Time Of Postoperative Drainage-tube Removal Research Articles

Whole-Course Intraperitoneal Robot-Assisted Choledochal Cyst Excision with a Hidden Incision in Children Under 1 Year Old.

Background: Whole-course intraperitoneal robot-assisted choledochal cyst resection in children under 1 year of age is controversial due to its technical challenges. Current Pfannenstiel incision is widely used in adults for its cosmetic effects but is rarely used in children. Materials and Methods: We conducted a prospective, single-center study to assess the feasibility, safety, and cosmesis of whole-course intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year of age. Results: Ten patients were treated with our surgical protocol, and there was no conversion to laparotomy. The average total operation time was 223 minutes. The average duration of anesthesia was 260.2 minutes. The average docking time between the robot arm and Trocar was 17.5 minutes. The average intraoperative blood loss was 16 mL. No postoperative complications occurred in the 10 patients. The mean time to start drinking water after surgery was 2.4 days. The mean postoperative drainage tube removal time was 2.6 days. The average length of stay was 8.5 days. The scar assessment scale total scores of the 2 observers were (6.8 ± 1.23) and (7.4 ± 1.84), respectively. For every patient, there are only four abdominal surgery scars of which 75% of scars were hidden by underpants and 25% of scars were not covered. Conclusion: It is feasible and safe to perform whole-courses intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year old. It also has a hidden incision effect and is worthy of promotion.

Feasibility and safety of uniportal thoracoscopy for chronic pulmonary aspergillosis

Surgery plays a crucial role in the treatment of patients with chronic pulmonary aspergillosis (CPA). However, there is currently limited information available regarding the use of uniportal thoracoscopy (Uni-VATS) in CPA patients. To address this gap, we conducted a retrospective analysis of surgical procedures performed at a single center, aiming to demonstrate the feasibility and safety of Uni-VATS for patients with CPA. We collected basic information and surgical data from patients who underwent surgery for CPA at our hospital between January 2018 and June 2022. All patients received voriconazole antifungal medication for 3–6 months post-surgery and were monitored for a minimum of 6 months. A total of 110 patients, comprising 59 cases in the traditional open chest incision group and 51 cases in the Uni-VATS group, met the inclusion criteria. Among those who underwent surgery, 70% were male (77/110). The median age (IQR) of all enrolled patients was 55 (46–62) years. There were no statistically significant differences in general information, such as age, sex, comorbidities, BMI, FEV1, FVC, clinical symptoms, location of the disease, and duration of voriconazole antifungal medication, between the OS group and the Uni-VATS group (p > 0.05). The postoperative complication rates were 40.7% (24/59) for the traditional open chest incision group and 17.6% (9/51) for the Uni-VATS group. Through univariate analysis, we identified sex and operative approach as risk factors for postoperative complications. Multivariate logistic analysis confirmed that male and OS procedures were the independent risk factors for postoperative complications. There were statistically significant differences in operative time, intraoperative blood loss volume, postoperative drainage volume, pain scores, postoperative drainage tube removal time, postoperative hospital stay time between the OS group and the Uni-VATS group (p < 0.05). Uni-VATS is a feasible and safe surgical procedure for patients with CPA, and we recommend it as a preferred option for selected patients with CPA.

Correlation between blood glucose level and poor wound healing after posterior lumbar interbody fusion in patients with type 2 diabetes.

To investigate the correlation of blood glucose level with poor wound healing (PWH) after posterior lumbar interbody fusion (PLIF) in patients with type 2 diabetes (T2D). From January 2016 to January 2023, a case-control study was conducted to analyse the clinical data of 400 patients with T2D who were treated by PLIF and internal fixation at our hospital. The following data were recorded: gender; age; body mass index (BMI); surgical stage; average perioperative blood glucose level; perioperative blood glucose variance; perioperative blood glucose coefficient of variation; glycated haemoglobin level; preoperative levels of total protein, albumin and haemoglobin; postoperative levels of total protein, albumin and haemoglobin; surgical time; intraoperative bleeding volume; operator; postoperative drainage volume; and postoperative drainage tube removal time of each group. The indicators for monitoring blood glucose variability (GV) included the SD of blood glucose level (SDBG), coefficient of variation (CV) and maximum amplitude of variation (LAGE) before and after surgery. According to the diagnostic criteria for PWH, patients with postoperative PWH were determined and assigned to two groups: Group A (good wound healing group; n = 330 patients) and Group B (poor wound healing group; n = 70 patients). The preoperative and postoperative blood GV indicators, namely SDBG, CV and LAGE, were compared between these two groups. We also determined the relationship between perioperative blood GV parameters and PWH after PLIF surgery and its predictive value through correlation analysis and receiver-operating characteristic curve. Of the 400 enrolled patients, 70 patients had PWH. Univariate analysis revealed significant differences between the two groups in the course of diabetes, mean fasting blood glucose (MFBG), SDBG, CV, LAGE, preoperative hypoglycaemic program, surgical segment, postoperative drainage time, incision length and other factors (p < 0.05). However, no significant differences were noted in factors such as gender, age, body mass index, hypertension, coronary heart disease, admission fasting blood glucose, preoperative haemoglobin A1c, surgical time, intraoperative bleeding volume, intraoperative blood transfusion volume and postoperative drainage volume (p > 0.05). The area under the curve (AUC) values of preoperative SDBG, CV and LAGE were 0.6657, 0.6432 and 0.6584, respectively. The cut-off values were 1.13 mmol/L, 6.97% and 0.75 mmol/L, respectively. The AUC values for postoperative SDBG, CV and LAGE were 0.5885, 0.6255 and 0.6261, respectively. The cut-off values were 1.94 mmol/L, 24.32% and 2.75 mmol/L, respectively. The multivariate ridge regression analysis showed that preoperative MFBG, SDBG, CV and LAGE; postoperative SDBG, CV and LAGE; postoperative long drainage time; and multiple surgical segments were independent risk factors for T2D patients to develop surgical site infection after PLIF (p < 0.05). The perioperative blood GV in patients with T2D is closely related to the occurrence of PWH after PLIF. Reducing blood GV may help to reduce the occurrence of PWH after PLIF.

