Pyloric Sympathectomy: A Novel Way to Get Pylorus Relaxation? Report of Two Bariatric Cases

Objective: This case report aimed to demonstrate a possible neuromuscular effect of pyloric sympathectomy on the pylorus motility, leading to its permanent relaxation, observed in two bariatric surgical cases, one primary and the other, revisional. Background: Pyloric sphincter is a physiological barrier to free gastric emptying. In sleeve gastrectomy and in Roux-en-Y gastric bypass revisions, that put the remnant stomach in transit, the pylorus can contribute to generate a high intragastric pressure, which could lead to acute gastric fistulas and/or chronic gastroesophageal reflux disease. The possibility of functionally relaxing the pylorus, promoting intragastric pressure reduction, could represent a protective maneuver against these complications. Methods: We describe herein a surgical maneuver applied in two cases of bariatric surgeries, with the intention of facilitating antrum-duodenal region exposure, in a sleeve gastrectomy and in a Roux-en-Y gastric bypass conversion to SADI-S. For this, a ligation of terminal peripyloric vessels was done, allowing a passage of a tape, which surrounded the pylorus, for its traction. In both cases, 30-day and 1-year endoscopic evaluations were done, to assess esophagitis signs, anastomosis healing and anatomical pouch aspect. A clinical evaluation was also done, to assess gastroesophageal symptoms (validated questionnaire). Results: In the postoperative endoscopic evaluations, no esophagitis were observed in any case and the gastric pouches had normal aspect, with the expected anatomical findings, compatible with the surgeries performed. The anastomosis healed without problems, in the revisional case. Interestingly, in both cases, it was observed a complete pyloric sphincter relaxation, which lasted until 1-year endoscopic evaluation. There were no fistulas, nor esophagitis in any of these cases. Clinically, there were no symptoms of gastroesophageal reflux disease (validated questionnaire). Conclusion: The observation of a pyloric durable atomy, that followed peripyloric dissection and vessels ligation (arterial branches), with its concomitant sympathectomy, can represent a new way of decompressing gastric chamber, either in primary or revisional bariatric surgeries. This maneuver can be protective against acute fistulas and gastroesophageal disease. Additional studies are necessary to confirm this hypothesis.

Pulmonary embolism after shoulder surgery:Is it a real threat?

Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.

Clinical significance of perioperative probiotic intervention on recovery following intestinal surgery

Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and digestive tract reconstruction associated with intestinal surgeries often disrupt the intestinal flora,prompting interest in the potential role of probiotics in postoperative recovery.Lan et al conducted a prospective randomized study on 60 patients with acute appendicitis,revealing that postoperative administration of Bacillus licheniformis capsules facilitated early resolution of inflammation and restoration of gastrointestinal motility,offering a novel therapeutic avenue for accelerated postoperative recovery.This editorial delves into the effects of perioperative probiotic supplementation on physical and intestinal recovery following surgery.Within the framework of enhanced recovery after surgery,the exploration of new probiotic supplementation strategies to mitigate surgical complications and reshape gut microbiota is particularly intriguing.

Machine learning and deep learning to improve prevention of anastomotic leak after rectal cancer surgery

Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.

Cerebral complications after unilateral biportal endoscopic surgery:A case report

BACKGROUND Unilateral biportal endoscopic(UBE)surgery has developed rapidly during the past decade.Continuous epidural space irrigation is generally considered the principal reason for cerebral complications following UBE surgery.We present a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus.CASE SUMMARY A 70-year-old woman with lumbar disc herniation underwent UBE surgery stably under general anesthesia.Uncontrollable hypertension occurred immediately after transfer to the postoperative care unit,accompanied by increased heart rate and tachypnea.During the recovery process,the patient responded to external stimuli but was confused and unable to complete command actions.Neck stiff-ness and significantly increased muscle strength on the left side indicated the presence of de-cerebrate rigidity.An urgent brain computed tomography scan showed pneumocephalus compressing the brainstem.After receiving analgesia and sedation treatment,the patient was conscious three hours later and recovered rapidly.She was discharged on the fifth postoperative day and followed up for 3 months with no surgical or brain complications.CONCLUSION Cerebral complications emerging during the general anesthesia awakening period following UBE surgery are not entirely due to increased intracranial pressure.Pneumocephalus induced by dural injury may also be a potential cause.

