The “Guidelines for the Diagnosis and Treatment of Obesity (2024 Edition)” was formulated by the National Health Commission in cooperation with multidisciplinary experts nationwide, and was formally released on October 17, 2024. As China’s first authoritative guideline for obesity, it comprehensively covers the etiology, epidemiology, diagnosis, classification, staging, and related diseases of obesity. The guideline emphasizes the high risk of obesity-related diseases, and for the first time puts forward a standardized diagnosis and treatment pathway, sorting out various treatment options including lifestyle interventions, pharmacotherapy, metabolic/bariatric procedures, and traditional Chinese medicine treatments. At the same time, the guideline advocates the multi-disciplinary treatment model, which integrates expertise and methodologies from various disciplines to develop personalized treatments for patients. We interpreted and discussed the diagnostic assessment and multimodal management of obesity, so as to enhance readers’ understanding of the guideline and promote the standardization of evidence-based practices in obesity care.
ObjectiveTo investigate the effects of early enteral nutrition containing ω-3 polyunsaturated fatty acids combined with intravenous infusion of alanyl-glutamine on inflammatory response and immune function of postoperative gastric cancer patients.MethodsA total of 110 patients, accepting radical operation for gastric cancer in West China Hospital of Sichuan University during October 2017 to December 2018, were prospectively incorporated in the study and were randomly divided into 2 groups equally. Patients in the control group were enterally fed with a formula containing ω-3 polyunsaturated fatty acids for 6 consecutive days after surgery. Patients in the experimental group accepted the same enteral feeding but combined with intravenous infusion of alanyl-glutamine (20 g/d). Both enteral feeding and intravenous infusion started within 24 hours after surgery. Peripheral venous blood was gathered within 3 days before surgery and on the morning of the first, third, and seventh postoperative days to detect inflammatory, immunological, and nutritional indexes. Complications, length of hospital stay, and hospital cost were also taken notes.ResultsFifty-two patients in the control group and fifty-two patients in the experimental group respectively finished the study. In both groups, 3 patients withdrew from the study for inadequacy of radical operation. Neutrophilic granulocyte percentage, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) on the third postoperative day, C-reactive protein (CRP), procalcitonin (PCT), IL-6, and TNF-α on the seventh postoperative day, were significantly lower in the experimental group (P<0.05). Immunological indexes including immunoglobulin G (IGG), immunoglobulin A (IGA), percentage of CD3+ T cells, and percentage of CD4+ T cells, nutritional markers including total protein (TP), plasma albumin (ALB), and prealbumin (PAB) were significantly higher in the experimental group on the seventh postoperative day (P<0.05). When the study ended, none significant differences of the rates of both infectious complications (wound infection, intra-abdominal infection, pulmonary infection, urinary system infection, blood system infection, and anastomotic fistula) and noninfectious complications (diarrhea, abdominal distension, and abdominal pain) were observed between the two groups (P>0.05). Time of the first anal discharge, length of hospital stay, and hospitalization cost between the two groups were not significantly different neither (P>0.05).ConclusionEarly enteral nutrition containing ω-3 polyunsaturated fatty acids combined with intravenous infusion of alanyl-glutamine contributes to reduce inflammatory response and improve immune function and nutrition status of patients with gastric cancer after surgery.
Objective To compare the postoperative outcomes of elderly and non-elderly patients undergoing inguinal hernia repair in same-day surgery mode, and explore the utility and safety of same-day surgery mode in inguinal hernia repair. Methods Patients who underwent inguinal hernia repair in Day Surgery Center, West China Hospital of Sichuan University between January 1st 2021 and October 31st 2021 were prospectively included. The patients were divided into elderly group (≥60 years old) and non-elderly group (18-59 years old). The preoperative conditions, postoperative outcomes, discharge readiness and social support of the two groups were analyzed. Results A total of 451 patients were enrolled, including 111 elderly patients and 340 non-elderly patients. The male proportion, prevalence rates of preoperative comorbidities, and bilateral inguinal hernia proportion in the elderly group were significantly higher than those in the non-elderly group (P<0.05), and the body mass index in the elderly group were significantly lower than that in the non-elderly group (P<0.05). There was no significant difference in anesthesia method, analgesic method, bleeding volume, or surgery time between the two groups (P>0.05). The postoperative pain score of the non-elderly group was higher than that in the elderly group (Z=–2.226, P=0.026), but there was no statistically significant difference in the rate of postoperative unplanned analgesia, rate of discharge delay, pain score on the third day after discharge, re-consultation within one month after discharge, complications within one month after discharge, or post-discharge satisfaction (P>0.05). The total score of social support was higher in the elderly group than that in the non-elderly group (31.77±3.04 vs. 29.75±4.78; t=4.182, P<0.001). Conclusion The same-day surgery mode for inguinal hernia repair is feasible and safe in elderly patients and worthy of implementation.
ObjectiveTo evaluate the safety, feasibility, and efficacy of single-incision plus one-port laparoscopic sleeve gastrectomy (SILS+1) for patients with obesity. MethodsA retrospective analysis was conducted on obese patients undergoing laparoscopic sleeve gastrectomy (LSG) from January 2023 to November 2024. Patients were stratified into two groups: SILS+1 and conventional multi-port LSG (MPLSG). Comparative parameters included operative time, postoperative hospital stay, complication rates, weight loss outcomes, and improvement in metabolic indicators [including hemoglobin A1c (HbA1c), triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C)]. ResultsA total of 95 patients with obesity were enrolled, including 40 in the SILS+1 group and 55 in the MPLSG group. The SILS+1 group had significantly lower preoperative BMI, HbA1c, and TC levels compared to the MPLSG group (P<0.05), and a significantly higher proportion of female patients (P<0.05). Other baseline characteristics, such as age, TG, and HDL-C levels, showed no statistically significant differences (P>0.05). Operative time was significantly longer in the SILS+1 group than in the MPLSG group [(100.16 ± 17.53) min vs. (93.82 ± 20.83) min, P<0.001]. The proportion of patients requiring drainage tube placement was significantly lower in the SILS+1 group [55.0% (22/40) vs. 76.4% (42/55), P=0.049]. There were no statistically significant differences between the two groups in the need for additional trocar sites, change in Hb level from preoperative to postoperative day 1, postoperative hospital stay, or incidence of postoperative complications (Clavien-Dindo grade I) (P>0.05). No 30-day readmissions occurred in either group. One patient in the SILS+1 group required an additional trocar site. Gastrointestinal patency was normal in all patients, with no signs of contrast agent leakage or stricture observed. Both SILS+1 and MPLSG procedures demonstrated equivalent efficacy in weight loss outcomes (P>0.05) and in their effects on HbA1c, TG, and TC levels (P>0.05). The SILS+1 procedure showed a significant advantage in improving HDL-C levels (F=6.221, P=0.015), with significantly higher postoperative HDL-C levels observed at 6 months postoperatively compared to the MPLSG group (F=2.500, P=0.027). ConclusionsFor selected obese populations, SILS+1 represents a feasible and safe alternative to MPLSG. This technique demonstrates equivalent efficacy to MPLSG in early-stage weight loss and metabolic improvement, serving as a transitional approach toward pure single-incision laparoscopic sleeve gastrectomy.