The efficacy and safety analysis of cervical and abdominal double single-port minimally invasive esophagectomy

Objective: To summarize the efficacy and safety of minimally invasive esophagectomy through cervical and abdominal double single-port. Methods: A total of 28 patients who underwent cervical and abdominal double single-port minimally invasive radical resection of esophageal cancer from January 2021 to October 2022 in the First Affiliated Hospital of Fujian Medical University were retrospectively collected, including 18 males and 10 females, aged 58-80 (72±4) years. All patients were placed in the supine position, the single port was operated through the cervical mediastinum first, then the single port was operated through the abdominal cavity, and finally the neck was anastomosed. The operative time, intraoperative blood loss, postoperative ambulation time, postoperative drainage tube removal time, postoperative complications, postoperative pathological examination results, postoperative discharge time of patients were recorded and followed. Results: In the included 28 patients, there were twenty-six patients successfully completed the cervical and abdominal double single-port minimally invasive radical resection of esophageal cancer, and two patients were transferred to the right thoracoscopic surgery due to oozing of blood and unclear visual field, without conversion to laparotomy or enlargement of the incision occurred. The operation time was 125 to 215 (152±32) minutes, including 43 to 100 (56±15) minutes in the mediastinum and 35 to 63 (40±5) minutes in the abdominal cavity. Intra-operative blood loss was 55-100 (45±20) ml. There were 8 to 14 (11±3) lymph nodes dissected in the mediastinum and 7 to 15 (9±3) lymph nodes dissected in the abdominal cavity. Twenty-eight patients were active in bed 1 to 2 days after surgery. The left cervical drainage tube was removed 2 days after surgery. There was no anastomotic fistula, anastomotic stenosis, pulmonary infection, chylothorax and stomach emptying disorder in the whole group. Pleural effusion occurred in 4 cases, all of them had pleural damage during the operation, and were cured after postoperative puncture and drainage; two cases had hoarseness and one case had cough after eating, all patients were discharged from hospital after eating liquid. Postoperative hospital median stay was [ M(Q1, Q3)] 7(6, 9) d. The postoperative pathological examination results of all patients were squamous cell carcinoma, and the postoperative pathological stage was pT1-3N0-1M0. The median postoperative follow-up was 25 (5, 35) months, and no patients had complications, recurrence, metastasis or death during the follow-up period. Conclusion: The cervical and abdominal double single-hole minimally invasive radical resection of esophageal cancer is safe and feasible, with good short-term efficacy, which provide an opportunity for radical surgery for patients with advanced age, poor cardiopulmonary function or insufficient thoracic conditions.

Is VATS suitable for lung diseases with hemoptysis? Experience from a hemoptysis treatment center in China

