In perioperation period, the dynamic changes of solubla interleulcin-2 receptor (sIL-2R) in serum were determined by ELISA in 60 patients with gastric cancer (GC), and then was compared with those of 30 normal individuals and 40 selective patients who necieved common abdominal surgery. Results: At the day before and ten days after operation, the sIL-2R of patients with GC was higher than that of normal individual. But twenty days after operation, the sIL-2R reduced to as normal level. Conclusion: As a immunodepressive index, the sIL-2R of patients with GC was increased obviously, and after radical gastrectomy, it decreased gradually. So by determining sIL-2R, we can evaluate the immunologic function of patientswith GC.
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.
ObjectiveTo explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).MethodThe clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.ResultsTLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.ConclusionFrom preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.
With the swift evolution of bariatric and metabolic surgery, additional procedures building upon sleeve gastrectomy have consistently surfaced. Recent studies suggest that sleeve gastrectomy with jejunojejunal bypass (SG-JJB) yields superior short-term weight reduction outcomes compared to sleeve gastrectomy alone, with weight loss and glycemic control effects akin to Roux-en-Y gastric bypass, and without significant complications. As a result, SG-JJB is regarded as a safe and efficacious bariatric procedure, noted for its technical simplicity and reversibility, presenting substantial clinical utility. Nonetheless, high-quality, multicenter, large-sample, long-term follow-up randomized controlled trials are essential to further ascertain its long-term efficacy and safety, and to facilitate its standardized implementation. This article seeks to review the advancements in SG-JJB research, evaluate its effectiveness and safety in managing obesity and associated comorbidities, and explore its future developmental trajectory.
ObjectiveTo evaluate the weight loss outcomes, metabolic disease remission, and complications profiles of laparoscopic sleeve gastrectomy (LSG) based on a large single-center cohort experience. MethodsA retrospective observational study was conducted. Clinical data of patients who underwent LSG at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from June 2021 to June 2024 were collected based on predefined inclusion and exclusion criteria. The outcomes including percentage of total weight loss (%TWL), metabolic disease remission, and the incidence of postoperative complications were assessed. ResultsA total of 1 568 patients met the inclusion and exclusion criteria were finally included, including 304 males and 1 264 females. The age at surgery was (31.51±8.01）years old, and the body mass index was (37.26±4.18) kg/m2. At 1 year after surgery, the %TWL was (32.84±6.38)%, and the complete remission rate of diabetes was 96.2% (304/316). Complications within 1 year after surgery: 1 (0.06%) case of postoperative bleeding, 2 (0.13%) cases of gastric leakage, 1 (0.06%) case of vitamin B1 deficiency, and 1 (0.06%) case of unilateral common peroneal nerve entrapment injury. The total complications rate was 0.32% (5/1 568). No mortality was observed. ConclusionsLSG has significant short-term efficacy and higher safety in treatment of obesity and related metabolic diseases. In particular, experiences in aspects such as complications prevention and multidisciplinary follow-up management could provide references for centers in the early stage of development.
ObjectiveTo analyze the risk factors affecting delayed gastric emptying (DGE) after laparoscopic distal gastrectomy for gastric cancer. MethodsThe gastric cancer patients who underwent laparoscopic distal gastrectomy in the Jiaozuo People’s Hospital from January 1, 2013 to December 31, 2022 were retrospectively collected. The occurrence of DGE was recorded. Meanwhile, the multivariate binary logistic regression analysis was performed to screen the risk factors affecting the DGE. ResultsA total of 350 gastric cancer patients underwent laparoscopic distal gastrectomy and met the inclusion and exclusion criteria of this study were included, 17 (4.9%) of whom developed DGE. The multivariate binary logistic regression analysis results showed that the preoperative gastric outflow tract obstruction (OR=8.582, P=0.009), intraoperative jejunal nutrition tube indwelling (OR=14.317, P=0.010), more peritoneal drainage tube placement (OR=5.455, P=0.006), and intraoperative blood loss ≥140 mL (OR=4.912, P=0.018) increased the risk of DGE. ConclusionAccording to the results of this study, when patients undergoing laparoscopic distal radical gastrectomy for gastric cancer accompanied by preoperative gastric outflow tract obstruction, intraoperative jejunal nutrition tube indwelling, more peritoneal drainage tube placement, and more intraoperative blood loss, it should be paid more attention to prevention DGE, and early detection and treatment, so as to improve the prognosis of patients.
ObjectiveTo measure gastric wall thickness in patients with obesity and to investigate the relation between gastric wall thickness and clinicopathologic characteristics. MethodsThe clinicopathologic data of the patients who underwent laparoscopic sleeve gastrectomy (LSG) in the Affiliated Hospital of Xuzhou Medical University from February to August 2023 were collected. The gastric wall thickness of the gastric tissue specimens resected following LSG was measured by a tissue measuring device at 3 predetermined positions (gastric antrum, gastric body, and gastric fundus) at a compressive pressure of 8 g/mm2, and multiple linear regression was used to analyze the factors affecting the thickness of the gastric wall. ResultsA total of 232 patients were collected in this study, including 49 males and 183 females. Preoperative body mass index (BMI) was 28.2–61.8 kg/m2 with (38.4±5.3) kg/m2, and the patients with BMI ≥40 kg/m2 were 82 cases and <40 kg/m2 were 150 cases. The thickness of the gastric wall in the gastric antrum, gastric body, and gastric fundus of 232 patients was (3.04±0.38) mm, (2.26±0.51) mm, and (1.63±0.32) mm, respectively. The results of multiple linear regression analysis showed that the thickness of the gastric wall at the gastric antrum was related to the gender of the patients, that is, the thickness of the gastric wall at the gastric antrum was thinner in the females as compared with the males (standard coefficients β=–0.152, t=–2.167, P=0.031), while the thickness of the gastric wall at the gastric fundus was related to the BMI of the patients, and the higher BMI, the thicker thickness of the gastric wall at the gastric fundus (standard coefficients β=0.153, t=2.281, P=0.023). ConclusionsAccording to the results of this study, the thickness of the gastric wall is related to the anatomical position of the gastric wall. During LSG surgery, the size and height of the Staple lines are selected at different anatomical positions of the cutting edge for males and obese patients with higher BMI.
