Gastrointestinal Function Recovery Time Research Articles

Efficacy of combined use of octreotide and sodium tanshinone IIA sulfonate in patients with cirrhosis complicated with severe acute pancreatitis

Purpose: To assess the prognosis of liver cirrhosis complicated with severe acute pancreatitis (SAP) after treatment with octreotide in combination with sodium tanshinone IIA sulfonate. Methods: A total of 164 patients with cirrhosis complicated with SAP were randomly assigned to two groups, each with 82 patients. Serum levels of inflammatory factors, as well as vascular endothelial function and liver function indices were determined. Treatment outcomes in the patients were recorded in terms of abdominal pain relief time, gastrointestinal function recovery time, hospital stay duration, and incidence of complications. Results: Relative to the control group, there were decreases in concentrations of inflammatory indices in the study cohort. Endothelial function index levels increased in the two groups, but the levels of endothelin (ET) and von Willebrand Factor (vWF) decreased more in the study group of patients, when compared to the control group, while nitric oxide (NO) level was raised (p < 0.05). Liver function improved in both groups. There were marked reductions in serum ALT, AST and total bilirubin (TBIL) in study cohort, relative to the control cohort (p < 0.05). However, albumin (ALB) levels were comparable in the two groups. Abdominal pain relief time, duration of hospitalization and time taken for normal digestive system function were shorter in the study cohort (p < 005). Receiver operating characteristic (ROC) curve analysis revealed that after treatment with octreotide and sodium tanshinone IIA sulfonate, values of area under the curve (AUC) for abdominal pain relief time, gastrointestinal function recovery time and hospital stay were 0.886, 0.918 and 0.794, respectively. Conclusion: The combined use of octreotide and sodium tanshinone IIA sulfonate inhibits the release of inflammatory factors in cirrhotic patients with SAP, and improves vascular endothelial and liver functions, thereby improving disease prognosis. These data constitute a good scientific basis for the use of octreotide and sodium tanshinone IIA sulfonate in the treatment of liver cirrhosis complicated with SAP.

Exploring the Effect of Qi Cross-Shaped Moxibustion on the Recovery of Gastrointestinal Function after Hip Fracture in the Elderly

Objective: To explore the effect of Qi cross-shaped moxibustion on the recovery of gastrointestinal function in elderly hip fracture patients after surgery. Methods: 62 elderly hip fracture surgery patients were selected as the base analysis sample, enrolled in January 2023–May 2024, and divided into an observation group (n = 31) and a control group (n = 31) using the digital table random draw scheme. The patients in the control group underwent conventional dietary intervention, and the patients in the observation group underwent Qi cross-shaped moxibustion intervention, comparing the gastrointestinal function recovery time and quality of life scores (PAC-QOL) of patients with constipation between the two groups. Results: The gastrointestinal function recovery time of the observation group was lower than that of the control group (P < 0.05); the PAC-QOL score of the observation group was lower than that of the control group after the intervention (P < 0.05). Conclusion: Qi cross-shaped moxibustion can shorten the recovery time of gastrointestinal function and improve the quality of life of elderly hip fracture patients after surgery, and it has the value of promotion and application.

Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients.

Da Vinci Robotics-assisted total mesorectal excision (TME) surgery for rectal cancer is becoming more widely used. There is no strong evidence that robotic-assisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer. To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery. A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023. The patients were divided into a robot-assisted group (the R-TME group) and a laparoscopic group (the L-TME group), and the short-term efficacy of the two groups was compared. There were 45 elderly patients (≥ 60 years) in the R-TME group and 50 elderly patients (≥ 60 years) in the L-TME group. There were no differences in demographics, conversion rates, or postoperative complication rates. The L-TME group had a longer surgical time than the R-TME group [145 (125, 187.5) vs 180 (148.75, 206.25) min, P = 0.005), and the first postoperative meal time in the L-TME group was longer than that in the R-TME (4 vs 3 d, P = 0.048). Among the sex and body mass index (BMI) subgroups, the R-TME group had better outcomes than did the L-TME group in terms of operation time (P = 0.042) and intraoperative assessment of bleeding (P = 0.042). In the high BMI group, catheter removal occurred earlier in the R-TME group than in the L-TME group (3 vs 4 d, P = 0.001), and autonomous voiding function was restored. The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery; however, robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis. Optimizing the learning curve can shorten the operation time, reduce the recovery time of gastrointestinal function, and improve the prognosis.

