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Delayed gastric emptying (DGE) is a common complication following upper gastrointestinal surgery, especially following distal gastrectomy and partial pancreaticoduodenectomy (Whipple procedure). Its underlying mechanism remains unclear and needs to be elucidated. Through negative feedback mechanisms, duodenal distension inhibits gastric emptying. In our experience in performing a gastrojejunostomy, we speculate that this mechanism may still exist in the proximal jejunum and is activated by jejunal distension or stretching. There are many surgical factors leading to this mechanism activation. When a jejunal anastomosis is created by a relative large caliber of a circular stapling device, the mucosa may suffer from a circumferential scratch or bruising injury resulting in local inflammation. Afferent loop twisting may also lead to distal duodenum and/or jejunal distension. In addition, a mild/slight tension may exist on the mesenteric side of the gastrojejuostomy, especially when the antecolic route for reconstruction of the gastrojejunostomy has been performed. The inflammatory mucosa may keep the jejunum circumferentially distended, the bowel twist might compromise the lumen patency, and tension on gastrojejuostomy would stretch the jejunal wall. Any of these factors might contribute to the mechanisms of DGE by the negative feedback mechanisms.

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Delayed gastric emptying (DGE) is a common complication following upper gastrointestinal surgery, especially following distal gastrectomy and partial pancreaticoduodenectomy (Whipple procedure). Its underlying mechanism remains unclear and needs to be elucidated. Through negative feedback mechanisms, duodenal distension inhibits gastric emptying. In our experience in performing a gastrojejunostomy, we speculate that this mechanism may still exist in the proximal jejunum and is activated by jejunal distension or stretching. There are many surgical factors leading to this mechanism activation. When a jejunal anastomosis is created by a relative large caliber of a circular stapling device, the mucosa may suffer from a circumferential scratch or bruising injury resulting in local inflammation. Afferent loop twisting may also lead to distal duodenum and/or jejunal distension. In addition, a mild/slight tension may exist on the mesenteric side of the gastrojejuostomy, especially when the antecolic route for reconstruction of the gastrojejunostomy has been performed. The inflammatory mucosa may keep the jejunum circumferentially distended, the bowel twist might compromise the lumen patency, and tension on gastrojejuostomy would stretch the jejunal wall. Any of these factors might contribute to the mechanisms of DGE by the negative feedback mechanisms. [ABSTRACT FROM AUTHOR]

To explore the clinical value of hierarchical and multi-point suspension technique during laparoscopic pyeloplasty ( LP ) for children with congenital ureteropelvic junction obstruclion ( UPJO ) . Methods Taking 138 children with UPJO as the resrch object who received LP treatment in Qilu Hospital of Shandeng University from March 2017 to Decembe1· 2020. The hierarchical and multi-point suspension technique wa5 applied. There were 114 boys and 24 girls with an average age of 34. 8 ( 1 - 168 ) month. The lesion side was left ( n = 98) and right ( n = 40). Postoperative ultrasonic follow-ups were performed for outcome evaluations. Results All operations were successful. Average opera Live duration was ( 108. 5 ± 27. 7) min, intraoperative anastomotic time ( 40. 1 ± 6. 2 ) min, volume of blood loss ( 5 - 25) ml and average postoperative hospitalization stay 5. 9 days. Four cases of postoperative urinary infection improved after susceptible anti-inflammatory treatment based upon the results of urine culture. One child of lymphatic leakage improved after delayed removal of abdominal drainage tube and symplomatic supports. For two cases of hematuria,symptoms disappeared after removal of double J stent. During a follow-up period of 6 to 12 months, clinical symptoms disappeared and ultrasonic re-examination revealed that hydronephrosis disappeared or decreased, and renal cortex thickened to varying degrees. Conclusion During laparoscopic pyeloplasty, application of hierarchical and multi-point suspension technique offers a better operative field and a satisfactory outcome. IL can effectively lower the difficulty of suturing and significantly shorten operative duration. And beginners may master it quickly and easily. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the effect of Braun anastomosis (BE) on delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD). Methods A retrospective analysis was performed for the clinical data of 132 patients who underwent PD in The First Hospital of Lanzhou University from December 2016 to December 2019, and according to whether BE was performed during surgery, the patients were divided into BE group with 54 patients and non - BE group with 78 patients. The two groups were compared in terms of postoperative complications (DGE, pancreatic fistula, and biliary fistula), intraoperative condition, general examination indicators, postoperative treatment and recovery, and hospitalization to evaluate the effect of BE in preventing DGE after PD. The t - test was used for comparison of normally distributed continuous data between two groups, and the Mann - Whitney U test was used for comparison of non - normally distributed continuous data between two groups; the chi - square test and the Fisher' s exact test were used for comparison of categorical data between two groups. Results Compared with the non - BE group, the BE group had a significantly lower incidence rate of grade C DGE after surgery (5.56% vs 19.23%,,x² = 5. 067, P < 0. 05 ), a significantly shorter time to the first chemotherapy [45. 00 (38.00 - 49. 75 ) days vs 53.00 (44.00 -65.00) days, H = -2. 495, P =0.013 ), a significantly shorter length of postoperative hospital stay [ 15.00 (12.75 -19. 25 ) days vs 18.00 (15.00 -25.50) days, H = -3. 358, P <0.05, and a significantly lower number of times of the use of antiemetic drugs [1.00(0 -0.25) times vs 1.00(1.00 -4.00) times, H = -2. 347, P=0.019]. There were no significant differences between the two groups in the time of operation, intraoperative blood loss, hospital cost, survival time, duration of gastric tube placement, time to resume eating, and overall incidence rates of DGE, pancreatic fistula, biliary fistula, gastrointestinal fistula, abdominal bleeding, incision infection, wound dehiscence, and intestinal obstruction (all P >0. 05 ). Conclusion BE can effectively reduce the incidence rate of grade C DGE after PD. [ABSTRACT FROM AUTHOR]

