World Journal of Gastrointestinal Surgery最新文献

{"title":"One-anastomosis gastric bypass <i>vs</i> sleeve gastrectomy for complications, perioperative status, and quality of life: Meta-analysis.","authors":"Hyder Osman Mirghani","doi":"10.4240/wjgs.v18.i1.112017","DOIUrl":"10.4240/wjgs.v18.i1.112017","url":null,"abstract":"<p><strong>Background: </strong>One-anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) are safe and effective bariatric surgeries. Literature assessing the complications, mortality, operative time/minutes, hospital stay/days, gastroesophageal reflux (GORD), malnutrition, and quality of life is scarce.</p><p><strong>Aim: </strong>To compare OAGB and SG regarding the above outcomes.</p><p><strong>Methods: </strong>We searched 4 databases from inception up to July 2025. The keywords bariatric surgery, metabolic surgery, gastric bypass, SG, complications, perioperative, quality of life, operative time, hospital stay, GORD, malnutrition, and mortality were used. Out of 1163 studies retrieved, 54 full texts were reviewed, and 31 studies were included in the meta-analysis.</p><p><strong>Results: </strong>No significant differences were evident between OAGB and SG regarding complications, odds ratio (OR), 1.37, 95% confidence interval (CI): 0.78-2.41. Operative time/minutes, hospital stay/days, and quality of life were similar between the two procedures, mean differences, 2.55, 95%CI: 3.61-8.70; -0.55, 95%CI: -1.12 to 0.02; and -0.37, 95%CI: -1.18 to 0.43 respectively, in sub-analyses including super-obesity and high diabetes, no significant differences were found regarding complications rate and operative time with higher hospital stay in patients with diabetes. Mortality and GORD were higher in SG, OR, 4.70, 95%CI: 1.64-13.52, and OR, 3.23, 95%CI: 1.56-6.72, while malnutrition was more common in OAGB, OR, 0.46, 95%CI: 0.36-0.59.</p><p><strong>Conclusion: </strong>There were no differences between OAGB and SG regarding complications, mortality, operation time/minutes, hospital stay/days, and quality of life. Mortality and GORD were higher in SG, while malnutrition was higher in OAGB. Further well-controlled trials comparing OAGB and SG regarding long-term outcomes are needed.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"112017"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203092","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":"Age and red cell distribution width in pancreatic cystic neoplasms: A simple tool for preoperative malignancy risk stratification.","authors":"Shu-Qi Ren, Yuan-Huan Han, Chuang Cai","doi":"10.4240/wjgs.v18.i1.115078","DOIUrl":"10.4240/wjgs.v18.i1.115078","url":null,"abstract":"<p><p>The study conducted by Martli <i>et al</i>, on the preoperative risk stratification of malignant potential in pancreatic cystic neoplasms (PCNs), identifies age and red cell distribution width (RDW) as independent predictors. This study offers a simple and cost-effective clinical tool for preoperative assessments. The significance lies in its integration of routine laboratory parameters with clinical features, effectively addressing the limitations associated with the accessibility and operator dependency of imaging and invasive diagnostic methods. However, factors such as the retrospective design, single-center setting, small sample size, and selection bias because of the inclusion of only surgical cases limit the generalizability of the findings. Future studies should emphasize multi-center prospective validation to further clarify the biological role of RDW in the malignant transformation of PCNs and to explore integrated models that combine RDW with imaging characteristics and molecular biomarkers, ultimately enhancing precision in individualized clinical decision-making.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"115078"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202651","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":"Successful treatment of gastrobronchial fistula following laparoscopic sleeve gastrectomy: A case report and review of literature.","authors":"Kai-Ho Fang, Hao-Ming Chang, Ti-Hui Wu","doi":"10.4240/wjgs.v18.i1.114041","DOIUrl":"10.4240/wjgs.v18.i1.114041","url":null,"abstract":"<p><strong>Background: </strong>Gastrobronchial fistula (GBF) is a rare but severe complication after sleeve gastrectomy (SG). GBF is associated with significant morbidity and mortality. Diagnosis is often delayed due to nonspecific symptoms. Therefore, timely recognition and management are critical. Endoscopic management, as the cornerstone of initial therapy, can be performed in a combined or stepwise manner for chronic or refractory cases.