Application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy / 中华消化外科杂志

Objective@#To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.@*Methods@#The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators: (1) surgical situations; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test.@*Results@#(1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death. (2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232, -0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P<0.05). (3) Postoperative situations: in the concealed incision group, 56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance. In the traditional incision group, 42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance. There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z=-4.012, P<0.05). Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9)days and (64 408±5 123)yuan, versus (5.2±1.5)days and (64 953±3 477)yuan of the traditional incision group (t=-1.788, -0.804, P>0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group. (4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group; other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment. Other patients had no readmission due to postoperative complications.@*Conclusion@#Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible, with good cosmetic effects.

Application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy / 中华消化外科杂志

Objective To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.Methods The retrospective cohort study was conducted.The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected.There were 51 males and 111 females,aged (35± 8)years,with a range from 12 to 47 years.Of 162 patients,72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group.Observation indicators:(1) surgical situations;(2) intraoperative situations;(3) postoperative situations;(4) follow-up.Follow-up using outpatient examination,telephone interview,and WeChat was performed to detect the postoperative complications at 1,3,6 months and 1,2,5 years postoperatively up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and the t test was used for comparison between groups.Count data were represented as absolute numbers,and were analyzed by the chisquare test or fisher exact probability.Ordinal data were analyzed by the Wilcoxon rank sum test.Results (1) Surgical situations:patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy,without conversion to open surgery,reoperation,or perioperative death.(2) Intmoperative situations:the operation time and volume of intraoperative blood loss of the concealed incision group were (102± 17) minutes and (11±4) mL,respectively,versus (105± 19) minutes and (11 ±.4) mL of the traditional incision group (t=-1.232,-0.676,P＞0.05).There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group,respectively,with a significant difference between the two groups (x2=6.280,P＜0.05).(3) Postoperative situations:in the concealed incision group,56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance.In the traditional incision group,42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance.There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z =-4.012,P＜0.05).Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9) days and (64 408±5 123) yuan,versus (5.2± 1.5) days and (64 953± 3 477)yuan of the traditional incision group (t =-1.788,-0.804,P＞0.05).There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group,respectively,with no significant difference between the two groups (x2=2.894,P＞0.05).There was no postoperative complication such as infection,hemorrhage or anastomotic leakage in either group.(4) Follow-up:32 of 162 patients were lost to follow-up,including 10 in the concealed incision group and 22 in the traditional incision group;other 130 patients were followed up for 1-14 months,with a median follow-up time of 7 months.During the follow-up,1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding,and was cured after symptomatic supportive treatment.One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment.Other patients had no readmission due to postoperative complications.Conclusion Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible,with good cosmetic effects.

Insights into the Therapeutic Potential of Heparinized Collagen Scaffolds Loading Human Umbilical Cord Mesenchymal Stem Cells and Nerve Growth Factor for the Repair of Recurrent Laryngeal Nerve Injury

Recurrent laryngeal nerve (RLN) injury can result in unilateral or bilateral vocal cords paralysis, thereby causing a series of complications, such as hoarseness and dyspnea. However, the repair of RLN remains a great challenge in current medicine. This study aimed to develop human umbilical mesenchymal stem cells (HuMSCs) and nerve growth factor (NGF)-loaded heparinized collagen scaffolds (HuMSCs/NGF HC-scaffolds) and evaluate their potential in the repair of RLN injury. HuMSCs/NGF HC-scaffolds were prepared through incorporating HuMSCs and NGF into heparinized collagen scaffolds that were prefabricated by freeze-drying in a template. The resulting scaffolds were characterized by FTIR, SEM, porosity, degradation in vitro, NGF release in vitro and bioactivity. A rabbit RLN injury model was constructed to appraise the performance of HuMSCs/NGF HC-scaffolds for nerve injury repair. Electrophysiology, histomorphology and diagnostic proteins expression for treated nerves were checked after application of various scaffolds. The results showed that the composite scaffolds with HuMSCs and NGF were rather helpful for the repair of broken RLN. The RLN treated with HuMSCs/NGF HC-scaffolds for 8 weeks produced a relatively normal electromyogram, and the levels of calcium-binding protein S100, neurofilament and AchE pertinent to nerve were found to be close to the normal ones but higher than those resulted from other scaffolds. Taken together, HuMSCs/NGF HC-scaffolds exhibited a high score on the nerve injury repair and may be valuable for the remedy of RLN injury.