Several surgical manipulations, such as pulmonary nodules location, intraoperatively mapping on pulmonary segmental-and subsegmental bronchi and sentinel lymph node mapping, are intractable problems in clinical practice. The application of near-infrared fluorescent imaging of indocyanine green to evaluate the situations of blood perfusion and lymphatic drainage in human tissues has been proved to be a safe fluorescence angiography technique and widely used in clinical practice. However, the application of this technique in thoracic surgery is relatively few. Here, we reviewed the reports using near-infrared fluorescent imaging of indocyanine green to evaluate blood perfusion, lymph node mapping, thoracic mapping, etc. in animal model and clinical trials, showing its promising prospects in thoracic surgery.

Objective: To compare the effect of the penetrating-suture pancreaticojejimostomy and traditional sumre in pancreaticoduodenectomy(PD), and analyze their application value in PD. Methods: The data of 60 patients underwent PD in our hospital from September 2010 to December 2015 were collected, who were divided into two groups according to the difference of the anastomosis Methods: The penetration group and traditional group, with 30 patients in each group. The penetration group was treated with penetrating-suture pancreaticojejimostomy, while the traditional group was treated with traditional suture. Compared the clinical indexes (time of pancreaticojejimostomy, amount of bleeding during operation and postoperative hospital stay) and perioperative complications (such as pancreatic fistula, lymph leakage, gastric emptying, pulmonary infection, anastomotic bleeding, abdominal abscess, etc). Then compared the rates of re-operation, re-admission between the two groups. Results: The time of pancreaticojejimostomy, amount of bleeding dining operation and postoperative hospital stay in penetration group were lower than the traditional group, the differences were statistically significant (P<0.05). The incidence of perioperative pancreatic fistula was 10.00% in penetratnion group, which was significantly lower than 40.00% in the traditional group, the difference was statistically significant(P<0. 05), and the B grade pancreatic fistula hi penetratnion group was significantly lower than traditional group, the difference was statistically significant (P<0.05). There was no significant difference in the rates of re-operation, re-admission between the two groups (P>0.05). Conclusion: Penetrating-suture pancreaticojejimostomy is good for postoperative recovery of patients with PD. and the incidence of perioperative pancreatic fistula is low, which is a effective mothod of intestinal anastomosis. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the incidence of postoperative complications in laparoscopic versus open common hepatic duct-jejunal Roux-en-Y anastomosis. MethodsThe databases of PubMed, Web of Science, CNKI, VIP, and Wanfang Data were searched for related studies on postoperative complications in laparoscopic or open common hepatic duct-jejunal Roux-en-Y anastomosis published up to May 20, 2016. Two reviewers performed literature screening according to inclusion and exclusion criteria, data extraction, and quality assessment independently. STATA12.0 software was used for the meta-analysis. ResultsA total of 9 studies with 548 patients were enrolled. Among these patients, 261 underwent laparoscopic surgery and 287 underwent open surgery. The results of the meta-analysis showed that compared with the open surgery group, the laparoscopic surgery group had lower incidence rates of total complications (OR=0.40, 95% CI： 0.24-0.68, P=0.001), incision infection (OR=0.20, 95% CI： 0.08-0.53, P=0.001), and adhesive ileus (OR=0.25, 95% CI： 0.06-0.99, P=0.049). However, there was no significant difference in the incidence of bile leakage between the two groups (P＞0.05). ConclusionCompared with open surgery, laparoscopic common hepatic duct-jejunal Roux-en-Y anastomosis has a lower incidence of total postoperative complications, and therefore, it is a safe and feasible surgical procedure. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical outcomes of dilute methylene blue solution on the treatment of lacrimal duct anastomosis. Methods: 65 cases with lacrimal canalicular laceration were randomly divided into GroupA (n=35) andB (n=30). The patients in Group A were treated with the methylene blue, while the patients in Group B were treated with Worst pig tail probe. Then the clinical effects of the two groups were evaluated and compared. Results: There was no statistically significant difference about the curative rate between the two groups (P>0.05). The operation time in Group A was shorter than that of Group B, and the difference was statistically significant (P<0.05). Conclusions: Mucosa staining function of methylene blue could help the surgeon successfully find the tear small tube nasal side broken end, reduce operation-induced injury, shorten the operation time and improve the success rate of operation. It is easy to use and responded with good tolerance. [ABSTRACT FROM AUTHOR]

