Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
ObjectiveTo understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. MethodsThe patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. ResultsA total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ2=3.749, P=0.053; χ2=2.205, P=0.138; χ2=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ2=3.316, P=0.069; χ2=3.712, P=0.054). ConclusionsFrom the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.
ObjectiveTo provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.MethodsThe clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.ResultsThe incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1% vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate.ConclusionCOPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.
ObjectiveTo systematically review the postoperative complications between robotic-assisted surgery (RAS) and laparoscopic-assisted surgery (LAS) in children with hirschsprung's disease (HSCR). MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, and WanFang Data databases were electronically searched to collect non-randomized controlled studies related to the objective from inception to May 10, 2025. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 7 studies involving 901 children were included. The results of meta-analysis showed that the RAS group had a lower incidence of postoperative enterocolitis than the LAS group (OR=0.64, 95%CI 0.42 to 0.98, P=0.04) and a higher rate of complication-free outcomes (OR=2.16, 95%CI 1.26 to 3.72, P<0.01). No statistically significant differences were found between the two groups in intraoperative duration, intraoperative blood loss, postoperative anastomotic complications, fecal soiling, adhesive intestinal obstruction, wound infection, incisional hernia, perianal infection, or urinary retention (P>0.05). ConclusionCurrent evidence shows that RAS significantly reduces the risk of postoperative enterocolitis and improves the rate of complication-free outcomes in children with HSCR but offers no advantages in intraoperative indicators or other complications. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo evaluate the safety and feasibility of non-nasogastric tube throughout the perioperative period of classical Whipple pancreaticoduodenectomy. MethodsA retrospective analysis was conducted on the clinical data of 63 patients who underwent Whipple pancreaticoduodenectomy at West China Hospital of Sichuan University from June 2020 to August 2023. According to whether nasogastric tube was placed throughout the perioperative period, the patients were divided into nasogastric tube group (NGT group, n=32) and no nasogastric tube group (no NGT group, n=31). The intraoperative indicators such as gastrointestinal anastomosis mode and outcome measures such as postoperative hospital stay were compared between the two groups. Results① Preoperative baseline data: the proportion of benign diseases (P=0.005) and preoperative pancreatitis (P=0.003) of the no NGT group were higher than those of the NGT group, and other preoperative baseline data, such as age and sex, were not statistically significant (P>0.05). ② Intraoperative index: the proportion of circular stapler (P=0.009) was smaller and the operation time was shorter (P<0.001), but there was no significant difference in the anastomosis, intraoperative blood transfusion and intraoperative bleeding (P>0.05). ③ Postoperative outcome measures: the postoperative length of hospital stay (P<0.001) and the incidence of delayed gastric emptying (P<0.001) of the no NGT group were lower than those in the NGT group, but the postoperative time of food intake, incidence of pancreatic fistula, incidence of postoperative bleeding, and Clavien-Dindo grade of complications were not significant (P>0.05), and on one died within 30 d after operation. ConclusionsThe results of this study preliminarily show that, it is safe and feasible not to place nasogastric tubes throughout the perioperativeperiod in patients undergoing classical Whipple pancreaticoduodenectomy. Compared with placing nasogastric tube, it can shorten the postoperative hospital stay, reduce the incidence of postoperative delayed gastric emptying.
ObjectiveTo analyze risk factors of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. MethodData were collected retrospectively for consecutive patients undergoing defunctioning ileostomy following sphincter preservation surgery for rectal cancer, from January 2014 to December 2014. ResultsOne hundred and thirty patients were included (median time to reversal 132 d, range 39-692 d), of whom 35 patients (26.92%) had postoperative complications after stoma reversal. The main complications included 23 cases of diarrhea, 6 cases of bowel obstruction, 9 cases of incision infection, and 4 cases of perianal eczema. The results of univariate analysis showed that the distant of tumor from anal verge <5 cm (P=0.010), postoperative adjuvant chemotherapy (P=0.002), and time to reversal (P=0.025) were related to the postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. The result of multivariate analysis by using a logistic regression model showed that the time to reversal (OR=1.006, P=0.021) was a significant independent risk factor for it. ConclusionDelay reversal of defunctiong ileostomy might increase risk of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.
ObjectiveTo analyze the effect and incidence rate of major postoperative complications of pericardial devascularization in treatment of portal hypertension. MethodsEnglish and Chinese literatures about pericardial deva-scularization in treatment of portal hypertension were searched through Medline, Elsevier, PubMed, CNKI, and WanFang database, and meta analysis was taken in the process by using R-2.15 software. ResultsIn total of 671 literatures were searched and 23 were selected finally according to inclusion criteria and exclusion criteria.The results of meta analysis showed that, the effect of pericardial devascularization in treatment of portal hypertension were as follows:the incidence rate of rebleeding was 21%(95% CI: 0.18-0.24), the incidence rate of hepatic encephalopathy was 4%(95% CI: 0.02-0.06), the incidence rate of ascites was 29%(95% CI: 0.14-0.47), mortality of operation was 3%(95% CI: 0.02-0.04), mortality was 23%(95% CI: 0.15-0.33). ConclusionsThere is a certain incidence rate of complications of pericardial devascularization, of which the most common complication is rebleeding.So, it is necessary to do further improvement and development of pericardial devascularization.