Duhamel and transanal endorectal pull-throughs for Hirschsprung disease: a Bayesian network meta-analysis

BackgroundTo comprehensively compare the effects of open Duhamel (OD), laparoscopic-assisted Duhamel (LD), transanal endorectal pull-through (TEPT), and laparoscopic-assisted endorectal pull-through (LEPT) in Hirschsprung disease.MethodsPubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP were comprehensively searched up to August 4, 2022. The outcomes were operation-related indicators and complication-related indicators. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Network plots, forest plots, league tables and rank probabilities were drawn for all outcomes. For measurement data, weighted mean differences (WMDs) and 95% credibility intervals (CrIs) were reported; for enumeration data, relative risks (RRs) and 95%CrIs were calculated.ResultsSixty-two studies of 4781 patients were included, with 2039 TEPT patients, 1669 LEPT patients, 951 OD patients and 122 LD patients. Intraoperative blood loss in the OD group was more than that in the LEPT group (pooled WMD = 44.00, 95%CrI: 27.33, 60.94). Patients lost more blood during TEPT versus LEPT (pooled WMD = 13.08, 95%CrI: 1.80, 24.30). In terms of intraoperative blood loss, LEPT was most likely to be the optimal procedure (79.76%). Patients undergoing OD had significantly longer gastrointestinal function recovery time, as compared with those undergoing LEPT (pooled WMD = 30.39, 95%CrI: 16.08, 44.94). The TEPT group had significantly longer gastrointestinal function recovery time than the LEPT group (pooled WMD = 11.49, 95%CrI: 0.96, 22.05). LEPT was most likely to be the best operation regarding gastrointestinal function recovery time (98.28%). Longer hospital stay was observed in patients with OD versus LEPT (pooled WMD = 5.24, 95%CrI: 2.98, 7.47). Hospital stay in the TEPT group was significantly longer than that in the LEPT group (pooled WMD = 1.99, 95%CrI: 0.37, 3.58). LEPT had the highest possibility to be the most effective operation with respect to hospital stay. The significantly reduced incidence of complications was found in the LEPT group versus the LD group (pooled RR = 0.24, 95%CrI: 0.12, 0.48). Compared with LEPT, OD was associated with a significantly increased incidence of complications (pooled RR = 5.10, 95%CrI: 3.48, 7.45). Patients undergoing TEPT had a significantly greater incidence of complications than those undergoing LEPT (pooled RR = 1.98, 95%CrI: 1.63, 2.42). For complications, LEPT is most likely to have the best effect (99.99%). Compared with the LEPT group, the OD group had a significantly increased incidence of anastomotic leakage (pooled RR = 5.35, 95%CrI: 1.45, 27.68). LEPT had the highest likelihood to be the best operation regarding anastomotic leakage (63.57%). The incidence of infection in the OD group was significantly higher than that in the LEPT group (pooled RR = 4.52, 95%CrI: 2.45, 8.84). The TEPT group had a significantly increased incidence of infection than the LEPT group (pooled RR = 1.87, 95%CrI: 1.13, 3.18). LEPT is most likely to be the best operation concerning infection (66.32%). Compared with LEPT, OD was associated with a significantly higher incidence of soiling (pooled RR = 1.91, 95%CrI: 1.16, 3.17). Patients with LEPT had the greatest likelihood not to develop soiling (86.16%). In contrast to LD, LEPT was significantly more effective in reducing the incidence of constipation (pooled RR = 0.39, 95%CrI: 0.15, 0.97). LEPT was most likely not to result in constipation (97.81%). LEPT was associated with a significantly lower incidence of Hirschprung-associated enterocolitis (HAEC) than LD (pooled RR = 0.34, 95%CrI: 0.13, 0.85). The OD group had a significantly higher incidence of HAEC than the LEPT group (pooled RR = 2.29, 95%CrI: 1.31, 4.0). The incidence of HAEC was significantly greater in the TEPT group versus the LEPT group (pooled RR = 1.74, 95%CrI: 1.24, 2.45). LEPT was most likely to be the optimal operation in terms of HAEC (98.76%).ConclusionLEPT may be a superior operation to OD, LD and TEPT in improving operation condition and complications, which might serve as a reference for Hirschsprung disease treatment.

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra- and extrahepatic bile duct stones.

