RESUMO
Digestive tract reconstruction for gastric cancer has gone through a century and gradually formed a mature and complete system. Reasonable digestive tract reconstruction is one of the key factors in minimizing functional disorders after gastrectomy and enhancing quality of life. Therefore, this article summarizes the history and current situation of digestive tract reconstruction both domestically and internationally, including distal gastrectomy, total gastrectomy, proximal gastrectomy, and pylorus preserving gastrectomy, in order to seek the future development direction of digestive tract reconstruction and benefit gastric cancer patients.
Assuntos
Gastrectomia , Procedimentos de Cirurgia Plástica , Neoplasias Gástricas , Gastrectomia/métodos , Gastrectomia/história , Humanos , Neoplasias Gástricas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/história , Qualidade de Vida , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/história , Trato Gastrointestinal/cirurgiaRESUMO
Colorectal cancer is a common malignant tumor of the digestive tract, and surgical resection is one of its main treatment methods. The reconstruction of the digestive tract in colorectal surgery is a crucial step that directly affects the postoperative recovery and quality of life of patients. The key points of colorectal surgery reconstruction include reasonable planning of the digestive tract reconstruction path, trying to preserve the neural innervation and blood supply of the intestine as much as possible, and selecting appopriate surgical instruments and anastomotic materials. This article aims to explore in depth the quality control strategies for gastrointestinal reconstruction in colorectal surgery, including precise preoperative evaluation, optimized surgical plans, meticulous intraoperative procedures, and effective quality monitoring systems. By comprehensively analyzing and elaborating on these aspects, scientific basis and practical guidance are provided to improve the quality of digestive tract reconstruction in colorectal surgery.
Assuntos
Neoplasias Colorretais , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos de Cirurgia Plástica , Controle de Qualidade , Humanos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Colorretais/cirurgia , Anastomose Cirúrgica/métodos , Trato Gastrointestinal/cirurgia , Qualidade de Vida , Cirurgia Colorretal/métodosRESUMO
With features such as high-definition magnification of the surgical field, filtering of hand tremor, and robotic arm with multi-degree-of-freedom rotatable wrist, surgical robot has unique advantages in various aspects of digestive tract reconstruction (DTR) after robotic gastrectomy (RG). Currently, there is still controversy about the selection and standardized application of DTR after RG for gastric cancer. To standardize the selection and implementation of DTR, we describe various aspects of quality control before DTR, selection of indications, principles of DTR, and prevention and management of postoperative complications of DTR. We also comment on the operation details of robotic-assisted and total robotic DTR, including manual suture, linear anastomosis with linear stapler, and circular anastomosis with circular stapler. Meanwhile, we propose our prospects on the potential application of new technology in robotic DTR for gastric cancer.
Assuntos
Gastrectomia , Procedimentos de Cirurgia Plástica , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas , Humanos , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos de Cirurgia Plástica/métodos , Controle de Qualidade , Anastomose Cirúrgica/métodos , Complicações Pós-Operatórias/prevenção & controle , Trato Gastrointestinal/cirurgiaRESUMO