BackgroundSurgery is crucial in the treatment of the potentially fatal pulmonary hemoptysis condition. Currently, most patients with hemoptysis are treated by traditional open surgery (OS). To illustrate the effectiveness of video-assisted thoracic surgery (VATS) for hemoptysis, we developed a retrospective study of surgical interventions for lung disease with hemoptysis.MethodsWe collected and then analysed the data, including general information and post-operative outcomes, from 102 patients who underwent surgery for a variety of lung diseases with hemoptysis in our hospital between December 2018 and June 2022.ResultsSixty three cases underwent VATS and 39 cases underwent OS. 76.5% of patients were male (78/102). Comorbidities with diabetes and hypertension were 16.7% (17/102) and 15.7% (16/102) respectively. The diagnoses based on postoperative pathology included aspergilloma in 63 cases (61.8%), tuberculosis in 38 cases (37.4%) and bronchiectasis in 1 case (0.8%). 8 patients underwent wedge resection, 12 patients underwent segmentectomy, 73 patients underwent lobectomy and 9 patients underwent pneumonectomy. There were 23 cases of postoperative complications, of which 7 (30.4%) were in the VATS group, significantly fewer than 16 (69.6%) in the OS group (p = 0.001). The OS procedure was identified as the only independent risk factor for postoperative complications. The median (IQR) of postoperative drainage volume in the first 24 h was 400 (195–665) ml, which was 250 (130–500) ml of the VATS group, significantly less than the 550 (460–820) ml of the OS group (p < 0.05). The median (IQR) of pain scores 24 h after surgery was 5 (4–9). The median (IQR) of postoperative drainage tube removal time was 9.5 (6–17) days for all patients, and it was 7 (5–14) days for the VATS group, which was less than 15 (9–20) days for the OS group.ConclusionVATS for patients with lung disease presenting with hemoptysis is an effective and safe option that may be preferred when the hemoptysis is uncomplicated and the patient's vital signs are stable.

Application of a sectional U-shaped reinforcement combined with penetrating pancreaticojejunostomy (U-PPJ) for soft pancreas in laparoscopic pancreatic surgery.

Laparoscopic techniques have been widely used in pancreatic surgery, such as laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic central pancreatectomy (LCP). Laparoscopic pancreaticojejunostomy (LPJ) is a common procedure for LPD and LCP, and is also the most critical. The quality of LPJ is associated with the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). Although LPJ technology has been greatly improved, CR-POPF cannot be completely avoided especially to soft pancreas, which is an important reason for the high risk of laparoscopic pancreatic surgery. To date, there is a lack of standard LPJ approaches. Here, we report a U-shaped suture reinforcement for soft pancreatic section combined with penetrating pancreaticojejunostomy (PPJ) technique, called U-PPJ. Twenty-three patients with soft pancreas who underwent laparoscopic pancreatic surgery adopting U-PPJ method between 2017 and 2022 were enrolled (LPD = 19, LCP = 4). Preoperative, intraoperative and postoperative indexes were collected and analyzed. The results showed that all patients treated with U-PPJ were discharged without drainage tube or a small amount of exudate in the drainage tube does not require clinical treatment, but only needs to be removed after 2 days of observation. The average operation time was 417.35min. The intraoperative blood loss was 171.74ml. The pancreatic duct diameter was 3.41mm. The average postoperative hospitalization days were 11.83days. The average postoperative drainage tube removal time was 13.26days. The incidence of postoperative B-grade pancreatic fistula was 4.3%, and no C-grade pancreatic fistula occurred. In our experience, U-PPJ can be completed by a skilled surgeon in less than 20min. U-PPJ is safe, reliable, convenient and has a low incidence of CR-POPF in soft pancreas, which is worthy of clinical application. It also provides more options for laparoscopic pancreatic surgery. Since this is a retrospective study with a small number of cases, more prospective multicenter studies are needed to further verify its safety and efficacy.

Clinical Application of Thoracoscopic Resection of Anterior Mediastinal Tumors under the Xiphoid Process.

Objective To explore the feasibility and advantages of thoracoscopic resection of anterior mediastinal tumors through subxiphoid and lateral thoracic approaches. Method 74 patients with anterior mediastinal tumors hospitalized in our hospital from January 2019 to January 2022 were retrospectively analyzed. They were divided into the lateral chest group (31 cases) and the infraxiphoid group (43 cases) according to different operation methods. The tumor size, operation time, intraoperative bleeding, postoperative pain score, postoperative complications, postoperative drainage tube removal time, and hospital stay were compared between the two groups. Result The intraoperative bleeding and postoperative pain scores in the subxiphoid group were better than those in the lateral chest group. There was no significant difference in operation time and postoperative complications between the two groups. Conclusion Compared with the lateral thoracic approach, the thoracoscopic subxiphoid approach can be more safe and effective in resectioning anterior mediastinal tumors.

