ObjectiveTo systematically review the research progress in the selection of metabolic bariatric procedures, efficacy, safety, complication prevention, and long-term management for elderly patients, so as to provide references for surgical decision-making and perioperative management in future metabolic and bariatric surgery for elderly obese patients. MethodA review of recent domestic and international literature on metabolic and bariatric surgery in elderly patients was conducted. ResultsWith the intensification of societal aging, the incidence of obesity and related metabolic diseases among the elderly population has significantly increased. Metabolic and bariatric surgery has been proven to effectively reduce weight and improve obesity-related metabolic diseases in elderly patients. Current guidelines no longer consider age an absolute contraindication for surgery. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly used procedures internationally. SG is superior to RYGB in terms of surgical safety, while RYGB has greater advantages in improving metabolic diseases. Although the postoperative mortality and complications risks in elderly obese patients are higher than those in younger obese patients, strict preoperative assessment and individualized procedure selection can significantly reduce these risks. ConclusionsMetabolic and bariatric surgery can serve as an effective treatment for elderly obese patients, offering comprehensive benefits in weight loss and metabolic improvement. Procedure selection requires individualized assessment, balancing the patient’s baseline condition and metabolic needs. Postoperative success hinges on systematic long-term follow-up and management to ensure sustained benefits and safety. Future efforts should focus on clarifying the definitions or standards of “elderly” and “obesity,” followed by more large-sample, long-term follow-up randomized controlled studies to validate the safety and efficacy of metabolic and bariatric surgery.
Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenumjejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.
Objective To explore the influencing factors for early complications after laparoscopic sleeve gastrectomy (LSG). Methods A retrospective analysis was conducted for the clinical data of 306 obese patients undergoing LSG at the Weight Reduction and Metabolism Center of Xuzhou Medical University Affiliated Hospital of Lianyungang from January 2020 to September 2022. Early postoperative complications (≤30 d) of LSG were classified according to the Clavien-Dindo classification, and the influencing factors of early postoperative complications were explored. Results There were 27 cases (8.8%) suffered from early complications, including 8 cases of grade Ⅰ (2.6%), 15 cases of grade Ⅱ (4.9%), 4 cases of grade Ⅲ (1.3%), there were no grade Ⅳ and grade Ⅴ complications. The multivariate results showed that BMI≥45 kg/m2 [OR=3.63, 95%CI (1.10, 11.92)], high cholesterol [OR=7.12, 95%CI (2.42, 20.95)], and preoperative GERD [OR=3.69, 95%CI (1.11, 12.23)] were influencing factors for early complications. Conclusions LSG is a safe diagnostic and therapeutic method for treating obesity. Attention should be paid to the impact of BMI, high cholesterol, and preoperative GERD on the occurrence of complications after LSG.
ObjectiveTo investigate the feasibility of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer. MethodsThe data of two cases undergoing hand-assisted laparoscopic radical gastrectomy for gastric cancer, including operative time, operation related complications, intraoperative bleeding volumes, number of harvested lymph nodes, postoperative complications, time to restoration of bowel function, and length of postoperative hospital stay, etc, were retrospectively analyzed. ResultsTwo patients had undergone the successful hand-assisted laparoscopic radical total gastrectomy and distal gastrectomy without operation related complications. The operative time was 310 min and 220 min, respectively. While, the intraoperative bleeding volume was 120 ml and 80 ml with the number of harvested lymph node being 38 and 52, respectively. There were no postoperative bleeding, intestinal fistula, and anastomotic leakage， etc. The patients were discharged with smooth and fully recovery. ConclusionThe application of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer is feasible and safe. However, the effectiveness needs further exploring.
ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor. MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared. ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.
ObjectiveTo evaluate the changes of nutritional status following sleeve gastrectomy with ileal interposition duodenojejunal bypass operation in treatment of nonobese type 2 diabetes mellitus. MethodsA total of 47 patients submitted to sleeve gastrectomy with ileal interposition duodenojejunal bypass operation from March 2009 to November 2011 in this hospital were retrospectively analyzed. Serum iron, calcium, vitamin B12, folic acid, albumin (Alb), hemoglobin (Hb), glycosylated hemoglobin (HbA1c), and body mass index (BMI) were assessed before operation and on 6, 12, 24, and 36 months after operation. Results①The values of Alb, Hb, HbA1c, and iron after operation were significantly lower than those of the corresponding values before operation (P < 0.01), the values of calcium, vitamin B12, folic acid, and BMI had no significant differences between after operation and before operation (P > 0.05).②The incidences of the lower Alb and lower iron after operation were significantly higher than those before operation (P < 0.01), the other indexes had no significant differences between after operation and before operation (P > 0.05). ConclusionsSleeve gastrectomy with ileal interposition duodenojejunal bypass operation is an effective treatment of nonobese type 2 diabetes mellitus. However, nutritional deficiency is one of its side effects, which should be properly diagnosed and handled in order to improving the patient's quality of life and preventing related complications.