OBJECTIVES: To investigate the selection rules of acupoints for promoting gastrointestinal function recovery after colorectal cancer surgery using complex network technology. METHODS: Relevant literatures on acupuncture and moxibustion for promoting gastrointestinal function recovery after colorectal cancer surgery were searched from databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Chinese Journal Service Platform, and SinoMed from retrieved to May 9, 2023. Literatures were selected based on inclusion and exclusion criteria, and a database of acupuncture and moxibustion for promoting gastrointestinal function recovery after intestinal cancer surgery was established. Association rule analysis was performed using IBM SPSS Modeler 18.0. Clustering analysis was performed using IBM SPSS Statistics 26.0. Complex network analysis was conducted using Gephi0.9.2. RESULTS: A total of 255 articles were included, covering 113 acupoints, with a total usage frequency of 1 080 times. The top 5 frequently used acupoints were Zusanli (ST36), Shangjuxu (ST37), Tianshu (ST25), Zhongwan (CV12), and Neiguan (PC6). The meridians predominantly used were the Stomach Meridian, Conception Vessel, and Spleen Meridian. Commonly used specific acupoints included lower he-sea points, five shu acupoints, crossing points, and mu-front acupoints. Association rule analysis showed that the acupoint combination with the highest support degree was ST36-ST37 (33.82%), followed by ST36-ST25 (23.53%), ST36-CV12 (23.53%), and ST36-PC6 (22.43%). Clustering analysis identified 3 effective clusters. Complex network analysis revealed two core groups of acupointsï¼the back-lower limb prone position group and the abdomen-limb supine position group. Intervention measures primarily involved filiform needle acupuncture and electroacupuncture. Uniform reinforcing-reducing method was mostly used techniques, with strongly associated acupoints being ST37 and ST36ï¼lifting-thrusting and twisting reducing method came secondly, with strongly associated acupoints being ST25 and CV12. Overall, reducing technique was used more frequently than reinforcing technique. CONCLUSIONS: Acupuncture and moxibustion for promoting gastrointestinal function recovery after intestinal cancer surgery focuses on strengthening and harmonizing the spleen and stomach, cultivating the body's foundation, and regulating qi flow. The specific acupoints on the Stomach Meridian, Conception Vessel, and Spleen Meridian were mainly selected, and filiform needle acupuncture and uniform reinforcing-reducing technique were mainly used to realize the bidirectional regulation characteristics and advantages of acupuncture.
Assuntos
Pontos de Acupuntura , Terapia por Acupuntura , Moxibustão , Humanos , Neoplasias Intestinais/cirurgia , Neoplasias Intestinais/terapia , Recuperação de Função Fisiológica , Trato Gastrointestinal/cirurgia , Trato Gastrointestinal/fisiopatologia , MeridianosRESUMO
The healing of gastrointestinal anastomoses is a complex biological process influenced by numerous factors. Various strategies to support healing and prevent anastomotic leakage (AL) exist, encompassing preoperative, intraoperative and postoperative measures. Preoperative interventions aim to optimize the patient and the tissue environment, particularly the gut microbiome. Intraoperative measures are technical in nature and include the choice of surgical access, the anastomotic technique and anastomotic reinforcement. Various procedures of the intraoperative diagnostics enable identification of such anastomoses requiring additional protective measures. Recently, indocyanine green (ICG) fluoroscopy has become established for evaluation of tissue perfusion, while newer techniques such as spectral microscopy offer promising possibilities. Postoperative diagnostic methods aim to identify potential AL as early as possible to enable initiation of therapeutic steps even before the onset of symptoms. These procedures range from various imaging techniques to innovative bioresorbable, pH-sensitive implants for early AL detection. Due to the multifactorial genesis of AL and the diverse technical possibilities, no single method will become established for prevention of AL. Instead, a combination of measures will ultimately lead to optimal anastomotic healing. The use of artificial intelligence and analyses based on the data promises a better interpretation of the vast amount of data and therefore to be able to provide general recommendations.