Analysis on operational safety of chronic radiation intestinal injury

Objective: To investigate the safety and efficacy of surgical treatment for chronic radiation intestinal injury. Methods: A descriptive cohort study was performed. Clinical data of 73 patients with definite radiation history and diagnosed clinically as chronic radiation intestinal injury, undergoing operation at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to February 28, 2019, were reviewed and analyzed retrospectively. Patients did not undergo operation or only received adhesiolysis were excluded. All the patients had preoperative examination and overall evaluation of the disease. According to severity of intestinal obstruction and patients' diet, corresponding nutritional support and conservative treatment were given. Surgical methods: The one-stage bowel resection and anastomosis was the first choice for surgical treatment of chronic radiation intestinal injury. Patients with poor nutritional condition were given enterostomy and postoperative enteral nutrition and second-stage stoma closure and intestinal anastomosis if nutritional condition improved. For those who were unable to perform stoma closure, a permanent stoma should be performed. Patients with severe abdominal adhesion which was difficult to separate, enterostomy or bypass surgery after adhesiolysis would be the surgical choice. For patients with tumor metastasis or recurrence, enterostomy or bypass surgery should be selected. Observation parameters: the overall and major (Clavien-Dindo grades III to V) postoperative complication within 30 days after surgery or during hospitalization; mortality within postoperative 30 days; postoperative hospital stay; time to postoperative recovery of enteral nutrition; time to removal of drainage tube. Results: Of the 73 patients who had been enrolled in this study, 10 were male and 63 were female with median age of 54 (range, 34-80) years. Preoperative evaluation showed that 61 patients had intestinal stenosis, 63 had intestinal obstruction, 11 had intestinal perforation, 20 had intestinal fistula, 3 had intestinal bleeding, and 6 had abdominal abscess, of whom 64(87.7%) patients had multiple complications. Tumor recurrence or metastasis was found in 15 patients. A total of 65(89.0%) patients received preoperative nutritional support, of whom 35 received total parenteral nutrition and 30 received partial parenteral nutrition. The median preoperative nutritional support duration was 8.5 (range, 6.0-16.2) days. The rate of one-stage intestine resection was 69.9% (51/73), and one-stage enterostomy was 23.3% (17/73). In the 51 patients undergoing bowel resection, the average length of resected bowel was (50.3±49.1) cm. Among the 45 patients with intestinal anastomosis, 4 underwent manual anastomosis and 41 underwent stapled anastomosis; 36 underwent side-to-side anastomosis, 5 underwent end-to-side anastomosis, and 4 underwent end-to-end anastomosis. Eighty postoperative complications occurred in 39 patients and the overall postoperative complication rate was 53.4% (39/73), including 39 moderate to severe complications (Clavien-Dindo grade III-V) in 20 patients (27.4%, 20/73) and postoperative anastomotic leakage in 2 patients (2.7%, 2/73). The mortality within postoperative 30 days was 2.7% (2/73); both patients died of abdominal infection, septic shock, and multiple organ failure caused by anastomotic leakage. The median postoperative hospital stay was 13 (11, 23) days, the postoperative enteral nutrition time was (7.2±6.9) days and the postoperative drainage tube removal time was (6.3±4.2) days. Conclusions: Surgical treatment, especially one-stage anastomosis, is safe and feasible for chronic radiation intestine injury. Defining the extent of bowel resection, rational selection of the anatomic position of the anastomosis and perioperative nutritional support treatment are the key to reduce postoperative complications.

Clinical efficacy of laparoscopic resection for retroperitoneal tumor via transabdominal approach

Objective To investigate the clinical efficacy of laparoscopic resection for retroperitoneal tumor via transabdominal approach. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 37 patients with retroperitoneal tumor who underwent laparoscopic resection via transabdominal approach at Fujian Medical University Union Hospital between January 2011 and August 2017 were collected. The surgical approach of resection for retroperitoneal tumor at the left hypochondriac region, left iliac region, right hypochondriac region and right iliac region referred to laparoscopic distal pancreatectomy, laparoscopic left hemicolectomy, laparoscopic pancreatoduodenectomy and laparoscopic right hemicolectomy respectively. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor recurrence, metastasis and survival of patients up to November 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results (1) Intra- and post-operative recovery situations: 37 patients underwent successfully laparoscopic resection for retroperitoneal tumor via transabdominal approach. Among 37 patients, 4 were converted to open surgery, 4 were completed surgery with assisted small incision, 4 were combined with adjacent organ resection and other 25 underwent totally laparoscopic resection for retroperitoneal tumor. The operation time, volume of intraoperative blood loss, postoperative gastrointestinal recovery time, postoperative drainage-tube removal time and duration of postoperative hospital stay were respectively (181±73)minutes, (160±87)mL, (3.0±1.0)days, (3.0±2.0)days and (7±4)days. Of 37 patients, 3 with postoperative complications including 2 of chylous fistula and 1 of delayed gastric emptying were improved by symptomatic treatment. There was no perioperative death. (2) Follow-up and survival situations: 37 patients were followed up for 3-82 months, with a median time of 30 months. During the follow-up, 1 patient with inflammatory myofibroblastic tumor had recurrence at 15 months postoperatively and underwent surgical resection, however, the patient had liver metastasis at 9 months after the second operation and underwent interventional therapy repeatly. One patient with Castleman and 5 with lymphoma underwent regular chemotherapy and achieved disease-free survival. The other patients had disease-free survival. Conclusion Laparoscopic resection for retroperitoneal tumor via transabdominal approach is safe and feasible. Key words: Retroperitoneal neoplasms; Surgical procedures, operative; Laparoscopy; Approach

Thoracoscopic and laparoscopic radical resection for adenocarcinoma of the esophagogastric junction with side-to-side tubular gastroesophagostomy