</p><p><strong>Case summary: </strong>A 48-year-old male with class II obesity and metabolic syndrome underwent laparoscopic SG. Six months later, he developed poor oral intake, chest pain, and dyspnea. Chest radiography and computed tomography revealed massive left pleural effusion, and laboratory tests showed leukocytosis. Video-assisted thoracoscopic surgery and esophagogastroduodenoscopy revealed a fistulous tract between the sleeved stomach and pleural cavity. Management included decortication, nasoduodenal feeding, and multiple sessions of endoscopic vacuum therapy. Although the fistula orifice decreased in size, an upper gastrointestinal series performed during follow-up indicated progression to GBF. We repeated decortication and placed a covered self-expandable metallic stent. Six weeks later, the stent was removed. Esophagogastroduodenoscopy confirmed that the GBF successfully healed.</p><p><strong>Conclusion: </strong>Early suspicion, prompt diagnosis, and adequate intervention of GBF are crucial when the complication arises after laparoscopic SG. Endoscopic approaches, such as endoscopic vacuum therapy and stenting, are effective first-line therapies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"114041"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202865","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":"Biliary complications following donation after brainstem death liver transplantation.","authors":"Rawan Al-Rubaye, Mohamed Elshaer, Karim R Moawad, Rohit Gaurav","doi":"10.4240/wjgs.v18.i1.112906","DOIUrl":"10.4240/wjgs.v18.i1.112906","url":null,"abstract":"<p><strong>Background: </strong>Biliary complications are increasingly seen after liver transplantation. Different modalities are used to overcome these complications. In this study, we investigated the occurrence of biliary complications following donation after brainstem death (DBD) liver transplant and their management.</p><p><strong>Aim: </strong>To investigate the occurrence and management of biliary complication in patients who underwent orthotopic liver transplant (OLT) with grafts from DBD donors between October 2014 and October 2020.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent DBD OLT from October 2014 to October 2020. The primary outcome was biliary stricture, and the secondary outcome was return to theatre.</p><p><strong>Results: </strong>A total of 366 patients underwent DBD whole OLT during the study period. There were 229 (62.6%) males and 137 (37.4%) females. Recipients median age was 55 years (range 16-73 years) and donors median age was 51 years (range 11-89 years). Mean cold ischemic time was 581 ± 218.7 minutes. Duct to duct anastomosis was performed in 240 (65.6%) patients, and 126 (34.4%) patients underwent Roux-en-Y hepaticojejunostomy (RYHJ). Eighteen (4.9%) patients experienced bile leak, 39 (10.7%) patients experienced anastomotic biliary stricture and 18 (4.9%) patients had ischemic cholangiopathy. Main and segmental hepatic artery thrombosis occurred in 27 (7.4%) patients, 29 (7.9%) patients had early allograft dysfunction, and six (1.6%) patients experienced primary non function. Among 39 patients who developed anastomotic biliary stricture, 21 (53.8%) were treated with RYHJ representing 5.7% of the total transplant group. Endoscopic retrograde cholangiopancreatography was performed in nine patients (23.1%), conservative management in six patients (15.4%), percutaneous transhepatic cholangiography in two patients (5.1%) and re-transplantation in one patient who had concomitant ischemic cholangiopathy (2.6%). Overall, 84 (22.9%) patients returned to theatre and 27 (7.4%) patients underwent retransplant over five years follow up period. Multivariate analysis confirmed that RYHJ reconstruction emerged as the only significant independent protective factor against biliary complications (odds ratio = 0.473, 95% confidence interval: 0.23-0.97, <i>P</i> = 0.041).</p><p><strong>Conclusion: </strong>Biliary complications following DBD liver transplant are a frequent occurrence and careful monitoring and planning are required to improve patients' outcomes.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"112906"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202881","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":"Fu Zheng Li Qi Tang combined with FOCUS-PDCA model in postoperative rehabilitation of elderly biliary surgery patients.","authors":"Liu-Liu Zhou, Chun-Ling Li, Jin-Feng Zhang, Chun Wu, Zhi-Jun Cheng","doi":"10.4240/wjgs.v18.i1.113989","DOIUrl":"10.4240/wjgs.v18.i1.113989","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients undergoing biliary surgery face high risks of postoperative complications and delayed recovery due to reduced physiological reserve and frequent comorbidities. Effective rehabilitation strategies are urgently needed. Traditional Chinese medicine, such as Fu Zheng Li Qi Tang, may support recovery through multi-targeted regulation, while the find, organize, clarify, understand, select, plan, do, check and act (FOCUS-PDCA) model offers a systematic approach to optimize nursing quality. We hypothesized that combining Fu Zheng Li Qi Tang with the FOCUS-PDCA model would significantly improve postoperative recovery in elderly biliary surgery patients compared to routine care.</p><p><strong>Aim: </strong>To evaluate the effect of Fu Zheng Li Qi Tang plus FOCUS-PDCA on postoperative recovery in elderly biliary surgery patients.