee,Tokai University School of Medicine(23RC011).
文摘BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or better.As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells.However,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.abdominal cavity in IA.METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological responses.RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two groups.In addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA group.CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.
文摘Background: Prostate cancer ranks as the second most prevalent malignancy in men, with treatment strategies ranging from observation to various interventions. Radical prostatectomy is a common approach, aiming for a cure, and the technique for vesico-urethral anastomosis varies, employing separate or continuous stitches. However, a consensus on the optimal technique is lacking. This study aims to compare vesico-urethral anastomosis techniques (separate vs. continuous stitches) in laparotomy-based radical prostatectomies, evaluating peri and postoperative outcomes. Materials and Method: A retrospective analysis of 140 patients’ medical records yielded 86 eligible cases, divided into two groups based on anastomosis technique. Both groups underwent surgery at the same urology center between 2016 and 2019, with a follow-up period exceeding 12 months. Pre-operative characteristics were statistically similar between groups. Results: Perioperative complication rates did not significantly differ between the two techniques (p > 0.99). However, the continuous stitch group experienced a 20-minute longer procedure time (p 0.05), patients with continuous stitches had 2.5 times higher diaper usage at twelve months (p Conclusion: This research suggests that vesico-urethral anastomosis with separate stitches yields superior results in laparotomy-based radical prostatectomies compared to continuous stitches, demonstrating benefits in surgical time, hospital stay, sentinel drain duration, stenosis rates, and long-term urinary incontinence outcomes.
文摘BACKGROUND Anastomotic leaks remain one of the most dreaded complications in gastrointestinal surgery causing significant morbidity,that negatively affect the patients’quality of life.Experimental studies play an important role in understanding the pathophysiological background of anastomotic healing and there are still many fields that require further investigation.Knowledge drawn from these studies can lead to interventions or techniques that can reduce the risk of anastomotic leak in patients with high-risk features.Despite the advances in experimental protocols and techniques,designing a high-quality study is still challenging for the investigators as there is a plethora of different models used.AIM To review current state of the art for experimental protocols in high-risk anastomosis in rats.METHODS This systematic review was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.To identify eligible studies,a comprehensive literature search was performed in the electronic databases PubMed(MEDLINE)and Scopus,covering the period from conception until 18 October 2023.RESULTS From our search strategy 102 studies were included and were categorized based on the mechanism used to create a high-risk anastomosis.Methods of assessing anastomotic healing were extracted and were individually appraised.CONCLUSION Anastomotic healing studies have evolved over the last decades,but the findings are yet to be translated into human studies.There is a need for high-quality,well-designed studies that will help to the better understanding of the pathophysiology of anastomotic healing and the effects of various interventions.
基金the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07(to Yan XP)Key Research and Development Plan of Shaanxi Province,No.2021GXLH-Z-009(to Li Y).
文摘BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To investigate the feasibility of MCA for simultaneous esophagojejunostomy and jejunojejunostomy after total gastrectomy using beagle dogs.METHODS Sixteen beagles were randomly divided into an MCA group(study group,n=8)and a manual-suture anastomosis group(control group,n=8).Two different magnetic anastomosis devices were used in the study group for esophagojejunal and jejunojejunal anastomoses.Both devices included a pair of circular daughter and parent magnets each.The time of esophagojejunostomy and jejunojejunostomy,postoperative complications,and survival rate of the two groups were compared.The dogs were sacrificed one month after the operation and their anastomotic specimens were obtained.Healing was observed by the naked eye and a light microscope.RESULTS Digestive-tract reconstruction after total gastrectomy was successfully completed in both groups(survival rate=100%).In the study group,esophagojejunal and jejunojejunal anastomoses took 6.13±0.58 and 4.06±0.42 min,respectively,significantly lower than those in the control group(15.63±1.53 min,P<0.001 and 10.31±1.07 min,P<0.001,respectively).Complications such as bleeding,anastomotic leakage,and anastomotic stenosis were not observed.In the study group,the magnets did not interfere with each other.Discharge time of the jejunojejunal magnetic anastomosis device was 10.75±1.28 d,while that of the esophagojejunal magnetic anastomosis device was 12.25±1.49 d.Residual silk was found in the control group.The study group showed a greater smoothness of the anastomosis than that of the control group.All layers of anastomosis healed well in both groups.CONCLUSION MCA is a safe and feasible procedure for digestive-tract reconstruction after total gastrectomy in this animal model.
基金Supported by the National Natural Science Foundation of China,No.31600075
文摘BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.
文摘AIM:To compare the efficacy of double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) in therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y entero-enteric anastomosis.METHODS:Retrospective analysis of our patient cohort revealed 4 patients with enterobiliary anastomosis and Roux-en-Y entero-enteric anastomosis who underwent repeated ERC with DBE and SBE because of recurrent cholangitis.RESULTS:A total of 38 endoscopic retrograde cholangiopancreatography procedures were performed in 25 patients with Roux-en-Y entero-enteric anastomosis.DBE was used in 29 procedures and SBE in 9.The 4 patients who underwent repeated ERC with DBE and SBE suffered from recurrent cholangitis due to stenosis of the enterobiliary anastomosis.ERC was performed repeatedly to achieve balloon dilation with/without biliary stone extraction and multiple stent placement at the level of the enterobiliary anastomosis.In all 4 patients DBE and SBE were equally successful.Compared to DBE,SBE was equally effective in passing the Roux-en-Y entero-enteric anastomosis,reaching the enterobiliary anastomosis and performing therapeutic ERC.CONCLUSION:This retrospective comparison shows that DBE and SBE are equally successful in the performance of therapeutic ERC at the level of the enterobiliary anastomosis after Roux-en-Y entero-enteric anastomosis.
文摘In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-prone locations and RCAVF anastomosis angle is studied during maturation by developing two sets of RCAVF models for early (non-mature) and mature RCAVFs at five anastomosis angles. The impact of hemodynamics and wall shear stress (WSS) is examined to determine optimal anastomotic angles. Results indicate that acute angles produce more physiological WSS distributions and fewer disturbed regions, with early stenosis-prone regions located near the anastomosis that shift to the bending venous segment during remodeling. A pilot study comparing clinical and numerical results is conducted for validation.