Objective To investigate the clinical efficacy of thoracoscopic and laparoscopic radical resection for adenocarcinoma of the esophagogastric junction (AEG)with side-to-side tubular gastroesophagostomy. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 4 patients with AEG who were admitted to the First Affiliated Hospital of Xiamen University between November 2017 and June 2018 were collected. All the patients underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy and received 6 cycles of postoperative adjuvant chemotherapy with SOX regimen. Observation indicators: (1) surgical and postoperative recovery situations; (2) postoperative pathological examination; (3) follow-up and survival situations. The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy situations and survival of patients up to Semptember 2018. Results (1)Surgical and postoperative recovery situations: 4 patients successfully underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy, without conversion to thoracotomy, open surgery or perioperative death. Operation time, volume of intraoperative blood loss, time for postoperative fluid diet intake and postoperative drainage-tube removal time of case 1, 2, 3, 4 were respectively 420 minutes, 400 minutes, 320 minutes, 300 minutes and 100 mL, 100 mL, 150 mL, 100 mL and 9 days, 8 days, 8 days, 8 days and 11 days, 10 days, 10 days, 10 days. Case 1 with mild pneumonia and hiccup and case 2 with mild pneumonia were improved by symptomatic treatment, case 3 and 4 didn′t have complication. All the patients had postoperative patent anastomosis. Duration of postoperative hospital stay of case 1, 2, 3, 4 were respectively 12 days, 11 days, 11 days, 11 days. (2) Postoperative pathological examination: all the 4 patients had negative surgical margin. Number of lymph node dissected, number of positive lymph node, tumor diameter, Siewert type, depth of tumor infiltration, tumor histopathologic stage of case 1, 2, 3, 4 were respectively 32, 31, 17, 23 and 0, 4, 2, 6 and 3.5 cm, 5.0 cm, 5.0 cm, 4.0 cm and typeⅡ, Ⅰ, Ⅱ, Ⅰand subserosa, entire wall of the esophagogastric junction, subserosa, entire wall of the esophagogastric junction and ⅡA staging, ⅢB staging, ⅡB staging, ⅢA staging. Degree of tumor differentiation and pathological type were moderately differentiated adenocarcinoma in the 4 patients. (3) Follow-up and survival situations: 4 patients were followed up for 3-10 months, with a median time of 5 months. During the follow-up, 4 patients underwent chemotherapy and achieved disease-free survival. Conclusion Thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy is safe and feasible. Key words: Adenocarcinoma of the esophagogastric junction; Radical resection; Side-to-side tubular gastroesophagostomy; Laparoscopy; Thoracoscopy

Application value of π-shaped Roux-en-Y esophagojejunostomy in totally laparoscopic total gastrectomy

Objective To investigate the application value of π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 3 patients who underwent totally laparoscopic total gastrectomy in the Beijing Friendship Hospital of Capital Medical University between October 2016 and March 2017 were collected. Patients received π-shaped Roux-en-Y esophagojejunostomy. Patients who were diagnosed with Ⅱ and above stages by pathological examination underwent postoperative adjuvant chemotherapy with oxaliplatin + tegafur gimeracil oteracil. Observation indicators: (1) surgical and postoperative recovery situations; (2) follow-up and survival situations. The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to March 2018. Results (1) Surgical and postoperative recovery situations: 3 patients underwent successfully totally laparoscopic total gastrectomy, and π-shaped Roux-en-Y esophagojejunostomy was also performed. Case 1 had injury of spleen vessel when No 11p lymph nodes were dissected and then received successful hemostasis, and case 2 and 3 didn′t have complication. Operation time, digestive tract reconstruction time, volume of intraoperative blood loss, time to anal exsufflation and postoperative drainage-tube removal time of case 1, 2 and 3 were respectively 376 minutes, 290 minutes, 284 minutes and 26 minutes, 30 minutes, 24 minutes and 500 mL, 100 mL, 200 mL and 2 days, 3 days, 3 days and 4 days, 4 days, 5 days. Case 3 with left pleural effusion was cured by puncture and drainage treating, and case 1 and 2 didn′t have complication. Three patients were not complicated with anastomotic stoma-related complicaions. Results of postoperative pathological examination: number of lymph node dissected and TNM staging of case 1, 2 and 3 were respectively 20, 17, 20 and T1aN0M0 staging, T3N3M0 staging, T1bN0M0 staging. Duration of hospital stay in case 1, 2 and 3 was respectively 7 days, 8 days and 11 days. (2) Follow-up and survival situations: 3 patients were followed up, and follow-up time of case 1, 2 and 3 was respectively 18 months, 16 months, 12 months. During the follow-up, case 2 received postoperative adjuvant therapy, and then underwent palliative treatment of Paclitaxel and Xeloda after the case was rechecked out multiple liver metastases at postoperative month 12. Case 1 and 3 had disease-free survival. Conclusion The π-Shaped esophagojejunostomy is safe and feasible for totally laparoscopic total gastrectomy, and it can be used as an alternative to digestive tract reconstruction. Key words: Gastric neoplasms; Total gastrectomy; Digestive tract reconstruction; Esophagojejunostomy; Laparoscopy