</p><p><strong>Methods: </strong>One hundred and twenty elderly biliary surgery patients (age ≥ 60 years) were randomized into a control group (<i>n</i> = 60) receiving Fu Zheng Li Qi Tang and routine nursing, and an observation group (<i>n</i> = 60) receiving additional FOCUS-PDCA model. Postoperative recovery indicators (time to first flatus, ambulation, hospitalization), Visual Analog Scale pain scores, complications, and nursing satisfaction were compared.</p><p><strong>Results: </strong>The duration of postoperative bed rest, time to first flatus, and length of hospital stay in the observational group were all shorter than those in the control group (<i>P</i> < 0.0001). The Visual Analog Scale scores of patients in both groups at all time points after the operation were significantly reduced, and the scores of the observation group at all time points were lower than that of the control group (<i>P</i> < 0.0001). Moreover, the total incidence rate of complications in the patients of the observation group was lower, and the satisfaction with the nursing care was higher (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Fu Zheng Li Qi Tang combined with FOCUS-PDCA model accelerates postoperative recovery, relieves pain, reduces complications, and improves nursing satisfaction in elderly biliary surgery patients, demonstrating significant clinical value.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"113989"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202979","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":"Laparoscopic hepatectomy is feasible for patients diagnosed with hepatocellular carcinoma and cirrhotic liver.","authors":"Krerkrit Kijpongpans, Shunichi Ariizumi, Yusuke Ome, Yusuke Kawamoto, Yutaro Matsunaga, Goro Honda","doi":"10.4240/wjgs.v18.i1.114262","DOIUrl":"10.4240/wjgs.v18.i1.114262","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) commonly arises in cirrhotic livers. Laparoscopic hepatectomy (LH) has shown promising outcomes, but its safety in moderate liver dysfunction remains unclear. Despite comparable surgical indications for LH and open hepatectomy (OH), data on impaired liver function are scarce. The Japanese Liver Damage Grading System (LDGS), incorporating indocyanine green retention at 15 min, provides a precise functional assessment.</p><p><strong>Aim: </strong>To compare short-term and long-term outcomes of LH and OH in patients with HCC LDGS grade B or C.</p><p><strong>Methods: </strong>The 97 patients with HCC and LDGS grade B or C who underwent hepatectomy (26 LH; 71 OH) between 2010 and 2022 at Tokyo Women's Medical University Hospital were retrospectively analyzed. Propensity score matching (1:1) was applied. Baseline biochemical and tumor characteristics were compared. Short-term and long-term outcomes were assessed.</p><p><strong>Results: </strong>Before matching patients who underwent LH had smaller tumors (2.7 cm <i>vs</i> 4.5 cm, <i>P</i> = 0.004) and lower surgical difficulty scores (<i>P</i> < 0.001). After matching LH was associated with lower intraoperative blood loss (242 mL <i>vs</i> 941 mL; <i>P</i> = 0.049), reduced postoperative ascites (0% <i>vs</i> 21.2%; <i>P</i> = 0.035), and shorter hospital stay with no conversion to OH. The 5-year overall survival rate was significantly higher in the LH group (91% <i>vs</i> 36%; <i>P</i> = 0.021) while recurrence-free survival was comparable.</p><p><strong>Conclusion: </strong>LDGS provides a comprehensive assessment of surgical candidates with moderate cirrhosis. In patients with HCC and grade B or C liver damage, LH appears to have better long-term outcomes than OH due to reduced morbidity and preservation of liver function.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"114262"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202985","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":"Patterns and risk factors of early recurrence after radical resection for intrahepatic cholangiocarcinoma.","authors":"Chen-Yang Zhou, Jing-Yuan Chen, Dan Wang, Shu Zhu, Hong-Chang Luo","doi":"10.4240/wjgs.v18.i1.113518","DOIUrl":"10.4240/wjgs.v18.i1.113518","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intrahepatic cholangiocarcinoma (ICC) represents the second-most prevalent primary hepatic malignancy, demonstrating increasing worldwide occurrence. Although surgical methods have progressed, outcomes following curative resection remain suboptimal due to substantial recurrence frequencies. Recurrence occurring early, usually during the initial postoperative year, indicates aggressive tumor characteristics and predicts inferior outcomes compared with delayed recurrence. Comprehending patterns and predictive indicators of early relapse is essential for refining postoperative monitoring approaches and directing adjuvant treatment choices. The present investigation concentrated on determining risk indicators and recurrence characteristics to enhance personalized patient management strategies for ICC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To determine