Assuntos
Anastomose Cirúrgica , Fístula Anastomótica , Fístula Anastomótica/prevenção & controle , Fístula Anastomótica/diagnóstico , Humanos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Trato Gastrointestinal/cirurgia , Trato Gastrointestinal/microbiologia , Cicatrização/fisiologiaRESUMO
Purpose: Anxiety and depression can affect the physiology of the gastrointestinal tract through the brain-gut axis, causing gastrointestinal dysfunction, which is mainly manifested as indigestion, diarrhoea, constipation, or abdominal pain. Preoperative anxiety arises in children due to separation from parents, fear of unfamiliar surroundings and anaesthesia and surgical procedures.To discuss the effect of alleviating preoperative anxiety on postoperative recovery of gastrointestinal function in children with indirect inguinal hernia after laparoscopic high ligation of the hernia sac. Patients and Methods: 90 children with laparoscopic high ligation of the herniated sac in oblique inguinal hernia were randomly divided into control group (Group C) and experimental group (Group M). The Group M was given midazolam oral solution 0.5mg/kg (maximum dose 20mg), and The Group C was given 5% glucose solution with the same dose.Primary outcome was the time to first postoperative defecation and I-FEED scores.The secondary outcomes included mYPAS-SF scores; child sedation scores; child-parent separation scores; parental STAI scores;PHBQ scores;FLACC scores, operative time, and fluid input and surgeon job satisfaction. Results: Compared with Group C, there was a shorter time to first postoperative defecation (P < 0.05), and lower I-FEED scores on postoperative day 1 (P < 0.05). The mYPAS-SF scores, which were significantly different in Group M at T1, T2, and T3 (P < 0.05), parental STAI scores at S1, child sedation scores and child-parent separation scores in T1, and surgeon job satisfaction between the two groups were significantly different (P < 0.05). There were no statistically significant differences in I-FEED scores on days 2 and 3, PHBQ scores, FLACC scores, operative time, and fluid input between the two groups of children (P > 0.05). Conclusion: Preoperative application of midazolam oral solution to relieve preoperative anxiety helps to promote the recovery of postoperative gastrointestinal function in children with indirect inguinal hernia and increases the surgeon job satisfaction.
Assuntos
Ansiedade , Hérnia Inguinal , Laparoscopia , Humanos , Hérnia Inguinal/cirurgia , Masculino , Feminino , Pré-Escolar , Criança , Ligadura , Midazolam/farmacologia , Midazolam/administração & dosagem , Recuperação de Função Fisiológica , Trato Gastrointestinal/cirurgiaRESUMO
PURPOSE: Routine use of abdominal drain or prolonged antibiotic prophylaxis is no longer part of current clinical practice in colorectal surgery. Nevertheless, in patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (ICA), it may reduce perioperative abdominal contamination. Furthermore, in cancer patients, prolonged surgery with extensive dissection such as central vascular ligation and complete mesocolon excision with D3 lymphadenectomy (altogether radical right colectomy RRC) is called responsible for affecting postoperative ileus. The aim was to evaluate postoperative resumption of gastrointestinal functions in patients undergoing right hemicolectomy for cancer with ICA and standard D2 dissection or RRC, with or without abdominal drain and prolonged antibiotic prophylaxis. METHODS: Monocentric factorial parallel arm randomized pilot trial including all consecutive patients undergoing laparoscopic right hemicolectomy and ICA for cancer, in 20 months. Patients were randomized on a 1:1:1 ratio to receive abdominal drain, prolonged antibiotic prophylaxis or neither (I level), and 1:1 to receive RRC or D2 colectomy (II level). Patients were not blinded. The primary aim was the resumption of gastrointestinal functions (time to first gas and stool, time to tolerated fluids and food). Secondary aims were length of stay and complications' rate. CLINICALTRIALS: gov no. NCT04977882. RESULTS: Fifty-seven patients were screened; according to sample size, 36 were randomized, 12 for each arm for postoperative management, and 18 for each arm according to surgical techniques. A difference in time to solid diet favored the group without drain or antibiotic independently from standard or RRC. Furthermore, when patients were divided with respect to surgical technique and into matched cohorts, no differences were seen for primary and secondary outcomes. CONCLUSION: Abdominal drainage and prolonged antibiotic prophylaxis in patients undergoing right hemicolectomy for cancer with ICA seem to negatively affect the resumption of a solid diet after laparoscopic right hemicolectomy with ICA for cancer. RRC does not seem to influence gastrointestinal function recovery.