Effects of gastric bypass surgery on serum total bile acid in obese diabetic patients and rats / 中国病理生理杂志

AIM:To observe the effects of gastric bypass surgery on the levels of serum total bile acid in the obese diabetic patients and rats .METHODS: Anthropometric data of obese diabetic patients with gastric bypass surgery from June 2011 to June 2016 were collected in the First Affiliated Hospital of Jinan University .Obese diabetic animal mo-del was established in SD rats by high-fat diet feeding combined with intraperitoneal injection of low-dose streptozocin .Gas-tric bypass surgery or sham operation was performed on the rats with successful modeling .The levels of serum total bile acid were measured by a Hitachi automatic biochemistry analyzer , and the content of hepatic cholesterol 7α-hydroxylase (CYP7A1) was detected by ELISA.The expression of hepatic CYP7A1 and small heterodimer partner (SHP) at mRNA and protein levels was determined by real-time PCR and Western blot, respectively.RESULTS:The serum levels of total bile acid were significantly increased in postoperative obese diabetic patients and rats as compared with control groups .Gas-tric bypass surgery inhibited rat hepatic CYP 7A1 content, mRNA level and protein level , but stimulated hepatic SHP ex-pression.CONCLUSION:Total serum bile acid increases in both patients and rats after gastric bypass surgery by non -typical bile acid synthesis pathway .

Causes analysis and management of postoperative complications after laparoscopic Roux-en-Y gastric bypass of 450 patients / 中华消化外科杂志

Objective To explore the causes and management of postoperative complications of laparoscopic Roux-en-Y gastric bypass (LRYGB).Methods The retrospective cross-sectional study was conducted.The clinical data of 450 patients with metabolic diseases who underwent LRYGB between June 2004 and November 2016 were collected,including 283 (58 in hospital consultation) in the First Affiliated Hospital of Jinan University,140 in the Jihua Hospital Affiliated to Jinan University and 27 in the Zhengzhou Hospital of Jinan University.Observation indicators:situations of surgical completion,follow-up situations,occurrence,treatment and prognosis of complications.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications once at month 1,3,6 and 12 within 1 year postoperatively and once every year after 1 year postoperatively up to March 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio,and comparison between groups was analyzed using the chi-square test.Results All the 450 patients with metabolic diseases underwent successful LRYGB,including 50 receiving LRYGB during surgical internship period and 400 receiving LRYGB after surgical internship period,without conversion to open surgery.All the 450 patients were followed up for 70 months (range,1-153 months).Twenty-seven patients had postoperative complications,with an incidence of 6.00％ (27/450).The incidence of postoperative complications was 20.00％(10/50) in 50 patients receiving LRYGB during surgical internship period and 4.25％ (17/400) in 400 patients receiving LRYGB after surgical internship period,with a statistically significant difference (x2 =16.86,P＜ 0.05).Of 27 patients with postoperative complications,1 was complicated with fulminant acute pancreatitis and died from multiple organ failure at day 15 postoperatively,5 with intra-abdominal bleeding,2 with anastomotic leakage,3 with gastrojejunal anastomosis stenosis,2 with gastrojejunal anastomosis ulcer,1 with improper anastomosis,1 with respiratory failure,1 with umbilicus infection,3 with internal hernia,2 with dumping syndrome,6 with weight-loss failure (1 refused to undergo revision surgery),and patients with postoperative complications were improved or cured by surgery or conservative treatment except one death.Conclusions The incidence of complications in patients receiving LRYGB after surgical internship period is significantly reduced,and complications needs to make the individualized treatment plan.