Objective To explore the causes and the consequences of iatrogenic bile duct injury as well as experiences in its diagnosis and treatment. Method The clinical data of 28 in-patients who suffered from bile duct injury followed by cholecystectomy during January 1995 to September 2011 were collected and retrospectively analyzed. Result Bile duct injuries were found and diagnosed in al 28 in-patients during the processes of reoperation. Different treatments were carried out. 8 cases with mild injury were treated by placing the abdominal cavity drainage. 6 cases with bile duct split were repaired and set up with T tube drainage. 4 cases were initially treated by bile-intestinal Roux-y anastomosis. 1 case received repair operation of bile-intestinal Roux-y anastomosis after the external drainage of bile. 9 cases were initially treated with end-end bile duct anastomosis and 7 of 9 cases with concurrent anastomotic stenosis were performed repairing re-operations twice or more than twice. Among 7 cases, 1 case was performed with the operation of umbilical vein flap repair while 6 cases were treated with bile-intestinal Roux-y anastomosis repair. All cases in this observation were followed up to two years after repairing surgery: 2 patients died and the rest 26 patients recovered after treatment. Conclusions The initial repairing operation is critical for iatrogenic bile duct injury and bile-intestinal Roux - y anastomosis should be the first choice of therapy, and it should be operated by experienced surgeons. [ABSTRACT FROM AUTHOR]

Segmental gastrectomy is a common function preserving operation, and its combination with sentinel lymph node navigation technology shows a broad prospect in the treatment of early gastric cancer. Commonly anastomosis methods include the follows: (1) Hand-sewn anastomosis: this method is relatively simple, reduces the use of stapler, and can effectively reduce surgical cost. However, laparotomy or small-incision assisted laparoscopic surgery is required to accomplish anastomosis, so the surgical wound is relatively large. (2) Delta anastomosis: this anastomosis is entirely endoscopic, requiring no small incision with less surgical trauma. However, due to the presence of residual cavities in the small curvature of the side-to-side anastomosis, and the possibility of excessive incision of the posterior wall of the stomach, which may shorten the pyloric sleeve, there is an increased risk of gastric stasis after the operation. (3) Hybrid technique: this anastomosis method is safe and effective. However, it requires total endoscopic gastric anterior wall suture, which represents higher requirements for surgeons. Therefore, surgeons experienced in minimally invasive surgeries are recommended to perform this anastomosis. (4) Puncture technique: this anastomotic method is end-to-end anastomosis with low risk of gastric stasis, and is applicable for entirely endoscopic anastomosis. However, the stapler is not typically used for gastrointestinal surgery, which brings certain limitations to clinical promotion. These anastomoses have their own advantages and disadvantages, and their effects on gastric function are also controversial. In conclusion, the development of segmental gastrectomy is still in its infancy, and prospective multicenter randomized controlled trials are awaited to confirm the safety of oncology and standardize the techniques.

Whether the transanal total mesorectal resection (taTME) techniques increase the risk of anastomotic failure is inconclusive. This paper discusses the anastomotic problems of taTME from different aspects including anatomical factors and technical characteristics. In terms of the anatomic and physiological characteristics of the lower rectum, the Hiatal ligament and the density of the perirectal space is a disadvantage to the anastomosis of taTME, while the prolapse of the rectum may be a beneficial factor. Due to the unique technical characteristics of taTME, the main reason affecting its anastomosis at present is that the caudal space at the distal end is not sufficiently mobilized, especially for male and lower anastomosis. In addition, stapled anastomosis at the level of anorectal ring may cause more problems, while manual anastomosis at the lower level may bring better results.