Metabolic and bariatric surgery has continued to evolve under the dual imperatives of efficacy and safety. Sleeve gastrectomy (SG) with transit bipartition (SG-TB), derived from SG, reconstructs a “dual-channel” pathway that preserves the pylorus and proximal small-bowel function, while aiming to achieve metabolic effects comparable to biliopancreatic diversion with fewer severe nutritional complications. In 2025, the first Chinese expert consensus on SG-TB was released, and the inaugural international SG-TB consensus meeting was convened in Europe, reaching preliminary alignment on procedure classification, key technical parameters, and indications/contraindications. Emerging clinical evidence indicates that SG-TB confers advantages in weight reduction, remission of type 2 diabetes, and prevention of gastroesophageal reflux disease, and also demonstrates feasibility in revisional surgeries and complex cases. Nevertheless, current studies are predominantly observational, with limited evidence quality and considerable heterogeneity. Stratification of surgical parameters and establishment of reproducible training systems remain unmet needs. Building upon a synthesis of national and international consensus statements and recent clinical advances, this commentary further analyzes the challenges that SG-TB faces in procedural heterogeneity, evidence accumulation, individualized practice, and mechanistic research. This commentary seeks to offer practical reference and research directions for the bariatric community, ultimately supporting the advancement of SG-TB from a promising technique toward standardized and mainstream adoption.
The conectration of cholecystokinin infasting serum was determined by radioimmunoessay in 30 patients with gastric antrum cancer before and after radical sbutotal gastrectomy.It was 119.6±142.2pmol/L before the operation and 78.5±149.2pmol/L after the operation,which was significantly lower than that before the operation,P=0.022. The result suggests that the reduction of cholecytokinin secretion after gastrectomy was one of the important causes in the bile stasis,the disturbance of gallbladder emptying funcion and the formation of gallstone.
ObjectiveTo compare effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and single anastomosis sleeve ileal (SASI) bypass on weight loss and glucose regulating as well as difference in micronutrient deficiency in obese rats with type 2 diabetes mellitus. MethodsThirty-six Spraque-Dawley rats fed with high fat diet combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg) for 1 month were used to induce obese rats with type 2 diabetes mellitus, then were randomly averagely divided into 3 groups: SADI-S group, SASI group, and sham operation (SO) group. Eight rats from numbered rats of each group were randomly selected to carry out experimental observation. The rats’ body weight, food intake, and fasting blood glucose (FBG) were measured from before operation to postoperative 1–6 months. Meanwhile blood was collected before surgery, as well as at month 1 and 6 after surgery for oral glucose tolerance testing (OGTT) and insulin resistance testing (ITT). Serum glucagon-like peptide (GLP-1), hemoglobin, and albumin levels, as well as vitamin B12, calcium, and ferrum concentrations were measured before surgery as well as at month 1 and 6 after surgery. Results① The body weight, food intake (except 5–6 months), and FBG level in the SADI-S group and SASI group were lower than the SO group (P<0.05) from 1- to6-month after operation, and all obviously decreased at month 1 after operation (P<0.05), but there was no statistical differences between the SADI-S group and SASI group (P>0.05). ② The postoperative OGTT and ITT blood glucose levels in the SADI-S group and SASI group were lower than those in the SO group (P<0.05) and were lower than those in the preoperative levels (P<0.05), and the SADI-S group had a lower OGTT blood glucose level than the SASI group at month 6 after operation (P<0.05). ③ The GLP-1 levels of the SADI-S group and SASI group were higher than that of the SO group (P<0.05), and higher than before operation at month 6 after operation (P<0.05) , but there was no statistical difference was found between the SADI-S group and SASI group after operation (P>0.05). ④ The postoperative albumin levels of the SADI-S group and SASI groups= were lower than of the SO group (P<0.05) and were lower than before operation, and albumin level of the SADI-S group was lower than of the SASI group at postoperative month 6 (P<0.05); while the hemoglobin had no statistical differences among the 3 groups (P>0.05). ⑤ The ferrum concentration of the SADI-S group was lower than that of the SASI group and SO group at 1 month after operation (all P<0.05), while it increased slightly at month 6 after operation and had no statistical difference between the SADI-S group and SASI group (P>0.05); the calcium concentrations of the SADI-S group and SASI group only at 6 month after operation were lower than those of the SO group (P<0.05), and were lower as compared with before operation (P<0.05) , but no statistical difference was found between the SADI-S group and SASI group (P>0.05); the vitamin B12 had no statistical differences among the 3 groups (P>0.05). ConclusionsFor obese rats with type 2 diabetes mellitus, SADI-S and SASI have similar weight loss effect. Long-term glucose reduction of SADI-S shows a advantage than SASI, but influence of postoperative micronutrients of SASI is inferior to SASI.