Assuntos
Anastomose Cirúrgica , Antibioticoprofilaxia , Colectomia , Drenagem , Laparoscopia , Excisão de Linfonodo , Humanos , Colectomia/efeitos adversos , Projetos Piloto , Masculino , Laparoscopia/efeitos adversos , Feminino , Excisão de Linfonodo/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Idoso , Pessoa de Meia-Idade , Trato Gastrointestinal/cirurgiaRESUMO
STUDY OBJECTIVE: This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization. DESIGN: A prospective randomized controlled trial. SETTING: Operating room and gynecological ward in Wuhan Union Hospital. PATIENTS: We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis. INTERVENTIONS: Patients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment. MEASUREMENTS: The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3-4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge. MAIN RESULTS: The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (p < 0.05), with the lower I-FEED score (PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]) and the reduced incidence of I-FEED >2 (PCL:8% vs. PCL-EOF: 2% vs. control:21%). Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 [HR:0.09, 95%CI (0.01-0.72), p = 0.023], and was beneficial in promoting the patient's postoperative first flatus [PCL-EOF: HR:3.33, 95%CI (2.14-5.19),p < 0.001], first defecation [PCL-EOF: HR:2.76, 95%CI (1.83-4.16), p < 0.001], Bristol feces grade 3-4 [PCL-EOF: HR:3.65, 95%CI (2.36-5.63), p < 0.001], first fluid diet[PCL-EOF: HR:2.76, 95%CI (1.83-4.16), p < 0.001], and first normal diet[PCL-EOF: HR:6.63, 95%CI (4.18-10.50), p < 0.001]. Also, the length of postoperative hospital stay (PCL-EOF: 5d vs. PCL: 6d and control: 6d, p < 0.001), the total cost (PCL-EOF: 25052 ± 3650y vs. PCL: 27914 ± 4684y and control: 26799 ± 4775y, p = 0.005), and postoperative VAS pain score values [POD0 (PCL-EOF: 2 vs. control: 4 vs. PCL: 4, p < 0.001), POD1 (PCL-EOF: 1 vs. control: 3 vs. PCL: 2, p < 0.001), POD2 (PCL-EOF: 1 vs. control:2 vs. PCL: 1, p < 0.001), POD3 (PCL-EOF: 0 vs. control: 1 vs. PCL: 1, p < 0.001)] were significantly reduced in PCL-EOF group. CONCLUSIONS: Our primary endpoint, I-FEED score demonstrated significant reduction with perioperative liberal drinking, serving as a protective intervention against I-FEED>2. Gastrointestinal recovery metrics, such as time to first flatus and defecation, also showed substantial improvements. Furthermore, the intervention enhanced postoperative dietary tolerance and expedited early recovery. TRIAL REGISTRATION: ChiCTR2300071047(https://www.chictr.org.cn/).
Assuntos
Procedimentos Cirúrgicos em Ginecologia , Laparoscopia , Tempo de Internação , Recuperação de Função Fisiológica , Humanos , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Adulto , Estudos Prospectivos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Assistência Perioperatória/métodos , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Náusea e Vômito Pós-Operatórios/etiologia , Ingestão de Líquidos , Trato Gastrointestinal/cirurgia , Dieta da Carga de Carboidratos/efeitos adversos , Defecação/efeitos dos fármacos , Resultado do Tratamento , Período Pós-OperatórioRESUMO
OBJECTIVE: To compare the outcome of the laparotomy-assisted endoscopic removal (LAER) of gastrointestinal foreign bodies (FBs) with traditional enterotomy, and to determine which factors affected the ability to remove FBs. STUDY DESIGN: Retrospective observational study. SAMPLE POPULATION: Dogs and cats (n = 81) with gastrointestinal FBs. METHODS: Dogs and cats were divided into Group 1 (LAER, n = 40) and Group 2 (Enterotomy, n = 41). The localization and characteristics of the FBs (sharp or blunt; discrete or linear; single or multiple) were evaluated statistically to identify the factors that affected the ability of LAER to remove, partially or completely, the FBs (χ2 test). The length of the postoperative stay, postoperative analgesia, and resumption of spontaneous feeding were compared between groups (Mann-Whitney U-test). Short-term follow up (14 days) was recorded. RESULTS: Laparotomy-assisted endoscopic removal allowed complete or partial removal of FBs in 35/40 dogs and cats, regardless of the characteristics or the localization of the FBs. The presence of intestinal wall damage (p = .043) was associated with the conversion to an enterotomy. Group 1 required a shorter postoperative hospital stay (p = .006), less need for analgesia (p < .001), and experienced a faster resumption of spontaneous feeding (p = .012), and similar complication rate to Group 2. CONCLUSION: Laparotomy-assisted endoscopic removal resulted in a faster postoperative recovery when compared with an enterotomy. The FBs' characteristics or localization did not affect the efficacy of the technique to remove FBs. CLINICAL SIGNIFICANCE: Laparotomy-assisted endoscopic removal allows the removal of a variety of FBs, avoiding intestinal incision and resulting in a fast postoperative recovery.