Application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy

Objective To investigate the application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 13 patients who underwent laparoscopic partial splenectomy in the Ningbo First Hospital from March 2016 to October 2017 were collected. After preoperative assessment using computed tomography(CT) angiography, 13 patients underwent laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up situations. Follow-up using outpatient examination was performed to detect postoperative changes of peripheral blood platelet (PLT), thrombosis of splenic vein, lesions residual or recurrence up to November 2017. Measurement data were represented as average (range). Results (1) Intra- and post-operative recovery situations: 13 patients underwent successful laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail, without conversion to open surgery, including 6 with laparoscopic partial splenectomy of inferior pole of the spleen and 7 with laparoscopic partial splenectomy of upper pole of the spleen. Operation time was 42-93 minutes, with an average of 61 minutes; volume of intraoperative blood loss was 30-260 mL, with an average of 92 mL; postoperative gastrointestinal function recovery time was 22-47 hours, with an average of 34 hours; postoperative drainage tube removal time was 3.0-6.0 days, with an average of 4.2 days. The postoperative pathological examination of 13 patients: 7, 2, 2, 1 and 1 patients were respectively confirmed with splenic cysts, splenic hemangiomas, vascular hemangiomas, splenic hamartoma and splenic lymphangioma. Of 13 patients, 1 was complicated with splenic recess effusion and fever, and was improved with B ultrasound-guided percutaneous catheter drainage. Duration of hospital stay of 13 patients was 7.0-16.0 days, with an average of 9.6 days. (2) Follow-up situations: 13 patients were followed up for 1.0-19.5 months, with a median time of 8.5 months. During the follow-up, PLT level of 13 patients was normal. Color Doppler ultrasound examination showed no venous embolism, and CT angiography showed good vascular perfusion. There was no recurrence of splenic cysts in 7 patients and no tumor residual or recurrence in 6 patients. Conclusion Laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail is safe and effective, and it can precisely dissect splenic hilum, preserve blood supply and function of the remnant spleen, and reduce surgical injury. Key words: Splenic neoplasms, benign; Partial splenectomy; Secondary splenic pedicle separation; Superior posterior approach of the pancreatic tail; Laparoscopy

A clinical study of efficacy of polyglycolic acid sleeve after video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) is a common disease in thoracic surgery, and a prolonged postoperative air leakage is the most frequent and troublesome early complication after video-assisted thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage after a VATS bullectomy for PSP. This study was a prospectively randomised clinical study. The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in the Beijing Chaoyang Hospital and were randomly assigned to the experimental and control groups. The experimental group applied a PGA sleeve combined with an automatic stapler in the bullectomy, while in the control group, the bullae were resected using an automatic stapler alone during the operation. In addition, the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection. Useful clinical data were recorded, including the number of cases there was no air leakage immediately after the operation and air leakage lasted more than 3 days, the average postoperative air leakage, the drainage tube removal time, the postoperative hospital stay, the postoperative complications, and the postoperative recurrence. A total of 134 patients were enrolled in this study. The experimental group consisted of 60 subjects, and there were 74 in the control group. No operative related mortality was observed in either group. In the experimental group, 44 of the 60 patients did not have an air leakage immediately after the operation, which was significantly higher than the control group (73.33% vs. 54.05%, P=0.031). Compared with the control group, the average postoperative air leakage (0.57±1.11 days), the chest tube removal time (3.03±0.92 days), and the postoperative hospital stay (3.98±0.92 days) were all significantly shorter in the experimental group (P=0.048, P=0.012, and P=0.010, respectively). Moreover, the rate of postoperative complications in the experimental group was lower than the control group (3.33% vs. 16.22%, P=0.021). No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months. The use of PGA sleeve during surgery for PSP might effectively prevent early postoperative air leakage, as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.

Application value of ileal D-pouch in the total proctocolectomy with ileal pouch-anal anastomosis