Bile duct stones (BDSs) may cause patients to develop liver cirrhosis or even liver cancer. Currently, the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory, and there is a risk of postoperative complications. To compare the clinical effects of dual-modality endoscopy (duodenoscopy and laparoscopy) with those of traditional laparotomy in the treatment of intra- and extrahepatic BDSs. Ninety-five patients with intra- and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected; 45 patients in the control group were treated by traditional laparotomy, and 50 patients in the research group were treated by dual-modality endoscopy. The following factors were collected for analysis: curative effects, safety (incision infection, biliary fistula, lung infection, hemobilia), surgical factors [surgery time, intraoperative blood loss (IBL) volume, gastrointestinal function recovery time, and length of hospital stay], serum inflammatory markers [tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8], and oxidative stress [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced protein oxidation products (AOPPs)]. The analysis revealed markedly better efficacy (an obviously higher total effective rate) in the research group than in the control group. In addition, an evidently lower postoperative complication rate, shorter surgical duration, gastrointestinal function recovery time and hospital stay, and lower IBL volume were observed in the research group. Furthermore, the posttreatment serum inflammatory marker (TNF-α, IL-6, and IL-8) levels were significantly lower in the research group than in the control group. Compared with those in the control group, the posttreatment GSH-Px, SOD, MDA and AOPPs in the research group were equivalent to the pretreatment levels; for example, the GSH-Px and SOD levels were significantly higher, while the MDA and AOPP levels were lower. Dual-modality endoscopy therapy (duodenoscopy and laparoscopy) is more effective than traditional laparotomy in the treatment of intra- and extrahepatic BDSs and has a lower risk of postoperative complications; significantly shortened surgical time; shorter gastrointestinal function recovery time; shorter hospital stay; and lower intraoperative bleeding volume, while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.

Comparison between Retroperitoneal Laparoscopic Nephrectomy and Traditional Open Nephrectomy to Treat Polycystic Kidney Disease before Kidney Transplantation.

To compare the efficiency and safety between retroperitoneal laparoscopic nephrectomy and traditional open nephrectomy to treat autosomal-dominant polycystic kidney disease before kidney transplantation. A total of 57 patients diagnosed with huge autosomal-dominant polycystic kidney disease between 2000 and 2020 at our center were included in this study. Patients were divided into a retroperitoneal laparoscopic (RL; n=23) group and traditional open (TO; n = 34) group. We retrospectively analyzed and compared preoperative and perioperative variables between the two groups. Patients in the RL group showed a longer operation time (201.09±83.76min) compared to patients in the TO group (113.38 ± 51.84min, p < 0.001). The RL group also showed significantly less intraoperative blood loss (p = 0.025) and less intraoperative blood transfusion volume (p = 0.016) compared to the TO group. Meanwhile, time of gastrointestinal function recovery, bed leave, catheter indwelling and postoperative hospitalization in the RL group were 2.13 ± 0.63, 1.30 ± 1.0, 5.22 ± 2.09, 7.35±2.48 days, respectively, which were significantly shorter than the TO group (p < 0.05). Pain degree of patients during the first 48 hours after operation was similar between the RL and TO groups, but the opioid use percentage in the RL group was 8.70% (2/23) and was lower than the 26.47% (9/34) in the TO group (p = 0.022). Meanwhile, 5 and 23 patients exhibited postoperative complications in the RL and TO groups, respectively (p < 0.001). Both retroperitoneal laparoscopic nephrectomy and traditional open surgery are feasible to treat huge polycystic nephrectomy. However, patients who undergo retroperitoneal laparoscopic nephrectomy experience higher levels of safety and recover more rapidly.

The Impact of Laparoscopic Appendectomy and Open Appendectomy on B7-H3-Mediated Intrinsic Immune Response in Children with Acute Suppurative Appendicitis.

Surgery impairs immune function and increases postoperative complications. B7H3, a co-stimulatory molecule, plays a crucial role in immune regulation. The present study examined the impact of B7H3 on the postoperative immune response in children with acute suppurative appendicitis (ASA) by comparing preoperative and postoperative B7H3 levels in laparoscopic surgery (LA) and open appendectomy (OA). 198 pediatric ASA patients were enrolled. The researcher group performed LA, while the control group performed OA. Perioperative time, recovery time of gastrointestinal function, time to pass gas, length of incision, and length of hospitalization were compared in the perioperative period. Additionally, an ELISA assay was conducted to examine the levels of inflammatory factors and B7H3 and CD28. Short-term postoperative complications were also evaluated. Compared with the control group, the research group had a short operative time, gastrointestinal function recovery time, gas time, and hospitalization time. The short-term complication rate was significantly lower in the research group. More importantly, B7H3 and CD28 were insignificantly different preoperatively, but they were all reduced postoperatively. Moreover, the reduction was more pronounced in the research group. The same results were noted in inflammatory factors and immune markers, which were non-significant different preoperatively and were typically reduced postoperatively, particularly in the research group. Finally, postoperative B7H3 was positively correlated with both inflammatory factors and immune cell levels. B7H3 was reduced in both postoperative periods, and the reduction was more pronounced in the LA group. B7H3 may be involved in postoperative recovery by modulating postoperative inflammation and immune responses.

Effect of perioperative "Internet + rehabilitation guidance" based on IKAP theory on short-term prognosis of patients with esophageal cancer.