Assuntos
Doenças do Gato , Doenças do Cão , Corpos Estranhos , Laparotomia , Animais , Cães/cirurgia , Gatos/cirurgia , Estudos Retrospectivos , Doenças do Cão/cirurgia , Feminino , Masculino , Laparotomia/veterinária , Doenças do Gato/cirurgia , Corpos Estranhos/veterinária , Corpos Estranhos/cirurgia , Trato Gastrointestinal/cirurgia , Resultado do TratamentoRESUMO
With the increasing application of magnetic compression anastomosis (MCA) in gastrointestinal anastomosis, we identified an interesting phenomenon that an anastomosis is more prone to stenosis after endoscopic gastrointestinal MCA. We hypothesized that the increase in tissue tension during endoscopic procedures is the cause of anastomotic stenosis. In this study, we investigated the effect of tissue tension on gastroduodenal bypass MCA in Sprague-Dawley (SD) rats. Twenty SD rats were divided into the study group (high-tension group, n = 10) and control group (no tension group, n = 10), wherein the rats underwent complete gastroduodenal bypass magnetic anastomosis under high tension and no tension of the digestive tract, respectively. Anastomotic specimens were obtained 4 weeks after the operation, and anastomotic diameters of the two groups were observed and measured. The histological difference was observed by hematoxylin & eosin and Masson staining. The operation was successfully completed in all rats, and all survived until 4 weeks postoperatively. Anastomotic measurements revealed that the anastomosis diameter was significantly smaller in the study group than in the control group, and there were three cases of severe anastomotic stenosis. Histological observation showed that the amount of collagen fibers in the anastomosis was greater in the study group than in the control group. The results suggest that the high-tension state of the digestive tract is an important factor leading to anastomotic stenosis, and thus, we put forward the Yan-Zhang's Tissue Tension Theory of MCA to explain this phenomenon.
Assuntos
Anastomose Cirúrgica , Ratos Sprague-Dawley , Animais , Anastomose Cirúrgica/métodos , Ratos , Masculino , Trato Gastrointestinal/cirurgia , Constrição Patológica/cirurgia , MagnetismoRESUMO
OBJECTIVE: To retrospectively describe clinical characteristics of canine gastrointestinal foreign bodies (GIFB) that were successfully and unsuccessfully managed conservatively. ANIMALS: 68 client-owned dogs presented to the Texas A&M Small Animal Teaching Hospital between January 1, 2018, and October 1, 2023, for GIFB where medical management was attempted. CLINICAL PRESENTATION: Medical records were reviewed for signalment, history, physical examination, bloodwork, diagnostic imaging, foreign body type, location, treatments, and outcome. Success was defined as the passage of the foreign body through the colon, while failure was defined as requiring surgery, endoscopy, or euthanasia. RESULTS: Medical management was successful in 32 cases (47%; 95% CI, 0.32 to 0.66). Gastric dilation resolved in all success cases (n = 5 [100%]; 95% CI, 0.32 to 2.3) but did not resolve in any failure cases (13 [0%]). Small intestinal dilation resolved in all success cases (n = 13 [100%]; 95% CI, 0.53 to 1.7) but progressed in most failure cases (9 [75%]; 95% CI, 0.34 to 1.4). In the success group, 31 GIFB were nonlinear (96.9%; 95% CI, 0.66 to 1.4), while 1 was linear (3.1%; 95% CI, 0.001 to 0.17). In the failure group, 29 GIFB were nonlinear (80.6%; 95% CI, 0.54 to 1.16), while 7 were linear (19.4%; 95% CI, 0.08 to 0.4). Of the cases that elected surgery (n = 29 [42.7%]; 95% CI, 0.29 to 0.61), resection and anastomosis was performed in 3 cases (10.3%; 95% CI, 0.02 to 0.3). All cases that required resection and anastomosis were nonlinear GIFB. CLINICAL RELEVANCE: Conservative management of GIFB provides a feasible treatment option and may be considered based on presentation, foreign body location, hemodynamic stability of the patient, diagnostic imaging, and type of foreign body.