Effect of comprehensive perioperative nursing on pain intensity,complication rates,and comfort levels in patients undergoing gallstone surgery

BACKGROUND Surgery is the gold standard for gallstone treatment.Nevertheless,the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’health and quality of life to varying extents.Hence,it is essential to offer perioperative care to patients undergoing gallstone surgery.AIM To examine the impact of perioperative comprehensive nursing on pain intensity,complication rates,and patient comfort in individuals undergoing gallstone surgery.METHODS From February 2022 to February 2024,195 patients who underwent gallstone surgery at Sanmen People’s Hospital were selected and divided into two groups:A control group receiving routine nursing care(95 patients)and a research group receiving perioperative comprehensive nursing(100 patients).Key postoperative recovery indicators,including time to first postoperative anal exhaust,oral food intake,and ambulation,were observed,along with pain intensity(measured by the numeric rating scale),complication rate(bleeding,incision infection,recurrence),patient comfort(assessed using the visual analogue scale),and quality of life(measured by the World Health Organization Quality of Life-BREF).RESULTS The research group showed significantly shorter times to first postoperative anal exhaust,oral intake,and ambulation.Moreover,numeric rating scale pain scores in the research group were markedly lower post-nursing,and the total complication rate was significantly reduced compared to the control group.Furthermore,comfort levels improved considerably in the research group,and World Health Organization Quality of Life-BREF scores across the physical,psychological,social,and environmental domains were significantly higher compared to the control group following nursing care.CONCLUSION Perioperative comprehensive nursing effectively enhances postoperative recovery in patients undergoing gallstone surgery,reducing pain,lowering complications,and improving patient comfort and quality of life,which deserves clinical application.

Personalized nutritional care for immune function recovery in postoperative gastrointestinal surgery patients:An observational study

BACKGROUND Gastrointestinal(GI)surgery can significantly affect the nutritional status and immune function of patients.This study aimed to investigate the effects of personalized nutritional care on the recovery of immune function in patients who underwent postoperative GI surgery.AIM To study examines personalized nutritional care’s impact on immune function recovery,nutritional status,and clinical outcomes after GI surgery.METHODS This observational study included 80 patients who underwent GI surgery between 2021 and 2023.Patients received personalized nutritional care based on their individual needs and surgical outcomes.Immune function markers including lymphocyte subsets,immunoglobulins,and cytokines were measured preoperatively and at regular intervals postoperatively.Nutritional status,clinical outcomes,and quality of life were assessed.RESULTS Patients receiving personalized nutritional care showed significant improvements in immune function markers compared to baseline.At 4 weeks postoperatively,CD4+T-cell counts increased by 25%(P<0.001),while interleukin-6 levels decreased by 40%(P<0.001).Nutritional status,as measured by prealbumin and transferrin levels,improved by 30%(P<0.01).Postoperative complications reduced by 35%compared to historical controls.The quality-of-life scores improved by 40%at 3 months postoperatively.CONCLUSION Personalized nutritional care enhances immune function recovery,improves nutritional status,and reduces complications in patients undergoing postoperative GI surgery,highlighting its crucial role in optimizing patient outcomes following such procedures.

Clip-stone and T clip-sinus post laparoscopic biliary surgery:Two case reports and review of the literature

BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.

Gastroduodenal ulcer treated by pylorus and pyloric vagus-preserving gastrectomy

AIM To evaluate the curative effect of pylorus and pyloric vagus-preserving gastrectomy (PPVPG) on peptic ulcer.METHODS Treating 132 cases of GU and DU with PPVPG, and comparative studies made with 24 cases treated with Billroth Ⅰ (BⅠ) and 20 cases with Billroth Ⅱ (BⅡ); advantages and shortcomings evaluated.RESULTS Not a single death after PPVPG. No recurrence of the disorder in the subsequent follow-up for an average of 6.5 years. Curative effect (visik Ⅰ & Ⅱ) 97.7%. Acidity reduction similar to that found in BⅠ and BⅡ, but 97.7% of the BⅠ and all BⅡ cases having more than second degree intestinal fluid reflux, in contrast to 7.1% in PPVPG cases. Dumping syndrome occurred in the BⅠ and BⅡ cases, none in PPVPG cases. With regard to gastric emptying, food digestion, absorption, body weight and life quality, PPVPG proved to be superior to Billroth procedure.CONCLUSION PPVPG has the advantages of conventional Billroth gastrectomy in reducing acid, removing ulcer focus, and at the same time preserves the pylorus and pyloric vagus for maintaining the normal gastric physiological function. Dumping syndrome, intestinal fluid reflux and other complications of conventional gastrectomy may be avoided.

Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy

AIM: To investigate the differences in outcome following pylorus preserving pancreaticoduodenectomy(PPPD) and subtotal stomach-preserving pancreaticoduodenectomy(SSPPD).METHODS: Major databases including Pub Med(Medline), EMBASE and Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL) in The Cochrane Library were searched for comparative studies between patients with PPPD and SSPPD published between January 1978 and July 2014. Studies were selected based on specific inclusion and exclusion criteria. The primary outcome was delayed gastric emptying(DGE). Secondary outcomes included operation time, intraoperative blood loss, pancreatic fistula, postoperative hemorrhage, intraabdominal abscess, wound infection, time to starting liquid diet, time to starting solid diet, period of nasogastric intubation, reinsertion of nasogastric tube, mortality and hospital stay. The pooled odds ratios(OR) or weighted mean difference(WMD) with 95% confidence intervals(95%CI) were calculated using either a fixed-effects or random-effects model. RESULTS: Eight comparative studies recruiting 650 patients were analyzed, which include two RCTs, one non-randomized prospective and 5 retrospective trial designs. Patients undergoing SSPPD experienced significantly lower rates of DGE(OR = 2.75; 95%CI: 1.75-4.30, P < 0.00001) and a shorter period of nasogastric intubation(OR = 2.68; 95%CI: 0.77-4.58,P < 0.00001), with a tendency towards shorter time to liquid(WMD = 2.97, 95%CI:-0.46-7.83; P = 0.09) and solid diets(WMD = 3.69, 95%CI:-0.46-7.83; P = 0.08) as well as shorter inpatient stay(WMD = 3.92, 95%CI:-0.37-8.22; P = 0.07), although these latter three did not reach statistical significance. PPPD, however, was associated with less intraoperative blood loss than SSPPD [WMD =-217.70, 95%CI:-429.77-(-5.63); P = 0.04]. There were no differences in other parameters between the two approaches, including operative time(WMD =-5.30, 95%CI:-43.44-32.84; P = 0.79), pancreatic fistula(OR = 0.91; 95%CI: 0.56-1.49; P = 0.70), postoperative hemorrhage(OR = 0.51; 95%CI: 0.15-1.74; P = 0.29), intraabdominal abscess(OR = 1.05; 95%CI: 0.54-2.05; P = 0.89), wound infection(OR = 0.88; 95%CI: 0.39-1.97; P = 0.75), reinsertion of nasogastric tube(OR = 1.90; 95%CI: 0.91-3.97; P = 0.09) and mortality(OR = 0.31; 95%CI: 0.05-2.01; P = 0.22).CONCLUSION: SSPPD may improve intraoperative and short-term postoperative outcomes compared to PPPD, especially DGE. However, these findings need to be further ascertained by well-designed randomized controlled trials.

Vagus effect on pylorus preserving gastrectomy

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Retroperitoneal cavernous hemangioma resected by a pylorus preserving pancreaticoduodenectomy

A retroperitoneal hemangioma is a rare disease. We report on the diagnosis and treatment of a retroperitoneal hemangioma which had uncommonly invaded into both the pancreas and duodenum, thus requiring a pylorus preserving pancreaticoduodenectomy (PpPD). A 36-year-old man presented to our hospital with abdominal pain. An enhanced computed tomography scan without contrast enhancement revealed a 12 cm × 9 cm mass between the pancreas head and right kidney. Given the high rate of malignancy associated with retroperitoneal tumors, surgical resection was performed. Intraoperatively, the tumor was inseparable from both the duodenum and pancreas and PpPD was performed due to the invasive behavior. Although malignancy was suspected, pathological diagnosis identified the tumor as a retroperitoneal cavernous hemangioma for which surgical resection was the proper diagnostic and therapeutic procedure. Reteoperitoneal cavernous hemangioma is unique in that it is typically separated from the surrounding organs. However, clinicians need to be aware of the possibility of a case, such as this, which has invaded into the surrounding organs despite its benign etiology. From this case, we recommend that combined resection of inseparable organs should be performed if the mass has invaded into other tissues due to the hazardous nature of local recurrence. In summary, this report is the first to describe a case of retroperitoneal hemangioma that had uniquely invaded into surrounding organs and was treated with PpPD.

