World Journal of Gastrointestinal Surgery最新文献

{"title":"Prediction of perioperative complications in colorectal cancer <i>via</i> artificial intelligence analysis of heart rate variability.","authors":"Miao-Miao Ge, Li-Wen Wang, Jun Wang, Jiang Liu, Peng Chen, Xin-Xin Liu, Gang Wang, Guan-Wen Gong, Zhi-Wei Jiang","doi":"10.4240/wjgs.v17.i4.102934","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.102934","url":null,"abstract":"<p><strong>Background: </strong>Heart rate variability (HRV) represents efferent vagus nerve activity, which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers. Therefore, this study hypothesized that HRV monitoring could predict perioperative complication (PC) in colorectal cancer (CRC) patients.</p><p><strong>Aim: </strong>To investigate the prognostic value of HRV in hospitalized CRC patients.</p><p><strong>Methods: </strong>The observational studies included 87 patients who underwent CRC surgical procedures under enhanced recovery after surgery programs in a first-class hospital. The HRV parameters were compared between the PC group and the non PC (NPC) group from preoperative day 1 to postoperative day (Pod) 3. In addition, inflammatory biomarkers and nutritional indicators were also analyzed.</p><p><strong>Results: </strong>The complication rate was 14.9%. HRV was markedly abnormal after surgery, especially in the PC group. The frequency-domain parameters (including pNN50) and time-domain parameters [including high-frequency (HF)] of HRV were significantly different between the two groups postoperatively. The pNN50 was significantly greater at Pod1 in the PC group than that in the NPC group and returned to baseline at Pod2, suggesting that patients with complications exhibited autonomic nerve dysfunction in the early postoperative period. In the PC group, HFs were also enhanced from Pod1 and were significantly higher than in the NPC group; inflammatory biomarkers were significantly elevated at Pod2 and Pod3; the levels of nutritional indicators were significantly lower at Pod1 and Pod2; and the white blood cell count was slightly elevated at Pod3.</p><p><strong>Conclusion: </strong>HRV is independently associated with postoperative complications in patients with CRC. Abnormal HRV could predicted an increased risk of postoperative complications in CRC patients. Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"102934"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a multi-modal intervention protocol for preventing stress ulcers in critically ill older patients after gastrointestinal surgery.","authors":"Hai-Ming Xi, Man-Li Tian, Ya-Li Tian, Hui Liu, Yun Wang, Min-Juan Chu","doi":"10.4240/wjgs.v17.i4.100806","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.100806","url":null,"abstract":"<p><strong>Background: </strong>Stress ulcers are common complications in critically ill patients, with a higher incidence observed in older patients following gastrointestinal surgery. This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.</p><p><strong>Aim: </strong>To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit (ICU) patients postoperatively.</p><p><strong>Methods: </strong>A randomized controlled trial involving critically ill patients (aged ≥ 65 years) admitted to the ICU after gastrointestinal surgery was conducted. Patients were randomly assigned to either the intervention group, which received a multi-modal stress ulcer prevention protocol, or the control group, which received standard care. The primary outcome measure was the incidence of stress ulcers. The secondary outcomes included ulcer healing time, complication rates, and length of hospital stay.</p><p><strong>Results: </strong>A total of 200 patients (100 in each group) were included in this study. The intervention group exhibited a significantly lower incidence of stress ulcers than the control group (15% <i>vs</i> 30%, <i>P</i> < 0.01). Additionally, the intervention group demonstrated shorter ulcer healing times (mean 5.2 <i>vs</i> 7.8 days, <i>P</i> < 0.05), lower complication rates (10% <i>vs</i> 22%, <i>P</i> < 0.05), and reduced length of hospital stay (mean 12.3 <i>vs</i> 15.7 days, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery. This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"100806"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the effect of multi-channel continuous nursing intervention on patients post-radical gastrectomy.","authors":"Huan-Li Luo, Huan-Ling Luo","doi":"10.4240/wjgs.v17.i4.100848","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.100848","url":null,"abstract":"<p><strong>Background: </strong>Radical gastrectomy (RGE) for gastric carcinoma (GC) has exerted definite therapeutic efficacy in treating patients with GC. However, a notable risk of postoperative complications (POCs) persists among middle-aged and elderly patients with compromised physiological functions. Hence, developing and implementing reliable nursing interventions to optimize the comprehensive management of these patients is deemed imperative.