Assuntos
Doenças do Cão , Corpos Estranhos , Animais , Cães , Corpos Estranhos/veterinária , Corpos Estranhos/terapia , Corpos Estranhos/cirurgia , Doenças do Cão/terapia , Doenças do Cão/cirurgia , Estudos Retrospectivos , Feminino , Masculino , Resultado do Tratamento , Trato Gastrointestinal/cirurgiaAssuntos
Migração de Corpo Estranho , Humanos , Estudos Retrospectivos , Migração de Corpo Estranho/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Idoso , Colecistectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Adulto , Sistema Biliar/lesões , Trato Gastrointestinal/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Approach to enteric anastomotic technique has been a subject of debate, with no clear consensus as to whether handsewn or stapled techniques are superior in trauma settings, which are influenced by unique perturbances to important processes such as immune function, coagulation, wound healing and response to infection. This systematic review and meta-analysis compares the risk of anastomotic complications in trauma patients with gastrointestinal injury requiring restoration of continuity with handsewn versus staples approaches. METHODS: A comprehensive computer assisted search of electronic databases Medline, Embase and Cochrane Central was performed. Comparative studies evaluating stapled versus handsewn gastrointestinal anastomoses in trauma patients were included in this review. All anastomoses involving small intestine to small intestine, small to large intestine, and large intestine to large intestine were eligible. Anastomosis to the rectum was excluded. Outcomes evaluated were (1) anastomotic leak (AL) (2) a composite anastomotic complication (CAC) end point consisting of AL, enterocutaneous fistula (ECF) and deep abdominal abscess. RESULTS: Eight studies involving 931 patients were included and of these patients, data from 790 patients were available for analysis. There was no significant difference identified for anastomotic leak between the two groups (OR = 0.77; 95% CI 0.24-2.45; P = 0.66). There was no significant improvement in composite anastomotic complication; defined as a composite of anastomotic leak, deep intra-abdominal abscess and intra-abdominal fistula, in the stapled anastomosis group (OR = 1.05; 95% CI 0.53-2.09; P = 0.90). Overall, there was limited evidence to suggest superiority with handsewn or stapled anastomosis for improving AL or CAC, however this was based on studies of moderate to high risk of bias with poor control for confounders. DISCUSSION: This meta-analysis demonstrates no superiority improvement in anastomotic outcomes with handsewn or stapled repair. These findings may represent no effect in anastomotic outcome by technique for all situations. However, considering the paucity of information on potential confounders, perhaps there is a difference in outcome with overall technique or for specific subgroups that have not been described due to limited sample size and data on confounders. Currently, there is insufficient evidence to recommend an anastomotic technique in trauma.
Assuntos
Anastomose Cirúrgica , Fístula Anastomótica , Grampeamento Cirúrgico , Humanos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/efeitos adversos , Grampeamento Cirúrgico/métodos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Resultado do Tratamento , Técnicas de Sutura , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/complicações , Trato Gastrointestinal/cirurgia , Trato Gastrointestinal/lesõesRESUMO
Monitoring homeostasis is an essential aspect of obtaining pathophysiological insights for treating patients. Accurate, timely assessments of homeostatic dysregulation in deep tissues typically require expensive imaging techniques or invasive biopsies. We introduce a bioresorbable shape-adaptive materials structure that enables real-time monitoring of deep-tissue homeostasis using conventional ultrasound instruments. Collections of small bioresorbable metal disks distributed within thin, pH-responsive hydrogels, deployed by surgical implantation or syringe injection, allow ultrasound-based measurements of spatiotemporal changes in pH for early assessments of anastomotic leaks after gastrointestinal surgeries, and their bioresorption after a recovery period eliminates the need for surgical extraction. Demonstrations in small and large animal models illustrate capabilities in monitoring leakage from the small intestine, the stomach, and the pancreas.