Acquired double pylorus:Clinical and endoscopiccharacteristics and four-year follow-up observations

Double pylorus(DP), or duplication of the pylorus, is an uncommon condition that can be either congenital or acquired. Acquired DP(ADP) occurs when a peptic ulcer erodes and creates a fistula between the duodenal bulb and the distal stomach. The clinical features and endoscopic characteristics of four patients with ADP were reviewed and compared with previously reported cases. An accessory channel connects the lesser curvature of the prepyloric antrum with the duodenal bulb, and in all cases, a peptic ulcer was located in or immediately adjacent to the accessory channel. In one of the patients, the bridge between the double-channel pylorus disappeared, resulting in a single large opening and duodenal kissing ulcer after two years and three months. Finally, nonsteroidal anti-inflammatory drugs, Helicobacter pylori and other risk factors associated with ADP are assessed.

Performing robot-assisted pylorus and vagus nerve-preserving gastrectomy for early gastric cancer:A case series of initial experience

BACKGROUND Pylorus and vagus nerve-preserving gastrectomy(PPG)is a function-preserving surgery for early gastric cancer(GC)that has gained considerable interest in the recent years.The operative technique performed using the Da Vinci Xi robot system is considered ideal for open and laparoscopic surgery.AIM To introduce Da Vinci Xi robot-assisted PPG(RAPPG)-based operative procedure and technical points as well as report the initial experience based on the clinical pathology data of eight cases of early GC.METHODS Da Vinci Xi robot-assisted pylorus and vagus nerve-preserving gastrectomy(RAPPG)was performed for 11 consecutive patients with middle GC from December 2020 to July 2021.Outcome measures were postoperative morbidity,operative time,blood loss,number of lymph nodes harvested,postoperative hospital stay,time to first flatus,time to diet,and resection margins.RESULTS Eight of the 11 patients who were pathologically diagnosed with early GC were enrolled in a retrospective study to assess the feasibility and safety of RAPPG.The mean operative time,mean blood loss,mean number of lymph nodes harvested,length of preserved pylorus canal,distal margin,and proximal margin were 330.63±47.24 min,57.50±37.70 mL,18.63±10.57,3.63±0.88 cm,3.50±1.31 cm,and 3.63±1.19 cm,respectively.None of the cases required conversion to laparotomy.Postoperative complications occurred in two(25.0%)patients.Postoperative complications were hyperamylasemia and gastric stasis in one case and incision infection in the other.Time to first flatus was 3.75±2.49 d after the operation,andpostoperative hospital stay was 10.13±4.55 d.CONCLUSIONThe core technique in the Da Vinci Xi RAPPG is lymph node dissection and the anatomic methodof the nerve.Robotic surgical procedures are feasible and safe.With the progress of surgicaltechnology,optimization of medical insurance structure,and emergence of evidence-basedmedicine,automated surgery systems will have a broad application in clinical treatment.

Laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer: A retrospective study of long-term functional outcomes and quality of life

BACKGROUND Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was known to have benefits of function-preserving surgery compared to laparoscopy-assisted distal gastrectomy (LADG). However, in clinical settings, delayed gastric emptying and esophageal reflux following LAPPG can be serious issues, making surgeons reluctant to perform LAPPG. It is unclear that LAPPG had better longterm functional outcomes and quality of life compared to LADG. AIM To evaluate the long-term functional outcomes and patient-reported quality of life of LAPPG compared to those of LADG. METHODS We reviewed the clinicopathological data of 195 patients who underwent LADG with Billroth II anastomosis and 101 patients who underwent LAPPG for cT1N0 gastric cancer in the middle third of the stomach between 2012 and 2015. Postoperative complications, nutritional parameters, and survey results of the European Organization for Research and Treatment of Cancer Questionnaire C30 and STO22 questionnaire were compared between the two groups. RESULTS The serum hemoglobin level was significantly higher in the LAPPG group than in the LADG group (P < 0.001). In the endoscopic findings, incidence of bile reflux was lower (P < 0.001);however, the incidence of residual food was higher in the LAPPG group than in the LADG group (P < 0.001). Regarding the quality of life score, the LAPPG group had a better physical functioning score (86.7 vs 90.0, P = 0.032) but also greater pain and reflux when compared to the LADG group [8.3 vs 16.7 in pain, 11.1 (interquartile range, 0, 22.2) vs 11.1 (interquartile range, 11.1, 33.3) in reflux, P = 0.034 and 0.001, respectively]. CONCLUSION LAPPG is beneficial to recovery of anemia and to bile reflux, however, it might be unfavorable in terms of pain and reflux symptoms compared to LADG with Billroth II anastomosis.