Precise laparoscopic Roux-en-Y gastric bypass in the treatment of 140 patients with obesity and metabolic diseases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of precise laparoscopic Roux-en-Y gastric bypass(LRYGB) in the treatment of obesity and metabolic diseases.</p><p><b>METHODS</b>Clinical and follow-up data of obese patients underwent precise LRYGB in our department between June 2011 and April 2013 were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 140 obese patients were included in this study. All the precise LRYGB procedures were successfully performed with no conversion to open surgery or perioperative death. Average operation time was (138.0±21.3) min, postoperative hospital stay was (5.2±1.2) d. No severe complications was observed. The percentages of excess weight loss in 1, 3, 6, and 12 month after operation were (26.4±8.6)%, (53.3±6.7)%, (75.3±7.9)%, (78.5±8.5)%, respectively. The improvement rates of fatty liver, hyperlipidemia, hypertension and type 2 diabetes mellitus were 84.6%(33/39), 92.3%(12/13), 77.3%(17/22) and 82.4%(14/17).</p><p><b>CONCLUSIONS</b>Precise LRYGB is a modified and optimized traditional surgical technique which does not significantly increase the operative time. It is safe and feasible. The postoperative weight loss effect is significant and it can effectively improve the related co-morbidities.</p>

Three-port transumbilical endoscopic cholecystectomy performed using conventional laparoscopic instruments / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy and safety of three-port transumbilical endoscopic cholecystectomy performed using conventional laparoscopic instruments.</p><p><b>METHODS</b>Thirty-two patients undergoing three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments (group A) with 3 ports around the umbilicus were compared with 96 patients (group B) receiving the conventional 4-port routine endoscopic cholecystectomy.</p><p><b>RESULTS</b>All the procedures were successfully completed without conversion to open laparotomy. In group A, the procedures were completed smoothly in 30 cases while 2 cases required another port (5 mm) punctured below the xyphoid due to severe adhesion around the cyst. The median operating time was 39.7∓5.2 min in group A, significantly longer than that in group B (25.3∓3.3 min, P<0.001), but the patients in group A obtained better cosmetic results (P<0.001); the median blood loss, recovery time of postoperative intestine function, length of postoperative hospital stay, and the rate of use of postoperative painkillers were comparable between the two groups. Bile leakage or other postoperative complications occurred in none of cases in the two groups.</p><p><b>CONCLUSION</b>In cases without severe adhesion around the cyst, three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments is a safe and feasible alternative to routine endoscopic cholecystectomy with better cosmetic results.</p>

Endoscopic Thyroidectomy via Breast Approach Using Gasless Anterior Neck Skin Lifting Method / 中国微创外科杂志

Objective To study the benefits and drawbacks of endoscopic thyroidectomy via breast approach by using gasless anterior neck skin lifting method.Methods A total of 21 patients with thyroid diseases were enrolled in this study,including 16 cases of nodular goiter and 5 cases of primary hyperthyroidism.All the cases underwent endoscopic subtotal thyroidectomy through breast approach while the operational space was established by using an abdomen suspending device and 2 Kirschner pins to mechanically suspend and retract the anterior neck skin.Results The endoscopic subtotal thyroidectomy was completed successfully in all of the cases without conversion to open surgery.The mean operation time was 82.5 minutes(ranging from 57 to 125 minutes).Intraoperative blood loss was less than 20 ml.Post-operational recovery was satisfying in all the patients.Drainage volume averaged 80.6 ml(50 to 150 ml).The patients were followed up for 1 to 12 months after the operation,during which no complications occurred.Conclusions Endoscopic thyroidectomy via breast approach using gasless anterior neck skin lifting method is a safe and low-cost procedure.By using the method,CO2 insufflation-related complications can be avoided.Although the operational space established by this method is relatively small,the operation can be completed without much difficulies.