Objective To explore the clinical value of ileal D-pouch in the total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA). Methods The retrospective cross-sectional study was conducted. The clinical data of 9 patients with ulcerative colitis and 8 patients with familial polyposis who underwent TPC-IPAA at the Zhongnan Hospital of Wuhan University between October 2014 and June 2015 were collected. The ileal D-pouch was built during the operation. Observation indicators: (1) intra- and post-operative situations: surgical situation, intraoperative complications, interval time between TPC-IPAA and ileostomy, total operation time, build time and volume of ileal D-pouch, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function, time of postoperative drainage-tube removal, postoperative complications and duration of hospital stay, (2) follow-up situation. Follow-up was performed by outpatient examination and telephone interview up to July 2016. Follow-up included detecting the patients′ recovery and evaluating gastrointestinal quality of life index (GIQLI), postoperative Wexner incontinence score, frequency of defecation at 24 hours and at the night and patients′ satisfaction. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were represented as the M (range). Results (1) Intra- and post-operative situations: 17 patients underwent TPC-IPAA, and no patient died during the perioperative period. One patient with familial polyposis had intraoperative intestinal perforation, and handsewn TPC-IPAA was conducted after building ileal D-pouch. And other patients didn′t have postoperative complications. Of 9 patients with ulcerative colitis, 1 underwent three-stage operation and other 8 underwent two-stage operations. Nine patients underwent ileostomy at (177±38)days after TPC-IPAA. Of 8 patients with familial polyposis, 1 underwent one-stage operation and other 7 underwent two-stage operations. Seven patients underwent ileostomy at (158±45)days after TPC-IPAA. Total operation time, build time of ileal D-pouch, volume of ileal D-pouch, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function and time of postoperative drainage-tube removal in the 17 patients were (216±25)minutes, (18±4)minutes, (172±18)mL, (107±31)mL, (43±10)hours and (7.9±2.1)days, respectively. Three patients complicated with wound infection or fat liquefaction were improved by symptomatic treatment. One patient with ulcerative colitis was complicated with incomplete intestinal obstruction at 5 days postoperatively and then improved by symptomatic treatment. Other patients didn′t have postoperative complications. A median duration of postoperative hospital stay in the 17 patients was 9 days (range, 7-17 days). (2) Follow-up situation. All the 17 patients were followed up for 12-21 months with a median time of 16 months. During the follow-up, 1 patient was complicated with vaginal fistula at 21 days postoperatively and then was cured at 26 days after conservative treatment. All the 17 patients didn′t have fecal incontinence at night. One patient continued to take oral antidiarrheal-drugs for 7 months, and dietary restrictions of 2 patients were respectively relieved at 2 months and 8 months postoperatively. GIQLI, postoperative Wexner incontinence score, frequency of defecation at 24 hours and at the night were 113±12, 3.3±0.8, 5.5±1.2, 2.0±0.6 at 1 month postoperatively and 120±9, 2.8±0.8, 5.0±1.0, 1.5±0.5 at 3 months postoperatively and 122±7, 2.7±0.6, 4.6±0.8, 1.0±0.6 at 6 months postoperatively and 122±7, 2.5±0.6, 4.3±1.0, 0.8±0.6 at 12 months postoperatively, respectively. Sixteen patients were very satisfied with surgical outcomes and 1 was partially satisfied with surgical outcomes. Conclusion Ileal D-pouch is safe and feasible in the TPC-IPAA of patients with ulcerative colitis and familial polyposis, with the advantages of postoperative good anus functions and high quality of life. Key words: Ulcerative colitis; Familial polyposis; Total proctocolectomy with ileal pouch-anal anastomosis; Ileal D-pouch

Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with portal vein resection and artificial vascular graft and reconstruction

Objective To explore the application value of Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with portal vein (PV) resection and artificial vascular graft and reconstruction. Methods The retrospective descriptive study was adopted. The clinical data of 1 patient with cancer of pancreatic head combined with biliary and duodenal obstructions who was admitted to the Southwest Hospital of the Third Military Medical University in November 2015 were collected. Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction were applied to the patient due to intra-operative tumor extensive invasion to the PV and angiogenesis around the tumor. The operation time, volume of intraoperative blood loss and transfusion, time of postoperative drainage-tube removal, postoperative complications, result of postoperative pathological examination, duration of postoperative hospital stay and results of follow-up were observed. The follow-up of outpatient examination and telephone interview was performed to detect the survival of the patient up to February 2016. Results The patient underwent successful Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction. The length of intraoperative excisional PV, operation time, volume of intraoperative blood loss, volume of red blood cell suspension and blood plasma infusions were 3 cm, 670 minutes, 600 mL, 400 mL and 200 mL, respectively. The patient got out-off-bed activity at postoperative day 1 and fluid diet intake after gastric-tube removal at postoperative day 3, and drainage-tube was removed at postoperative day 8. No postoperative complication was detected. The patient had unblocked main PV without obvious stenosis and filling defect by computer tomography rescanning. Adenosquamous carcinoma of the pancreatic head was confirmed by postoperative pathological examination. There were negative resection margins from the proximal and distal duodenum to the pancreas. The patient was discharged from hospital at postoperative day 12 and followed up for 3 months, with a good survival. Conclusions Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction are safe and feasible in the treatment of the cancer of pancreatic head combined with biliary and duodenal obstructions, with a good short-term outcome. Key words: Pancreatic head neoplasms; Pancreaticoduodenectomy; Portal vein resection, reconstruction; Da Vinci robotic surgical system; Laparoscopy