The aim of the study was to investigate the "Internet + rehabilitation guidance" under the theory of Information-Knowledge-Attitude-Practice (IKAP) in patients with esophageal cancer during the perioperative period and to analyze the influence on the short-term prognosis of patients with esophageal cancer. From April 2022 to February 2023, 118 patients who underwent radical esophagectomy in the First Hospital of Huai'an Affiliated Hospital of Nanjing Medical University were enrolled using the convenience sampling method. They were divided into the IKAP group (59 cases) and the Control Group (Group C) (59 cases), according to the random number table method. The conventional intervention was performed during the perioperative period, and the IKAP group was also given "Internet + rehabilitation guidance" based on IKAP theory. The first postoperative defecation time, exhaust time, feeding time, discharge time, and postoperative complication rate of the two groups were compared. Meanwhile, blood samples were collected before surgery and 1, 3, 7, and 30 days after surgery (at outpatient review) for the detection of inflammatory factor indexes and nutritional indexes. Patients within the IKAP group showed a shorter first postoperative exhaust and defecation time, eating time, and hospital compared to the control group (p<0.05). Before surgery, there was no significant difference in serum inflammatory factors and nutritional indexes between the two groups (p>0.05). Comparing the levels of serum inflammatory factors in the two groups after surgery, the levels of CRP and IL-6 in the IKAP group were lower than those in the control group on days 1, 3, and 7 after surgery. After 30 days, the serum CRP level was found to be lower than the control group, but no statistical difference with the control level of serum IL-6 (p<0.05) was found. Compared with the serum nutritional index levels in the two groups: 1 d after surgery, the serum HGB, PA, and TRF levels were not different (p>0.05). The serum ALB level in the IKAP group was higher than that in the control group (p<0.05). Postoperative 3 d, 7 d, the serum levels of HGB, ALB, PA, and TRF in the IKAP group were higher than those in the control group (p<0.05). After 30 d, there was no statistical difference in serum HGB levels between the two groups (p<0.05); Serum ALB, PA, and TRF levels in the IKAP group were higher than those in the control group (p<0.05). From preoperative to 30 days after surgery, serum CRP and IL-6 levels in 2 groups were first increased and then decreased, while serum HGB, ALB, PA, and TRF levels were first decreased and then increased. After surgery, the IKAP group showed a greater incidence of complications in patients than in controls (p<0.05). In patients with esophageal cancer, perioperative "Internet + rehabilitation guidance" based on IKAP theory can effectively shorten the postoperative gastrointestinal function recovery time and rapidly reduce the inflammatory response, improving the nutritional status of the body, thereby reducing the risk of short-term postoperative complications.

Clinical Evaluation of Enteral Nutrition + Probiotics in the Treatment of Gastrointestinal Dysfunction After Severe Traumatic Brain Injury

Objective: To evaluate the therapeutic effect of enteral nutrition + probiotics in patients with gastrointestinal dysfunction after severe craniocerebral injury. Methods: From September 2018 to February 2023, 80 patients (20–82 years old) with gastrointestinal dysfunction who were admitted to the Intensive Care Unit at the Third People’s Hospital of Xining were included in the study. Their primary condition was severe craniocerebral injury, and all of them received conventional symptomatic treatment. Group A received enteral nutrition + probiotic therapy, whereas group B received enteral nutrition only. The differences in the following indicators were compared before and after treatment: nutritional and biochemical indicators, gastrointestinal function indicators, Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA), APACHE II score, serum procalcitonin (PCT), neutrophil (N) ratio, and C reactive protein (CRP). Result: The nutritional and biochemical indicators in group A were higher than those in group B, P &lt; 0.05; the time to first passage of flatus, time to first passage of stool, and bowel sound recovery time in group A were shorter than those in group B, P &lt; 0.05; the GCS of group A was higher than that of group B, P &lt; 0.05; the SOFA and APACHE Ⅱ scores of group A were not different from those of group B, P &gt; 0.05; and the PCT, N ratio, and CRP levels of group A were lower than those of group B, P &lt; 0.05. Conclusion: In patients with gastrointestinal dysfunction after severe craniocerebral injury, enteral nutrition + probiotic therapy is highly effective and feasible, as it can optimize various nutritional indicators, shorten the gastrointestinal function recovery time, and reduce the body’s stress response.

Short-Term Safety Evaluation of Albumin-Bound Paclitaxel in Intraoperative and Postoperative Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer.

