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"Five steps four quadrants" modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in laparoscopic pancreaticoduodenectomy

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World Journal of Gastrointestinal surgery 2024年第2期16卷 503-510页

作者： Xiao-Si Hu Yong Wang Hong-Tao Pan Chao Zhu Shi-Lei Chen Hui-Chun Liu Qing Pang Hao Jin department of Hepatopancreatobiliary surgery Anhui No.2 Provincial People’s HospitalHefei 230041Anhui ProvinceChina

BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and *** To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD *** A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed *** patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were *** relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also *** Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 *** were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct *** BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/*** patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic *** analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection ***,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants

关键词： Five steps four quadrants Hepatic hilum lymph node Modularized en bloc clearance Laparoscopic pancreaticoduodenectomy

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“Hepatic hilum area priority,liver posterior first”:An optimized strategy in laparoscopic resection for type Ⅲ-Ⅳ hilar cholangiocarcinoma

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World Journal of Gastrointestinal surgery 2024年第7期16卷 2167-2174页

作者： Xiao-Si Hu Yong Wang Hong-Tao Pan Chao Zhu Shi-Lei Chen Shuai Zhou Hui-Chun Liu Qing Pang Hao Jin department of Hepatopancreatobiliary surgery Anhui No.2 Provincial People's HospitalHefei 230041Anhui ProvinceChina

BACKGROUND In recent years,pure laparoscopic radical surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma(HCCA)has been preliminarily explored and applied,but the surgical strategy and safety are still worthy of further improvement and *** To summarize and share the application experience of the emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types Ⅲ and *** The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively *** Among the 6 patients,4 were males and 2 were *** average age was 62.2±11.0 years,and the median body mass index was 20.7(19.2-24.1)kg/m^(2).The preoperative median total bilirubin was 57.7(16.0-155.7)μmol/*** patient had Bismuth-Corlette type Ⅲa,4 patients had Bismuth-Corlette type Ⅲb,and 1 patient had Bismuth-Corlette type Ⅳ.All patients successfully underwent pure laparoscopic radical resection following the strategy of“hepatic hilum area dissection priority,liver posterior separation first”.The operation time was 358.3±85.0 minutes,and the intraoperative blood loss volume was 195.0±108.4 *** of the patients received blood transfusions during the perioperative *** median length of stay was 8.3(7.0-10.0)*** bile leakage occurred in 2 patients,and all patients were discharged without serious surgery-related *** The emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ.This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA,shortens the learning curve,and

关键词： Hilar cholangiocarcinoma Bismuth-Corlette types Ⅲ and Ⅳ Laparoscopy Radical resection Strategy

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Albumin–bilirubin grade as a predictor of survival in hepatocellular carcinoma patients with thrombocytopenia

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1763-1772页

作者： Zhong-Ran Man Xuan-Kun Gong Kang-Lin Qu Qing Pang Bin-Quan Wu department of Hepatobiliary surgery The First Affiliated Hospital of Bengbu Medical CollegeBengbu 233000Anhui ProvinceChina department of Hepatobiliary surgery Anhui No.2 Provincial People’s HospitalHefei 230041Anhui ProvinceChina

BACKGROUND The models for assessing liver function,mainly the Child–Pugh(CP),albuminbilirubin(ALBI),and platelet–ALBI(PALBI)classifications,have been validated for use in estimating the prognosis of hepatocellular carcinoma(HCC)***,thrombocytopenia is a common finding and may influence the prognostic value of the three models in *** To investigate and compare the prognostic performance of the above three models in thrombocytopenic HCC *** A total of 135 patients with thrombocytopenic HCC who underwent radical surgery were retrospectively *** scores on the CP,ALBI and PALBI classifications were estimated ***–Meier curves with logrank tests and Cox regression models were used to explore the significant factors associated with overall survival(OS)and recurrence-free survival(RFS).RESULTS The preoperative platelet counts were significantly different among the CP,ALBI and PALBI *** a median follow-up of 28 mo,39.3%(53/135)of the patients experienced postoperative recurrence,and 36.3%(49/135)*** analysis suggested thatα-fetoprotein levels,tumor size,vascular invasion,and ALBI grade were significant predictors of OS and *** to the multivariate Cox regression model,ALBI was identified as an independent prognostic ***,CP and PALBI grades were not statistically significant prognostic *** The ALBI grade,rather than CP or PALBI grade,is a significant prognostic indicator for thrombocytopenic HCC patients.