Assuntos
Implantes Absorvíveis , Fístula Anastomótica , Trato Gastrointestinal , Ultrassom , Animais , Humanos , Homeostase , Estômago , Trato Gastrointestinal/cirurgia , Fístula Anastomótica/diagnóstico por imagem , Modelos AnimaisRESUMO
OBJECTIVE: In this study, we aimed to enhance the treatment protocols and help understand the harm caused by the accidental ingestion of magnetic beads by children. METHODS: Data were collected from 72 children with multiple gastrointestinal perforations or gastrointestinal obstructions. The 72 pediatric patients were divided into a perforation and a non-perforation group. The data collected for the analysis included the gender, age, medical history, place of residence (rural or urban), and symptoms along with the educational background of the caregiver, the location and quantity of any foreign bodies discovered during the procedure, whether perforation was confirmed during the procedure, and the number of times magnetic beads had been accidentally ingested. RESULTS: The accuracy rate of preoperative gastrointestinal perforation diagnosis via ultrasound was 71%, while that of the upright abdominal X-ray method was only 46%. In terms of symptoms, the risk of perforation was 13.844 and 12.703 times greater in pediatric patients who experienced vomiting and abdominal pain with vomiting and abdominal distension, respectively, compared to patients in an asymptomatic state. There were no statistical differences between the perforation and the non-perforation groups in terms of age, gender, medical history, and the number of magnetic beads ingested (P > 0.05); however, there were statistical differences in terms of white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033). A total of 56% of cases underwent a laparotomy along with perforation repair and 19% underwent gastroscopy along with laparotomy. All pediatric patients recovered without complications following surgery. CONCLUSION: Abdominal ultrasonography and/or upright abdominal X-ray analyses should be carried out as soon as possible in case of suspicion of accidental ingestion of magnetic beads by children. In most cases, immediate surgical intervention is required. Given the serious consequences of ingesting this type of foreign body, it is essential to inform parents and/or caregivers about the importance of preventing young children from using such products.
Assuntos
Corpos Estranhos , Trato Gastrointestinal , Humanos , Criança , Pré-Escolar , Trato Gastrointestinal/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Corpos Estranhos/complicações , Vômito/etiologia , Ingestão de Alimentos , Fenômenos MagnéticosRESUMO
DESCRIPTION: Subepithelial lesions of the gastrointestinal tract are not encountered uncommonly during routine endoscopy. There has been remarkable progress in the development of endoscopic options for the resection of subepithelial lesions, including full-thickness resection. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to describe the various techniques for endoscopic full-thickness resection and to facilitate their appropriate application in the management of subepithelial lesions. METHODS: This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology.
Assuntos
Ressecção Endoscópica de Mucosa , Gastroenterologia , Humanos , Trato Gastrointestinal/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodosRESUMO
Objective: This study aimed to investigate the efficacy of rapid recovery nursing therapy in enhancing digestive tract function recovery following intestinal surgery. Methods: This study included 100 post-intestinal surgery patients between March 2020 and March 2022. A random table method was used, and patients were assigned to either a control group receiving standard nursing care or an experimental group receiving rapid rehabilitation therapy. A thorough assessment compared different outcomes such as gastrointestinal function recovery, physical recuperation, stress levels, postoperative adverse events, nutritional status, nursing efficacy, and patient satisfaction between the two groups. Results: Compared to the control group, the experimental group exhibited significant improvements in gastrointestinal function and physiological parameters (P < .05). Additionally, the experimental group experienced fewer adverse effects, improved nursing outcomes, and higher patient satisfaction post-treatment (P < .05). Conclusions: Rapid rehabilitation nursing therapy in patients undergoing intestinal surgery substantially enhances digestive tract function and overall patient well-being. It effectively reduces the incidence of postoperative complications, accelerates the patient's recovery process, and improves their quality of life. Patient satisfaction with postoperative fast recovery care was notably high. This rehabilitation approach holds significant promise for patients undergoing intestinal surgery and merits wider adoption.