To evaluate the short-term safety of albumin-bound paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) during and after gastric cancer (GC) surgery. A retrospective analysis of clinical data was conducted for GC surgery patients at Zhongnan Hospital of Wuhan University, from January 2020 to September 2022. The study group (n = 120) received HIPEC and the control group (n = 268) did not receive albumin-bound paclitaxel. Short-term safety indicators including intraoperative complications, hematological toxicity, liver and kidney function, and gastrointestinal function recovery were compared between the two groups. There were no statistically significant differences between the two groups regarding intraoperative complications, hematological toxicity, liver and kidney function, and gastrointestinal function recovery time (P > 0.05 for all). In the study group, patients were further divided into subgroups based on dose and timing. Subgroup analysis revealed no significant differences among the different dose subgroups. However, when focusing on timing subgroups, the postoperative subgroup exhibited significantly higher white blood cell counts and bilirubin levels compared to the intraoperative subgroup, while the intraoperative subgroup had significantly higher bilirubin levels compared to both postoperative and intraoperative plus postoperative subgroups. Albumin-bound paclitaxel demonstrates good safety and tolerability in HIPEC during and after GC surgery, without increasing the risk of intraoperative complications.

Clinical effect of neoadjuvant chemotherapy combined with laparoscopic surgery for patients with colorectal cancer

Purpose: To assess the clinical effect of neoadjuvant chemotherapy in combination with laparoscopic surgery in treating progressive colorectal cancer.&#x0D; Methods: 90 patients with colorectal cancer admitted to Hebei Yanda Hospital, Hebei Langfang, China between December 2020 and December 2021 were enrolled. The patients were randomly grouped into control and study groups. Control group underwent laparoscopic surgery while the study group underwent neoadjuvant chemotherapy in addition to laparoscopic surgery. Gastrointestinal function recovery time, tumor control effect, tumor marker level, and adverse reactions were investigated and compared between the two groups.&#x0D; Results: Time to anal exhaust, time to first defecation, time to first solid food intake, and time to recover to normal bowel sounds were earlier in the study group compared to control group (p &lt; 0.05). Study group exhibited a greater overall rate of tumor control response., while the rate of tumor lymphatic metastasis was also significant (p &lt; 0.05). After treatment, the study group exhibited significantly lower levels of tumor markers compared to control group (p &lt; 0.05). The occurrence of adverse reactions was not significant between the two groups (p &gt; 0.05).&#x0D; Conclusion: Neoadjuvant chemotherapy in conjunction with laparoscopic surgery in the treatment of progressive rectal cancer improves patient outcomes and enhances prognosis.

Impact of perioperative care and cognitive training on neurological recovery and life ability in hypertensive intracerebral hemorrhage patients undergoing minimally invasive hematoma evacuation.

To evaluate the effects of perioperative care combined with cognitive training on neurological recovery and life ability in patients with hypertensive intracerebral hemorrhage undergoing minimally invasive hematoma evacuation. A retrospective analysis was conducted using electronic records and data from patients treated at the Central South Hospital of Wuhan University from March 2022 to March 2023. The control group consisted of 44 patients receiving routine care, while the research group included 56 patients who received perioperative care combined with cognitive training. Baseline characteristics were analyzed, and neurological function, cognitive function, motor function, life ability, emotional status, and quality of life were assessed before and after intervention. Additionally, recovery time of gastrointestinal function, hospital stay, complications, and nursing satisfaction were compared between the groups. Post-intervention, both groups showed significant decreases in NIHSS (National Institutes of Health Stroke Scale), SAS (Self-Rating Anxiety Scale), and SDS (Self-Rating Depression Scale) scores (P<0.05), with the research group showing significantly lower scores than the control group (all P<0.05). Significant improvements in MMSE (Mini-Mental State Examination), ADL (Activities of Daily Living), SS-QOL (Stroke Specific Quality of Life Scale), and motor function scores were observed in both groups, with the research group achieving significantly higher scores (all P<0.05). The research group had shorter recovery time for gastrointestinal function, reduced hospital stays, and lower complication rates compared to the control group (all P<0.05). Nursing satisfaction was significantly higher in the research group (P<0.05). Logistic multivariate analysis identified hemorrhage volume and nursing methods as independent risk factors affecting prognosis (P<0.05). Perioperative care combined with cognitive training significantly enhances neurological recovery, cognitive function, motor ability, and overall life quality in patients with hypertensive intracerebral hemorrhage undergoing minimally invasive hematoma evacuation.