关键词： Hepatocellular carcinoma Thrombocytopenia Child-Pugh Albumin-bilirubin Platelet-albumin-bilirubin

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Pancreatic pseudocyst:The past,the present,and the future

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World Journal of Gastrointestinal surgery 2024年第7期16卷 1986-2002页

作者： Jonathan GA Koo Matthias Yi Quan Liau Igor A Kryvoruchko Tamer AAM Habeeb Christopher Chia Vishal G Shelat department of General surgery Khoo Teck Puat HospitalSingapore 768828Singapore Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore department of surgery no.2 Kharkiv National Medical UniversityKharkiv 61022Ukraine department of General surgery Faculty of Medicine Zagazig UniversitySharkia 44511Egypt department of Gastroenterology Woodlands General HospitalSingapore 737628Singapore department of General surgery Tan Tock Seng HospitalSingapore 308433Singapore

A pancreatic pseudocyst is defined as an encapsulated fluid collection with a welldefined inflammatory wall with minimal or no *** diagnosis cannot be made prior to 4 wk after the onset of *** clinical presentation is often nonspecific,with abdominal pain being the most common *** a diagnosis is suspected,contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the *** ultrasound with cyst fluid analysis can be performed in cases of diagnostic *** of the pancreas can lead to complications such as hemorrhage,infection,and *** management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications,such as biliary or gastric outlet *** options include endoscopic or surgical *** aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions,diagnosis,and management of this condition.

关键词： Pancreatic pseudocyst Pancreatic fluid collection Cystic pancreatic lesions Pancreatitis Endoscopic ultrasound

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Management of early oesophageal cancer:An overview

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World Journal of Gastrointestinal surgery 2024年第5期16卷 1255-1258页

作者： Gavin G Calpin Matthew G Davey Noel E Donlon department of surgery Royal College of Surgeons in IrelandDublin D2Ireland department of Upper Gastrointestinal surgery Beaumont HospitalDublin D09V2N0Ireland

The incidence of esophageal cancer,namely the adenocarcinoma subtype,continues to increase exponentially on an annual *** indolent nature of the disease renders a significant proportion inoperable at first presentation,however,with the increased utilisation of endoscopy,many early lesions are now being identified which are suitable for endotherapeutic *** article details the options available for dealing with early esophageal cancer by endoscopic mean obviating the need for surgery thereby avoiding the potential morbidity and mortality of such intervention.

关键词： Esophageal cancer Endotherapy Endoscopic submucosal resection Endoscopic mucosal resection Endoscopy

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Clinical and Therapeutic Aspects of Inguinal Hernia in Children in the General surgery department of Reference Health Center in Commune I of Bamako Mali

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Surgical Science 2024年第2期15卷 54-63页

作者： Tounkara Cheickna Samake Hamidou Simpara Mama Diarra Issaka Sanogo Modibo Sidibe Souleymane Togola Modibo Dembele Bakary Tientigui Coulibaly Yacaria Togo Pierre Adégné Kante Lassana department of General surgery the Reference Health Center of Commune I Bamako Mali Directorate of Social Health Service the Armed Forces of Mali Bamako Mali department of Pediatric surgery Mali Hospital Bamako Mali department of General surgery the Gabriel TOURE University Hospital Bamako Mali department of Pediatric surgery Gabriel TOURE University Hospital Bamako Mali

Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of ca

关键词： Inguinal Hernia Child surgery Cs Ref C I Bamako Mali

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Effects of integrated management on surgical outcomes and mental health of patients following endoscopic submucosal dissection

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World Journal of Clinical Cases 2024年第20期12卷 4034-4040页

作者： Zhu-Hua Dai Lu Xu Yu Yang Xu-Ni He Ke Chen department of Gastroenterology Ningbo Yinzhou No.2 HospitalNingbo 315000Zhejiang ProvinceChina

BACKGROUND Endoscopic submucosal dissection(ESD)is a less invasive local treatment for diseases throughout the gastrointestinal *** To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after *** The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated *** The management group exhibited shortened fasting time and length of hospital stay compared to the control group(P2 h after surgery(P2 h after surgery(P<0.01).CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.