the characteristics and predictive indicators of early disease recurrence following curative surgical resection of ICC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective evaluation of 386 consecutive individuals who received curative surgical resection for ICC at our institution during the period spanning January 2017 through December 2021. Early disease recurrence was operationally defined as tumor relapse occurring within the first 12 postoperative months. Predictive indicators were examined through univariate and multivariate Cox proportional hazards regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Within our cohort of 386 individuals, 237 patients (61.4%) demonstrated disease recurrence throughout the observation period, with 178 cases (75.1%) manifesting early recurrence. The predominant anatomical locations of recurrent disease included hepatic tissue (66.7%), regional lymph nodes (18.1%), and peritoneal surfaces (8.0%). Independent predictive indicators of early recurrence encompassed: Neoplasm diameter exceeding 5 cm [hazard ratio (HR) = 2.14, 95% confidence interval (CI): 1.52-3.01, &lt;i&gt;P&lt;/i&gt; &lt; 0.001], presence of multiple tumor foci (HR = 1.89, 95%CI: 1.34-2.67, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), metastatic lymph node involvement (HR = 2.43, 95%CI: 1.71-3.45, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), microscopic vascular invasion (HR = 1.76, 95%CI: 1.25-2.48, &lt;i&gt;P&lt;/i&gt; = 0.001), carbohydrate antigen 19-9 concentrations surpassing 200 U/mL (HR = 1.92, 95%CI: 1.37-2.69, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and incomplete surgical margins (HR = 2.01, 95%CI: 1.38-2.93, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Individuals experiencing early recurrence demonstrated markedly reduced overall survival relative to those with delayed recurrence (median: 18.5 months &lt;i&gt;vs&lt;/i&gt; 42.3 months, &lt;i&gt;P&lt;/i&gt; &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Early disease recurrence following ICC resection occurs frequently and correlates with unfavorable clinical outcomes. Several neoplasm-associated and treatment-associated characteristics predict early relapse. These indicators can facilitate identification of patients at elevated risk who might benefit from int","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"113518"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12897915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203045","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":"Perioperative characteristics and outcomes of colorectal cancer in elderly patients.","authors":"Abdullah Sultan, Zaidi Zakaria, Samiya Riaz, Mohammed Dauda Goni, Andee Dzulkarnaen Zakaria","doi":"10.4240/wjgs.v18.i1.113040","DOIUrl":"10.4240/wjgs.v18.i1.113040","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) in older adults presents unique management challenges due to age-related physiological changes and comorbidities. However, this demographic is often underrepresented in clinical research.</p><p><strong>Aim: </strong>To characterise the perioperative features and outcomes of older CRC patients undergoing surgery at a tertiary hospital in Malaysia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using patient records of older individuals (≥ 65 years old) diagnosed with CRC and who underwent surgery at USM Specialist Hospital, Malaysia, between January 2017 and December 2021. Data on patient characteristics, operative details, pathological findings, body mass index (BMI) based on the Asian classification and postoperative outcomes were collected. Statistical analysis employed <i>χ</i> ² and <i>t</i>-tests to determine associations and identify significant predictors.</p><p><strong>Results: </strong>The study included 98 participants (57.1% males, 82.7% Malay), with the majority aged 65-69 years (44.9%). BMI indicated a significant association with age group (<i>P</i> = 0.023), with obesity more prevalent among individuals aged 70-74 years and 75-79 years. Type of operation (<i>P</i> = 0.046) and PN stage (<i>P</i> = 0.027) were also significantly associated with age group. Adjuvant treatment demonstrated a significant association with recurrence and follow-up (<i>P</i> = 0.006). Multivariate analysis revealed that BMI, ischaemic heart disease, and M stage were statistically significant predictors of patient survival after follow-up. Overweight patients were 11.22 times more likely to survive than those who were underweight [adjusted odds ratio (aOR) = 11.22, <i>P</i> = 0.016], whereas patients with ischaemic heart disease (aOR = 0.07, <i>P</i> = 0.027) or M1 stage disease (aOR = 0.24, <i>P</i> = 0.014) had significantly lower survival odds.</p><p><strong>Conclusion: </strong>BMI, ischaemic heart disease, and metastatic status are critical determinants of survival, highlighting the importance of comprehensive preoperative assessment and individualised management strategies in this vulnerable population. Further larger-scale, longitudinal studies are needed to improve outcomes among older adults with CRC.