</p><p><strong>Aim: </strong>To analyze the association of multi-channel continuous nursing intervention with POCs, negative emotions (NEs), and quality of life (QoL) of patients undergoing RGE for GC.</p><p><strong>Methods: </strong>This retrospective study selected 99 patients who underwent RGE for GC in our hospital from May 2020 to May 2023. Participants were categorized into the control (<i>n</i> = 49 cases) and research groups (<i>n</i> = 50 cases) receiving routine and multi-channel continuous nursing care, respectively. Comparative analysis involved data on postoperative rehabilitation (time to first anal exhaust, oral feeding and ambulation, and hospital stay), complications (nausea and vomiting, delayed gastric emptying, and abdominal distension), NEs [Self-rating Anxiety (SAS)/Depression Scale (SDS)], treatment compliance, self-efficacy, and QoL [World Health Organization QoL Brief Version (WHOQOL-BREF)].</p><p><strong>Results: </strong>Compared to the control group, the research group demonstrated earlier first postoperative anal exhaust, oral feeding, and ambulation, shorter hospital stay, lower POC rate, and more reduced SAS and SDS scores postintervention, which was significantly lower than the baseline. The treatment compliance scores were significantly higher in the research group than in the control group in terms of medication adherence, daily exercise, reasonable diet, and regular review. Further, the research group demonstrated increased self-efficacy scores in terms of positive attitude, self-stress relief, and self-decision-making, as well as the overall score postintervention, which were higher than the control group. Moreover, the research group reported notably higher WHOQOL-BREF scores in domains such as physiology, psychology, social relations, and environment.</p><p><strong>Conclusion: </strong>Multi-channel continuous nursing intervention prevents POCs in patients undergoing RGE for GC as well as significantly alleviates patients' NEs and boosts their QoL.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"100848"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Sijunzi decoction plus chemotherapy with gastrointestinal function and serum markers in patients after gastric carcinoma surgery.","authors":"Xiao-Dong Wang, Xiao-Qing Su, Hong Gao","doi":"10.4240/wjgs.v17.i4.100800","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.100800","url":null,"abstract":"<p><strong>Background: </strong>The deleterious effects of surgical trauma and subsequent postoperative complications pose significant challenges to the smooth recovery of patients after gastric cancer (GC) resection despite the substantial curative benefits provided by surgical interventions for GC. Hence, the investigation of more optimal and efficacious treatment approaches has become an urgent necessity in the medical community.</p><p><strong>Aim: </strong>To investigate the association of Sijunzi decoction plus chemotherapy with the gastrointestinal function and serum markers of patients after GC surgery.</p><p><strong>Methods: </strong>This study included patients who underwent GC surgery from June 2022 to February 2024. The control group included 45 patients who received chemotherapy (oxaliplatin + calcium folinate + 5-fluorouracil), whereas the research group consisted of 54 patients who received Sijunzi decoction therapy in addition to the treatment administered in the control group. Comparative analyses were conducted from the following perspectives: Gastrointestinal function (defecation time, intestinal gas discharge time, and hospitalization time), serum markers [carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 125, and CA199], nutritional indicators [total protein (TP) and transferrin (TRF), traditional Chinese medicine (TCM) syndrome score, and grades III-IV adverse events (gastrointestinal reactions, renal/liver function impairment, and myelosuppression).</p><p><strong>Results: </strong>The two groups demonstrated similar defecation time (<i>P</i> > 0.05), but the intestinal gas discharge time and hospitalization time were significantly shortened in the research group (<i>P</i> < 0.05). Further, the research group exhibited significant CEA, CA125, and CA199 reductions after treatment, which were lower compared to the control group, as well as notable increases in TP and TRF that were statistically higher than the control group (all <i>P</i> < 0.05). Furthermore, the research group demonstrated an evident decrease in TCM syndrome scores in areas, such as poor appetite, epigastric distension and pain, fatigue and weakness (<i>P</i> < 0.01), and abdominal distension after eating, which are notably lower than those in the control group (<i>P</i> < 0.01), with a comparable incidence of grades III-IV adverse events (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Our research results indicate that Sijunzi decoction plus chemotherapy exerts a good rehabilitation-promoting effect on gastrointestinal function in patients after GC surgery and significantly downregulates abnormally increased CEA, CA125, and CA199 levels.