Comparative evaluation of the perioperative anesthesia methods for cancer patients undergoing pancreaticoduodenectomy

BACKGROUND: Pancreatoduodenal resections are one of the most traumatic and technically complex interventions in abdominal surgery. The correct anesthetic management and pain relief allow to substantially reduce the risk of perioperative complications, which remains high even in high-volume oncology centers with extensive experience. Finding new components and methods of anesthesia combined with evaluation of their effectiveness and safety remains a pressing issue.&#x0D; AIM: To evaluate the efficacy and safety of using intravenous lidocaine infusion as a component of anesthesia and postoperative analgesia in cancer patients during pancreatoduodenal resection.&#x0D; MATERIALS AND METHODS: We analyzed the course of anesthesia, operation and postoperative period of 43 patients (mean age 63.2±7.1 years) undergoing pancreaticoduodenectomy. For the purposes of the study, patients were randomly divided into 2 groups, based on anesthesia method: for the first group (n=19) we used epidural analgesia as a component of perioperative anesthesia, for the second group (n=24) we used prolonged intravenous infusion of lidocaine at an average dose of 1 mg/(kg×h). We analyzed the severity of pain syndrome according to Numeric rating scale for pain in postoperative period, as well as opioid requirement, the time of gastrointestinal function recovery, and post-operative complications frequency. In order to prevent systemic toxicity, drug monitoring was carried out — the determination of the plasma concentration of lidocaine.&#x0D; RESULTS: Perioperative opioid requirement was comparable between groups, with no statistically significant differences observed. The degree of pain syndrome according to the Numeric rating scale for pain did not differ statistically, except for the number of points during activation on day 3: 4.00 (95% confidence interval 3.49–4.51) for epidural analgesia group, compared to 3.12 (95% confidence interval 2.64–3.61) for lidocaine infusion group, p=0.014. There was also a statistically significant increase in infusion volume for epidural analgesia group compared to lidocaine infusion group [8.83 ml/(kg×h) (Q1=7.90; Q3=10.06) and 7.33 ml/(kg×h) (Q1=6.28–Q3=8.49) respectively, p=0.034], as well as a greater need for intraoperative vasopressor support among the patients [15 (78.9%) and 10 (43.5%) respectively, p=0.029]. In the lidocaine group, the time to onset of peristalsis was significantly shorter than in the epidural analgesia group [median 48.0 h (Q1=48.00; Q3=72.00) compared to median 60.0 h (Q1=36.00; Q3=64.50) respectively, p=0.042]. The frequency of postoperative complications did not differ between the groups.&#x0D; CONCLUSION: Based on a comparative analysis of the study results, it can be concluded that prolonged intravenous infusion of lidocaine, as a component of perioperative anesthetic protection during pancreatoduodenal resections, is safe and comparable in terms of analgesic efficacy to epidural blockade.

Trans-retro-peritoneal laparoscopic partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results.

Urologists still encounter challenges when it comes to the surgical management of tumors located on the posterior lip and posterior renal hilar region. We propose a trans-retro-peritoneal (TRP) technique to address the difficulties associated with posterior hilar tumors during retroperitoneal laparoscopic partial nephrectomy (LPN). Its efficacy was evaluated in a retrospective case-control study. The patients with posterior hilar tumors (≤7 cm) that underwent retroperitoneal LPN were included. The TRP technique allowed the posterior hilar tumor completely visible by incising the ventral peritoneum and rotating kidney ventrally during retroperitoneal LPN, which was applied in 36 cases, while the conventional retroperitoneal LPN was performed in 22 cases. Perioperative data were analyzed to evaluate the efficacy of TRP-LPN. In TRP-LPN group, the TRP technique was successfully performed in all the patients without converting to open surgery or radical nephrectomy. The warm ischemia time was significantly shorter in TRP-LPN group than conventional LPN group (20.3 vs. 28.5 min, P<0.001). Furthermore, the mean estimated blood loss in TRR-LPN group was significantly less than that in conventional LPN group (86.5 vs. 90.9 mL, P<0.05). The mean operation time and recovery time of gastrointestinal function were similar between two groups. No severe complications occurred, and no positive surgical margin was found. The rate of Trifecta achievement was 50.0% (18/36) and 31.8% (7/22) respectively for TRP-LPN and conventional LPN (P=0.175). After mean follow-up of 21 months, no recurrence or metastasis occurred in all cases. Our findings, as demonstrated by the Trifecta outcomes, support the feasibility and efficacy of TRP-LPN in managing posterior renal hilar tumors. This approach may be considered as an efficient option for surgical management of such tumors.

Posterior Calot's Triangle Approach First Would Be a Better Choice for Chronic Atrophic Cholecystitis: A Retrospective Controlled Study.