关键词： Endoscopic submucosal dissection Gastrointestinal tract Hospital stay Outcome Mental health

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Development and validation of a prediction model for early screening of people at high risk for colorectal cancer

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World Journal of Gastroenterology 2024年第5期30卷 450-461页

作者： Ling-Li Xu Yi Lin Li-Yuan Han Yue Wang Jian-Jiong Li Xiao-Yu Dai department of General surgery Ningbo No.2 HospitalNingbo 315000Zhejiang ProvinceChina Center for Health Economics Faculty of Humanities and Social SciencesUniversity of NottinghamNingbo 315100Zhejiang ProvinceChina department of Global Health Ningbo Institute of Life and Health IndustryUniversity of Chinese Academy of SciencesNingbo 315000Zhejiang ProvinceChina School of Public Health Medical College of Soochow UniversitySuzhou 215123Jiangsu ProvinceChina

BACKGROUND Colorectal cancer(CRC)is a serious threat *** early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not *** China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been ***,it is necessary to develop a simple and efficient early screening model for *** To develop and validate an early-screening nomogram model to identify individuals at high risk of *** Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively *** cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect *** 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were *** participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve ***,the model was validated internally using a bootstrap resampling *** Seven variables,including demographic,lifestyle,and family history information,were *** logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P2-1.03 P2-0.48,P28,95%CI:4.04-4.54,P23-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training s

关键词： Colorectal cancer Early screening model High-risk population Nomogram model Questionnaire survey Dietary habit Living habit

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Study of Hemorrhoid Disease in the department of General surgery of the Cs Ref of the Commune I Bamako

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Surgical Science 2024年第2期15卷 36-47页

作者： Tounkara Cheickna Diarra Issaka Sanogo Modibo Togola Modibo Camara Ladji Soma Dembele Bakary Tientigui Traore Alhassane Togo Adégné Pierre Kante Lassana Ouattara Zanafon Diallo Gangaly department of General surgery The Reference Health Center in Commune I Bamako Mali department of General surgery The Gabriel Toure University Hospital Bamako Mali department of Urology The Gabriel Toure University Hospital Bamako Mali

This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.

关键词： Hemorrhoid surgery Cs Ref C I Bamako Mali

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Management of obstructed colorectal carcinoma in an emergency setting:An update

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 598-613页

作者： Efstathios T Pavlidis Ioannis N Galanis Theodoros E Pavlidis 2nd Propedeutic department of surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Colorectal carcinoma is common,particularly on the left *** 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is based on clinical presentation,plain abdominal radiogram,computed tomography(CT),CT colonography and positron emission tomography/*** best management strategy in terms of short-term operative or interventional and long-term oncological outcomes re-mains *** the most common left-sided obstruction,the first choice should be either emergency surgery or endoscopic decompression by self-expen-dable metal stents or *** operative plan should be either one-stage or two-stage ***-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma(colostomy or ileostomy).Primary anastomosis is more convenient but has increased risks of anastomotic leakage and ***-stage resection(Hart-mann’s procedure)is safer and the most widely used despite temporally affecting quality of *** control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or *** the less common right-sided obstruction,one-stage surgical resection is more beneficial than endoscopic *** role of minimally invasive surgery(laparoscopic or robotic)is a subject of *** laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rup-ture and subsequent septic *** decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival *** combination with neoadjuvant chemotherapy or radiation may have a p

关键词： Acute abdomen Obstructive ileus Colorectal carcinoma Emergency surgery Colectomy Intraluminal metal stents

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