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"100800"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal diagnostic and surgical approach to spontaneous esophageal rupture induced by severe coughing: A case report.","authors":"Shu-Yun Xiong, Chang-Jiang Liu, Yong-Feng Li, Han-Liang Zhang, Xiao-Wei Chen, Hai-Man Wang, Ji-Cai Chen","doi":"10.4240/wjgs.v17.i4.101578","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.101578","url":null,"abstract":"<p><strong>Background: </strong>Boerhaave syndrome, or spontaneous esophageal rupture, is a rare and life-threatening emergency, typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting. Early diagnosis is challenging as its symptoms often resemble those of other diseases. Understanding its pathological features and treatment strategies is therefore critical for clinical practice.</p><p><strong>Case summary: </strong>This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension. Following severe coughing, the patient developed chest pain, vomiting, and respiratory distress. Initial clinical evaluation was inconclusive, with a suspected diagnosis of cardiovascular or gastrointestinal conditions. After further examination, the diagnosis of spontaneous esophageal rupture was confirmed. Chest X-ray, computed tomography, and endoscopy revealed a rupture in the lower esophagus, along with mediastinal abscess and pleural effusion. Laboratory tests showed mild infection markers. The patient underwent surgical repair of the esophageal rupture (approximately 3 cm in length) with mediastinal drainage. Postoperatively, the patient's temperature normalized within 3 days, respiratory function improved, and pleural effusion significantly decreased. After two weeks of treatment, the patient was discharged without complications and had a favorable prognosis. The study suggests that while violent coughing is a rare trigger, it can lead to severe damage, and imaging techniques play a crucial role in diagnosis.</p><p><strong>Conclusion: </strong>Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges. Early recognition and timely intervention are crucial for improving prognosis. This case highlights the importance of imaging and surgical treatment, offering new insights for managing similar cases and providing valuable clinical guidance.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"101578"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for liver abscess liquefaction degree based on clinical, laboratory, and computed tomography data.","authors":"Hong-Yu Long, Xin Yan, Jia-Xian Meng, Feng Xie","doi":"10.4240/wjgs.v17.i4.104615","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104615","url":null,"abstract":"<p><strong>Background: </strong>Effective management of liver abscess depends on timely drainage, which is influenced by the liquefaction degree. Identifying predictive factors is crucial for guiding clinical decisions.</p><p><strong>Aim: </strong>To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.</p><p><strong>Methods: </strong>This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage. Patients were divided into a poor liquefaction group (<i>n</i> = 28) and a well liquefaction group (<i>n</i> = 82) based on the ratio of postoperative 24-hour drainage volume to abscess volume, using a cutoff value of 0.3. Clinical characteristics, laboratory indicators, and computed tomography imaging features were compared. A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.</p><p><strong>Results: </strong>Independent predictive factors for good liquefaction included the absence of diabetes [odds ratio (OR) = 0.339, <i>P</i> = 0.044], absence of pneumonia (OR = 0.218, <i>P</i> = 0.013), left-lobe abscess location (OR = 4.293, <i>P</i> = 0.041), cystic features (OR = 5.104, <i>P</i> = 0.025), and elevated preoperative serum alanine aminotransferase (ALT) levels (OR = 1.013, <i>P</i> = 0.041). The logistic regression model based on these factors demonstrated an area under the curve of 0.814, with a sensitivity of 90.24% and specificity of 67.86%. Five-fold cross-validation yielded an average accuracy of 83.61% and a kappa coefficient of 0.5209.</p><p><strong>Conclusion: </strong>Pneumonia, diabetes, abscess location, abscess composition, and preoperative serum ALT levels are significant predictors of liver abscess liquefaction. The model can guide clinical decision-making.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104615"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for bile leakage after laparoscopic common bile duct exploration in older patients with choledocholithiasis.","authors":"Ruo-Fei Xiong, Shan-Shan Lu, Zhi-Ming Wu, Hong-Jun Huang, Tao Xiao","doi":"10.4240/wjgs.v17.i4.102697","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.102697","url":null,"abstract":"<p><strong>Background: </strong>At present, there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration (LCBDE) for older patients with choledocholithiasis.