Objective: Compare the clinical efficacy of anterior and posterior Calot's triangle approach in laparoscopic cholecystectomy (LC) for chronic atrophic cholecystitis, to find out which approach is much safer and more reliable. Patients and Methods: From June 2020 to June 2022, 102 patients with chronic atrophic cholecystitis underwent LC in our hospital. They were divided into anterior Calot's triangle approach group and posterior Calot's triangle approach group. In addition, their clinical data, intraoperative conditions, surgical results, and postoperative recovery were analyzed. Results: LC was performed in 41 females and 28 males by the anterior Calot's triangle approach, and in 20 females and 13 males by the posterior Calot's triangle approach. There were no differences in age, gender, and body mass index between the two groups (P > .05). The probability of rupture of cystic artery between both groups was not significantly different (P = .549), and the intraoperative blood loss was more in the anterior group (P = .014). The operative time of the posterior approach appeared to be shorter (P = .013). Bile duct injury and conversion to open cholecystectomy revealed no significant difference (P > .05). The recovery time of gastrointestinal function, wound infection, white blood cell count, liver function, and postoperative hospital stay time were found to be not significantly different (P > .05). Conclusion: By the posterior Calot's triangle approach, LC is a convenient and feasible surgical procedure for chronic atrophic cholecystitis with less blood loss and can become easier without increasing the risk of surgery.

Oral Nutritional Supplements Enhanced Recovery After Orthopedic Surgery: An Application-Based Study

This research clarifies the application value of oral nutritional supplements in enhanced recovery after orthopedic surgery nursing for patients. One hundred patients from the orthopedics department of the First Affiliated Hospital of Harbin Medical University were recruited between June 2021 and December 2022 and were divided into control and experimental groups using the random number table method. After admission, both groups underwent a comprehensive evaluation and were scheduled for surgery. The control group received conventional nutrition propaganda and education, while the experimental group underwent enhanced recovery after surgical nursing nutritional management. After surgery, the time of getting out of bed for activity, postoperative hospitalization time, total hospitalization time, recovery time of intestinal sounds, anus exhaust time, and anus defecation time in the experimental group were lower than those in the control group. Serum albumin and hemoglobin levels were lower in the experimental group than in the control group. The incidence of complications in the experimental group decreased compared to that in the control group. Overall, use of oral nutritional supplements in orthopedic surgery patients can reduce postoperative recovery time of gastrointestinal function and hospitalization duration. It can help improve their nutritional status, prevent complications, and provide good conditions for the postoperative rehabilitation of patients.

Changes of Intestinal Flora and the Effect on Intestinal Function in Infants With Ventricular Septal Defect After Cardiopulmonary Bypass Surgery

This study aimed to investigate the changes in intestinal flora in infants with ventricular septal defect (VSD) after cardiopulmonary bypass (CPB) surgery and their potential relationship with postoperative gastrointestinal function recovery. Fecal samples of 20 infants with VSD were collected before and after CPB surgery at our hospital from September 2021 to March 2022. 16S rRNA was used to detect and analyze the fecal samples. The most abundant intestinal microbes in the preoperative intestinal flora were Enterococcus (37.14%), Bifidobacterium (20.71%), Shigella (8.15%), Streptococcus (5.19%), Lactobacillus (3.7%), Rothia (2.22%). However, the most abundant intestinal microbes in the postoperative intestinal flora were Enterococcus (49.63%), Bifidobacterium (12.59%), Shigella (10.37%), Streptococcus (8.14%), Rothia (4.43%). The diversity and species richness of intestinal flora after CPB surgery were significantly lower than those preoperatively. The intestinal Enterococcus content in patients with postoperative gastrointestinal dysfunction was significantly higher than that in patients without gastrointestinal dysfunction (P < 0.05). Intestinal Bifidobacterium content in patients with postoperative gastrointestinal dysfunction was significantly lower than that in patients without gastrointestinal dysfunction (P < 0.05). After surgery, the content of intestinal Enterococcus was negatively correlated with the full feeding time, and the content of intestinal Bifidobacterium was positively correlated with full feeding time. After CPB surgery, the diversity and richness of intestinal flora decreased, intestinal pathogenic bacteria increased, and beneficial intestinal bacteria decreased. An increase in Enterococcus and decrease in Bifidobacterium can increase the incidence of gastrointestinal dysfunction and prolong the recovery time of gastrointestinal function.

TPVB and general anesthesia affects postoperative functional recovery in elderly patients with thoracoscopic pulmonary resections based on ERAS pathway.