Pylorus- and vagus-nerve-preserving partial gastrectomy (D2 dissection)

Pylorus- and vagus nerve-preserving partial gastrectomy is important in improving the prognosis of early gastric cancer surgery, reducing surgical complications and improving the quality of life for such patients. In the present case, pylorus- and vagus nerve-preserving partial gastrectomy was performed using the bipolar electrocautery dissection technique combined with D2 dissection along the lesser sac.

Acquired double pylorus,due to penetrating gastric ulcer,presenting with melena

Acquired double pylorus (DP) is an uncommon condition consisting of two communicating channels between the gastric antrum and the first part of duodedum.Little is known about the origin of DP.As there is no specific gastrointestinal symptom due to DP,most often it is diagnosed by gastroscopy while performing for other indicationsFew data are also known about the clinical course of DP.In the patients with peptic ulcer symptoms,the pyloroplasty-like drainage effect,improving gastric emptying after the estabilishment of the fistula,could relieve these symptoms.This represents an unresolved issues about the necessity of repeating endoscopy to document in the patients with DP its final outcome,as the risk of ulcer recurrence.We describe a case of a 76-years-old woman admitted to our department for hyposideremic anemia associated to a recent history of melena.

Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy:A review of the literature and critical reappraisal of the implicated pathomechanism

Pylorus-preserving pancreaticoduodenectomy （PPPD） is nowadays considered the treatment of choice for periampullary tumors, namely carcinoma of the head, neck, or uncinate process of the pancreas, the ampulla of Vater, distal common bile duct or carcinoma of the peri-Vaterian duodenum. Delayed gastric emptying （DGE） comprises one of the most troublesome complications of this procedure. A search of the literature using Pubmed/IVledline was performed to identify clinical trials examining the incidence rate of DGE following standard Whipple pancreaticoduodenectomy （PD） vs PPPD. Additionally we performed a thorough in-depth analysis of the implicated pathomechanism underlying the occurrence of DGE after PPPD. In contrast to early studies, the majority of recently performed clinical trials demonstrated no significant association between the occurrence of DGE with either PD or PPPD. PD and PPPD procedures are equally effective operations regarding the postoperative occurrence of DGE. Further randomized trials are required to investigate the efficacy of a recently reported （but not yet tested in largescale studies） modification, that is, PPPD with antecolic duodenojejunostomy.

Stapled gastro/duodenojejunostomy shortens reconstruction time during pylorus-preserving pancreaticoduodenectomy

AIM:To investigate whether a stapled technique is superior to the conventional hand-sewn technique for gastro/duodenojejunostomy during pylorus-preserving pancreaticoduodenectomy(PpPD).METHODS:In October 2010,we introduced a mechanical anastomotic technique of gastro-or duodenojejunostomy using staplers during PpPD.We compared clinical outcomes between 19 patients who underwent PpPD with a stapled gastro/duodenojejunostomy(stapled anastomosis group)and 19 patients who underwent PpPD with a conventional hand-sewn duodenojejunostomy(hand-sewn anastomosis group).RESULTS:The time required for reconstruction was significantly shorter in the stapled anastomosis group than in the hand-sewn anastomosis group(186.0±29.4 min vs 219.7±50.0 min,P=0.02).In addition,intraoperative blood loss was significantly less(391.0±212.0 mL vs 647.1±482.1 mL,P=0.03)and the time to oral intake was significantly shorter(5.4±1.7d vs 11.3±7.9 d,P=0.002)in the stapled anastomosis group than in the hand-sewn anastomosis group.There were no differences in the incidences of delayed gastric emptying and other postoperative complications between the groups.CONCLUSION:These results suggest that stapled gastro/duodenojejunostomy shortens reconstruction time during PpPD without affecting the incidence of delayed gastric emptying.

Acquired double pylorus:A case report

Double pylorus is one of the rare anomalies of the gastrointestinal tract,it can be congenital or acquired.In this case we report a case of double pylorus because of chronic peptic ulcer.Upper GI endoscopy revealed gastroduodenal fistula located on the lesser curve of the antrum,the patient’s symptoms were improved rapidly by intensive antiulcer treatment.