目的探讨残胃代食管治疗胃大部切除术后食管癌的手术方法及效果 方法回顾分析我院1996年2月至2012年7月手术治疗14例胃大部切除术后食管癌患者的临床资料。其中男13例，女1例，年龄57.2（49～65）岁；5例行弓上吻合，9例行弓下吻合。 结果手术时间（2.3+0.4）h，术中失血量（270.0+60.0）ml；术后禁饮食时间（7.3+1.8）d，住院时间（13.7+3.1）d，无吻合口瘘和围术期死亡；术后并发症发生率为28.57%（4/14），以肺部炎症和心律失常为主。术后1年、3年和5年生存率分别为85.7%、50.0%和21.4%。 结论残胃代食管，将残胃连同脾脏、胰尾移至胸腔，行食管残胃吻合术，适用于治疗胃大部切除术后中下段食管癌，具有一定的优越性。
ObjectiveTo understand the research progress on micronutrient deficiency after gastrectomy for gastric cancer in order to provide a new ideas for its prevention and treatment. MethodThe literature on reseach relevant micronutrient deficiency after gastrectomy for gastric cancer in recent years at home and abroad was searched and reviewed. ResultsThe micronutrient deficiency after partial or total gastrectomy was more common for the patients with gastric cancer, especially some key nutrients such as iron, zinc, copper, fat soluble vitamins (vitamins A, D, E), vitamin B12, folate, and so on. The main reason for the micronutrient deficiency was due to the changes of the anatomical structure or physiological function of the gastrointestinal tract caused by surgery, as most micronutrients were absorbed through the duodenum or jejunum, bypassing the main absorption site of micronutrients after total or partial gastrectomy; In addition, preoperative malnutrition, neoadjuvant therapy, early and late postoperative complications, as well as postoperative adjuvant therapy, and reduced gastric acid secretion, might all lead to the micronutrient absorption disorders. There was also limited literature on the micronutrient supplementation after gastrectomy for gastric cancer, but some researchers still supported providing nutritional support before and after surgery for the gastric cancer patients with severe malnutrition. There was few literature reported on the adverse consequences of nutritional support for the gastric cancer patients underwent gastrectomy. ConclusionsAt present, there is still limited literature on the study of micronutrient deficiency and supplementation after gastrectomy for gastric cancer. With the increasing attention of clinician to the impact of micronutrients on diseases or health, the European Society for Extraintestinal and Enteral Nutrition developed the “ESPEN micronutrition guidelines” in 2022 and “Expert consensus on micronutrients deficiency and supplementation in malignant tumors” was published in China at 2024. In the current situation where relevant research is insufficient, it is recommended that clinicians refer to this guideline or expert consensus and provide personalized intervention for patients with micronutrient deficiencies based on their clinical conditions.
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 investigate the research progress of assisted techniques for lymph node dissection in gastric cancer. Method The literatures on the applications of assisted techniques of lymph node dissection in the gastric cancer radical gastrectomy in recent years were reviewed. ResultsAt present, the assisted techniques used for lymph node dissection in the radical gastrectomy mainly included the lymphatic tracing technology and laparoscopic and robotic surgeries. The lymphatic tracing technology mainly included the use of dye tracers, indocyanine green, gamma probe, intraoperative radiation technology, etc. Among which gamma probe and intraoperative radiation technology were expensive and not suitable for clinical application, and intraoperative radiation technology had a radiation risk, so it was rarely used currently. At present, the dye tracers and indocyanine green were mainly used in the clinical lymph node tracing, both of which could improve the detection rate and increase the number of lymph node dissection, and improve the prognosis of patients. The laparoscopic radical gastrectomy was not inferior to traditional radical gastrectomy in terms of lymph node dissection, and had been more widely used in the clinical practice due to its advantages of visualization, minimally invasive, quickly postoperative recovery, and good short-term efficacy. Compared with the conventional laparoscopic system, the robotic surgical system was more precise, dexterous, stable, and had a better feedback feeling, which was more conducive to the lymph node dissection of special location. ConclusionUse of lymphatic tracers, laparoscopy and robotics could increase lymph node detection rate and improve prognosis of patients.