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"113040"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12897905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203089","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":"Comparison of epidural anesthesia and intravenous self-control analgesia on postoperative recovery quality in duodenectomy.","authors":"Pan-Pan Li, Qiang Qu, Chang-Hui Shao","doi":"10.4240/wjgs.v18.i1.112988","DOIUrl":"10.4240/wjgs.v18.i1.112988","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy is associated with significant postoperative pain and morbidity. Both epidural anesthesia (EA) and intravenous patient-controlled analgesia (IVPCA) are commonly used for pain management, yet their comparative effectiveness on postoperative recovery quality remains unclear.</p><p><strong>Aim: </strong>To evaluate and compare the effects of these two analgesic techniques on recovery outcomes following pancreaticoduodenectomy.</p><p><strong>Methods: </strong>We retrospectively analyzed 186 patients (92 EA; 94 IVPCA) who underwent pancreaticoduodenectomy between January 2018 and December 2022, comparing outcomes including pain scores, ambulation time, bowel function recovery, hospital stay, complications, and patient satisfaction, with propensity score matching used to minimize selection bias, followed by appropriate statistical analysis.</p><p><strong>Results: </strong>After propensity score matching, EA patients demonstrated significantly lower pain scores (<i>P</i> < 0.001), earlier ambulation (28.5 ± 6.3 hours <i>vs</i> 41.2 ± 8.7 hours, <i>P</i> < 0.001), faster return of bowel function (65.3 ± 12.6 hours <i>vs</i> 78.9 ± 15.4 hours, <i>P</i> < 0.001), shorter hospital stays (14.2 ± 3.7 days <i>vs</i> 16.8 ± 4.2 days, <i>P</i> = 0.003), and higher satisfaction scores (8.3 ± 1.2 <i>vs</i> 7.1 ± 1.5, <i>P</i> < 0.001) compared to IVPCA patients.</p><p><strong>Conclusion: </strong>EA provides superior pain control, facilitates earlier ambulation and return of bowel function, shortens hospital stay, and improves patient satisfaction compared to IVPCA in patients undergoing pancreaticoduodenectomy. Despite a higher incidence of hypotension, EA appears to be the preferable analgesic technique for enhancing postoperative recovery quality in pancreaticoduodenectomy.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"112988"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202799","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":"Septic shock reduces intestinal microcirculation and anastomotic perfusion: A porcine laser speckle contrast imaging study.","authors":"Rupan Paramasivam, Claudia Jaensch, Nickolai M Kristensen, Susie Sarah Paramasivam, Helen Woldeselassie, Louise Kruse Jensen, Anders Husted Madsen, Mai-Britt Worm Ørntoft","doi":"10.4240/wjgs.v18.i1.111928","DOIUrl":"10.4240/wjgs.v18.i1.111928","url":null,"abstract":"<p><strong>Background: </strong>Septic shock disrupts systemic and organ-specific microcirculation, leading to poor tissue perfusion and impaired healing. While mesenteric hemodynamics have been studied, the impact of sepsis on intestinal microcirculation and anastomotic healing remains unclear.</p><p><strong>Aim: </strong>To assess the short-term effects of septic shock on microcirculation in the small intestine and colon, with a focus on hand-sewn and stapled anastomoses, using laser speckle contrast imaging (LSCI).</p><p><strong>Methods: </strong>Ten pigs underwent midline laparotomy with the creation of four anastomoses: One hand-sewn and one stapled anastomosis in both the small intestine and colon. LSCI measurements were taken before anastomosis formation (T_B), immediately after (T_A), and after one hour of rest (T₀). Septic shock was induced <i>via</i> intravenous <i>Escherichia coli</i> infusion, with subsequent LSCI measurements at 30-minute intervals (T₃₀-T₁₅₀). Results were expressed as relative changes compared to T_B.</p><p><strong>Results: </strong>Septic shock significantly reduced microcirculation in both untouched intestine and anastomoses. Hand-sewn anastomoses consistently exhibited higher perfusion than stapled anastomoses. At T₁₅₀, perfusion in hand-sewn anastomoses remained significantly higher than in stapled anastomoses (51% <i>vs</i> 34% of T_B, <i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>This study shows that septic shock significantly impairs intestinal microcirculation indicating a risk of intestinal ischemia if bacteriaemia and subsequent septic shock is untreated. Due to diminish blood flow following septic shock, the anastomotic healing may be compromised leading to increased risk of anastomotic leakage. Conclusively, this study provides a foundation for optimizing surgical strategies and improving patient outcomes in this high-risk population.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 1","pages":"111928"},"PeriodicalIF":1.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202811","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}