Thoracic surgery is easy to cause various perioperative complications, especially in elderly patients, due to their physical weakness and physiological function degeneration. Postoperative cognitive dysfunction is a common complication in elderly patients undergoing thoracic surgery. This study focuses on exploring the effects of thoracic paravertebral block (TPVB) combined with general anesthesia on postoperative functional recovery in elderly patients undergoing thoracoscopic radical resection for lung cancer based on enhanced recovery after surgery (ERAS) pathway. A total of 104 patients aged 60 years or older undergoing thoracoscopic radical resection of lung cancer were randomized into the combination group (n = 52) and the control group (n = 52). Patients in the control group were given general anesthesia alone, while patients in the combination group were given TPVB combined with general anesthesia. All patients applied the ERAS model for the perioperative intervention. Hemodynamic indices (heart rate [HR] and mean arterial pressure [MAP]) before anesthesia (T0), 5 min after thoracoscopic trocar placement (T1), at extubation (T2), 30 min after extubation (T3), and 6 h after the surgery (T4), postoperative analgesia, preoperative and postoperative serum pain stress factors (5-hydroxytryptamine [5-HT], prostaglandin E2 [PGE2], cortisol [Cor], substance P [SP], and norepinephrine [NE]), tumor markers (CYFRA21-1, CEA, and CA50), inflammatory factors (IL-6, TNF-α, and c-reactive protein (CRP)), lung function indicators (forced vital capacity [FVC] and forced expiratory volume in the first second [FEV1]), 6 min walking distance (6MWD), clinical recovery indicators, hospitalization status, and postoperative complications in patients between both groups were compared. Compared with the control group, patients in the combination group had lower HR and MAP at T1-T4 time points, less intraoperative doses of remifentanil and propofol, less patient-controlled interscalene analgesia compression number 24 h after the surgery, lower visual analogue scale scores 24 h after the surgery, shorter hospitalization time, postoperative off-bed time, postoperative chest tube removal time, postoperative first feeding time and gastrointestinal function recovery time, reduced postoperative serum levels of 5-HT, PGE2, Cor, SP, NE, CYFRA21-1, CEA, CA50, IL-6, TNF-α, and CRP, decreased complications, and higher FVC, FEV1, and 6MWD. Based on the ERAS pathway, TPVB combined with general anesthesia in thoracoscopic surgery for lung cancer in elderly patients can effectively reduce the patients' hemodynamic fluctuations, alleviate postoperative pain, accelerate the recovery process, and reduce complications.

Ulinastatin, A Multivalent Serine Protease Inhibitor, Improves Recovery of Pancreatic Cancer Patients Undergoing Laparoscopic Surgery

We aimed to explore the effect of an intravenous infusion of lidocaine combined with ulinastatin on perioperative analgesia and recovery for pancreatic cancer patients undergoing laparoscopic surgery. Postoperative extubation time, time of stay in the recovery room after anesthesia, gastrointestinal function recovery time, and hospital stay in the observation group were all lower in the group receiving ulinastatin. Also, there was a decrease in the Visual Analogue Scale scores for pain at rest and cough in the group receiving ulinastatin. The serum levels of pro-inflammatory cytokines interleukin-6, interleukin-8, and tumor necrosis factor-α were lower in the group receiving ulinastatin. In summary, ulinastatin improves the effect of lidocaine on perioperative analgesia and postoperative recovery of pancreatic cancer without additional side effects during laparoscopic-assisted surgery.

Effects of intraoperative esketamine addition on gastrointestinal function after benign gynaecological laparoscopic surgery: a double-blind, randomized controlled study

BackgroundGastrointestinal hypokinesis can occur transiently after benign gynecologic surgery. Opioids cause the side effect of postoperative gastrointestinal hypokinesis, but an opioid-sparing anaesthetic protocol based on esketamine reduces intraoperative opioid consumption. Therefore, this study hypothesised that an opioid-sparing anaesthetic protocol based on esketamine would shorten the gastrointestinal function recovery time after benign gynaecological laparoscopic surgery.MethodsThis was a prospective randomized controlled double-blind study conducted in a single centre. All patients scheduled for elective benign laparoscopic gynaecological surgery at Xing’an Meng People’s Hospital, Inner Mongolia Autonomous Region, from November 2021 to April 2022 were consecutively enrolled and randomly divided into the opioid-sparing anaesthesia group (Group OS) and the conventional anaesthesia group (Group C). Postoperative first exhaust time, feeding time and postoperative nausea and/or vomiting (PONV) were analyzed in both groups.ResultsA total of 71 patients were enrolled in this study, including 35 in Group OS and 36 in Group C. The general condition, operative time, type of surgery, intraoperative bleeding, intraoperative fluid volume and intraoperative urine volume were not statistically different between the two groups. Compared with Group C, significantly shorter first postoperative flatus time (11 [8, 14] h vs. 14 [11, 18], p = 0.003) and anaesthesia resuscitation time (7 [6, 9] h vs. 9 [7, 11] h, p = 0.013)were observed in the OS group. The incidence of PONV in Group OS was significantly lower compared with Group C (11.4% vs. 41.7%, p = 0.007).ConclusionThe esketamine-based opioid-sparing anaesthetic protocol can shorten the postoperative first flatus time after benign laparoscopic surgery in gynaecology, and reduce the incidence of PONV. In addition, the application of esketamine may reduce the postoperative opioid dose requirement of patients.Trial registration: This study was registered with the China Clinical Trials Registry (registration number: ChiCTR2100052528, 30/10/2021).