Clinical effect of fissure for ligamentum teres hepatic approach in hepatectomy

Objective To investigate the clinical effect of fissure for ligamentum teres hepatic (LTH) approach in hepatectomy. Methods The method of cross-sectional study was adopted.The clinical data of the 85 patients undergoing hepatectomy through fissure for LTH approach who were admitted to the West China Hospital of Sichuan University from February 2009 to December 2013 were collected.Among all the 85 cases, there were 61 of hepatocellular carcinoma, 12 of intrahepatic bile duct stones, 6 of bile duct cellular carcinoma and 6 of metastatic hepatic carcinoma.The operations involved dissecting fissure for LTH, dealing with portal vein, hepatic artery and bile duct inside the fissure, lowering the hepatic portal, mutilating hepatic parenchyma, and undergoing the hepatic left lateral lobectomy, left hemihepatectomy, mesohepatectomy, hepatic left and /or right trisegmentectomy.Operation method, operation time, volume of intraoperative blood loss, intraoperative blood transfusion, postoperative drainage-tube removal time and complications were recorded.The follow-up including recurrence and metastasis of tumor and survival of patients was conducted by outpatient examination and telephone interview up to August 2015.Measurement data with normal distribution were presented as ±s. Measurement data with skewed distribution were presented as M (range).The survival rate was caculated by Kaplan-Meier method. Results The 85 cases of hepatectomy were successfully completed through fissure for LTH approach, including 19 cases of hepatic left lateral lobectomy (9 with hepatocellular carcinoma, 6 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 20 cases of left hemihepatectomy (8 with hepatocellular carcinoma, 5 with intrahepatic bile duct stones, 4 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 5 cases of left hemihepatectomy + caudate lobectomy (3 with hepatocellular carcinoma, 1 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma), 14 cases of meso-hepatectomy (14 with hepatocellular carcinoma)and 27 cases of hepatic left and /or right trisegmentectomy due to hepatocellular carcinoma (15 of hepatic left trisegmentectomy and 12 of hepatic right trisegmentectomy).No perioperative death occurred.The median operation time was 280 minutes (range, 95- 430 minutes).The median volume of intraoperative blood loss was 450 mL (range, 200-3 200 mL).There were 18 cases of intraoperative blood infusion.The postoperative peritoneal drainage-tube removal time was 3 days (range, 2-5 days).Eleven patients with postoperative complications recovered after symptomatic conservative treatment, including 6 with lung infection, 4 with peritoneal effusion and 1 with abdominal infection.There was no case of intra-abdominal bleeding, bile leakage or hepatic failure.No patient died within 1 month after operation. Seventy-nine patients were followed up for a median time of 38 months (range, 18-53 months)with a follow-up rate of 92. 9% (79/ 85).The 1-year overall survival rate and 1-year disease-free survival rate were 79. 0% and 65. 0% , and the 3-year overall survival rate and 3-year disease-free survival rate were 56.0% and 34.0%, respectively. Conclusion Hepatectomy through fissure for LTH approach is safe, effective and easily operable, with a good short-term outcome. Key words: Liver neoplasms; Anatomical hepatectomy; Ligamentum teres hepatic

Synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma associated with cirrhotic portal hypertensive hypersplenism

Objective To investigate the safety and clinical efficacies of synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma (HCC) associated with cirrhotic portal hypertensive hypersplenism. Methods The clinical data of 5 patients with HCC associated with cirrhotic portal hypertensive hypersplenism who were admitted to the Clinical Medical College of Yangzhou University between January 2015 and April 2015 were retrospectively analyzed. Five patients underwent synchronous laparoscopic hepatectomy combined with splenectomy and intraoperative autologous blood transfusion. The operation time, volume of intraoperative blood loss, time for diet intake, postoperative drainage tube removal time, duration of hospital stay and occurrence of complications were observed. Patients were followed up by outpatient examination and telephone interview till June 2015. Measurement data with normal distribution were presented as ±s. Results Of the 5 patients without conversion to open surgery, 3 patients underwent synchronous laparoscopic hepatectomy combined with splenectomy, 1 patient underwent laparoscopic hepatectomy+ splenectomy+ cholecystectomy and 1 patient underwent laparoscopic hepatectomy+ splenectomy+ devascularization. The operation time and volume of blood loss were (225±41)minutes and (221±81)mL. All the patients received intraoperative autologous blood transfusion without homologous blood transfusion. Two patients were complicated with abdominal effusion including 1 patient associated with pleural effusion, and symptoms of 2 patients disappeared after conservative treatment. All the patients took fluid diet at postoperative day 1 and out-of-bed activity at postoperative day 2, and drainage tubes were removed at postoperative day 3, with good recovery and without perioperative death. The duration of postoperative hospital stay was (7.8±0.8)days. All the 5 patients were followed up and survived well up to the end of follow-up. Conclusion Synchronous laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of HCC associated with cirrhotic portal hypertensive hypersplenism with an exact curative effect. Key words: Liver neoplasms; Hypersplenism; Splenectomy; Hepatectomy; Laparoscopy