</p><p><strong>Aim: </strong>To identify the potential risk factors for bile leakage after LCBDE in older patients.</p><p><strong>Methods: </strong>A retrospective, single-center observational analysis was performed on patients aged ≥ 70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022. The included patients were divided into non-bile leakage and bile leakage groups. Risk factors were determined by analyzing the observation indicators.</p><p><strong>Results: </strong>Seventy older patients with choledocholithiasis who underwent LCBDE were included. Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE (<i>P</i> < 0.05). We further analyzed the bile bacteria, and univariate analysis showed that <i>Enterococcus faecalis</i> (<i>E. faecalis</i>) (<i>P</i> < 0.05) and <i>Pseudomonas aeruginosa</i> (<i>P</i> < 0.05) were associated with an increased risk of postoperative bile leakage in older patients (<i>P</i> < 0.05). Multivariate analysis showed that <i>E. faecalis</i> was an independent risk factor for postoperative bile leakage in older patients (<i>P</i> < 0.05). The results of antibiotic sensitivity analysis showed that <i>E. faecalis</i> had 100% susceptibility to penicillin, ampicillin, linezolid, vancomycin, and furantoin.</p><p><strong>Conclusion: </strong><i>E. faecalis</i>-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in older patients with choledocholithiasis. We suggest coverage with antibiotics to which <i>E. faecalis</i> is sensitive.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"102697"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging bias field correction improves tumor prognostic evaluation after transcatheter arterial chemoembolization for liver cancer.","authors":"Ke Liu, Jun-Biao Li, Yong Wang, Yan Li","doi":"10.4240/wjgs.v17.i4.104187","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104187","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter arterial chemoembolization (TACE) is a key treatment approach for advanced invasive liver cancer (infiltrative hepatocellular carcinoma). However, its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor's diffuse and multifocal growth pattern. Volumetric imaging, especially enhanced tumor volume (ETV), offers a more comprehensive assessment. Nonetheless, bias field inhomogeneity in magnetic resonance imaging (MRI) poses challenges, potentially skewing volumetric measurements and undermining prognostic evaluation.</p><p><strong>Aim: </strong>To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE, and to analyze how this improved measurement impacts prognostic prediction.</p><p><strong>Methods: </strong>We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024. The improved N4 bias field correction algorithm was applied to process MRI images, and the ETV before and after treatment was calculated. The ETV measurements before and after correction were compared, and their relationship with patient prognosis was analyzed. A Cox proportional hazards model was used to evaluate prognostic factors, with Martingale residual analysis determining the optimal cutoff value, followed by survival analysis.</p><p><strong>Results: </strong>Bias field correction significantly affected ETV measurements, with the corrected baseline ETV mean (505.235 cm³) being significantly lower than before correction (825.632 cm³, <i>P</i> < 0.001). Cox analysis showed that the hazard ratio (HR) for corrected baseline ETV (HR = 1.165, 95%CI: 1.069-1.268) was higher than before correction (HR = 1.063, 95%CI: 1.031-1.095). Using 412 cm³ as the cutoff, the group with baseline ETV < 415 cm³ had a longer median survival time compared to the ≥ 415 cm³ group (18.523 months <i>vs</i> 8.926 months, <i>P</i> < 0.001). The group with an ETV reduction rate ≥ 41% had better prognosis than the < 41% group (17.862 months <i>vs</i> 9.235 months, <i>P</i> = 0.006). Multivariate analysis confirmed that ETV reduction rate (HR = 0.412, <i>P</i> < 0.001), Child-Pugh classification (HR = 0.298, <i>P</i> < 0.001), and Barcelona Clinic Liver Cancer stage (HR = 0.578, <i>P</i> = 0.045) were independent prognostic factors.</p><p><strong>Conclusion: </strong>Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer. The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis, providing important reference for developing individualized treatment strategies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104187"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term efficacy of laparoscopic radical resection for colorectal cancer and risk of unplanned reoperation after surgery.","authors":"Wen-Bin Li, Jiang Li, Wei Yu, Jian-Hua Gao","doi":"10.4240/wjgs.v17.i4.102442","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.102442","url":null,"abstract":"<p><strong>Background: </strong>Surgery is the first choice of treatment for patients with colorectal cancer. Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions. With the continuous development of medical technology, laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease.</p><p><strong>Aim: </strong>To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer, and the differences in the risk analysis of unplanned reoperation after operation.</p><p><strong>Methods: </strong>As the research subjects, this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022. Among them, 50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group. Data pertaining to clinical indexes, gastrointestinal hormones, nutrition indexes, the levels of inflammatory factors, quality of life, Visual Analog Scale score, and the postoperative complications of the two groups of patients before and after treatment were collected, and the therapeutic effects in the two groups were analyzed and compared.</p><p><strong>Results: </strong>Compared with the control group, perioperative bleeding, peristalsis recovery time, and hospital stays were significantly shorter in the research group. After surgery, the levels of gastrin (GAS) and motilin (MTL) were decreased in both groups, and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group. The hemoglobin (Hb) levels increased after surgery, and the level of Hb in the research group was significantly higher compared with the control group. After the operation, the expression levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group. One year after the operation, the quality of life of the two groups was greatly improved, with the quality of life in the research group being significantly better.</p><p><strong>Conclusion: </strong>Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction; moreover, the quality of life of patients was significantly improved, which warrants further promotion.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"102442"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforated peptic ulcer in pregnancy and puerperium: A systematic review.","authors":"Goran Augustin, Jure Krstulović, Ante Tavra, Zrinka Hrgović","doi":"10.4240/wjgs.v17.i4.101682","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.101682","url":null,"abstract":"<p><strong>Background: </strong>Peptic ulcer disease (PUD) during pregnancy is extremely rare. Perforated peptic ulcer (PPU) during pregnancy has high maternal and fetal mortality. Symptoms attributed to pregnancy and other diagnoses make the diagnosis of preoperative PPU during pregnancy and puerperium challenging.</p><p><strong>Aim: </strong>To identify predictive factors for early diagnosis and treatment, and the association between the diagnosis and maternal/neonatal outcomes.</p><p><strong>Methods: </strong>We searched PubMed, PubMed Central, and Google Scholar. Articles were analyzed following preferred reporting items for systematic reviews and meta-analysis. The search items included: 'ulcer', 'PUD', 'pregnancy', 'puerperium', 'postpartum', 'gravid', 'labor', 'perforated ulcer', 'stomach ulcer', 'duodenal ulcer', 'peptic ulcer'. Additional studies were extracted by reviewing reference lists of retrieved studies. We included all available full-text cases and case series. Demographic, clinical, obstetric, diagnostic and treatment parameters, and outcomes were collected.</p><p><strong>Results: </strong>Forty-three cases were collected. The mean maternal age was 30.9 years; 36.6% were multiparous, and 63.4% were nulliparous or primiparous, with multiparas being older than primiparas. Peptic ulcer perforated in 44.2% of postpartum and 55.8% of antepartum patients. Antepartum PPU incidence increased with advancing gestation 2.3% in the first, 7% in the second, and 46.5% in the third trimester. The most common clinical findings were abdominal tenderness (72.1%), rigidity (34.9%), and distension (48.8%). Duodenal ulcer predominated (76.7%). In 79.5%, the time from delivery to surgery or vice versa was > 24 hours. The maternal mortality during the third trimester and postpartum was 10% and 31.6%, respectively. The trimester of presentation did not influence maternal mortality. The fetal mortality was 34.8%, with all deaths in gestational weeks 24-32.</p><p><strong>Conclusion: </strong>Almost all patients with PPU in pregnancy or puerperium presented during the third trimester or the first 8 days postpartum. Early intervention reduced fetal mortality but without influence on maternal mortality. Maternal mortality did not depend on the use of X-ray imaging, perforation location, delivery type, trimester of presentation, and maternal age. Explorative laparoscopy was never performed during pregnancy, only postpartum.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"101682"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}