Obesity is a disease state characterized by the accumulation of abnormal or excessive fat that threatens human health. With the rapid development of the economy and society and the change in lifestyle, obesity is highly prevalent in our country and has become an important disease that threatens the health of the population. Different from traditional non-surgical treatments, metabolic and bariatric surgery has a definite curative effect, is not easy to rebound, has good safety, and has sufficient evidence of clinical benefit, which can make many obese patients, especially those with moderate to severe obesity, fully recover. The treatment of obesity has become an important means in the comprehensive treatment of obesity. This article intends to describe the application of bariatric metabolic surgery in the comprehensive treatment of obesity from three aspects: bariatric surgery indications, surgical method selection, and perioperative multidisciplinary intervention.
ObjectiveTo assess impact of typical parameters recommended by enhanced recovery after surgery (ERAS) program in elective colorectal surgery, and provide some recommendations for surgeon and anesthesiologist. MethodThe published articles about ERAS program in elective colorectal surgery in recent years were searched in these databases(EMBASE, PubMed, Cochrane Library, Ovid), the impact of each parameter was evaluated basing on hospital stay and rate of postoperative complications. ResultsAfter analyzing the literatures, the parameters, which were applied in current rehabilitation programs and covered the pre-, intraand post-operative periods in colorectal surgery, were identified as potential impacting consequences of colorectal surgery. Strong agreements were obtained for the following recommendations:① Preoperative management:bowel preparation, fasting, preanesthetic medication, and nutritional care.② Intraoperative management:fluid management, preventing hypothermia, method of surgery and incision, drugs usages of antibiotics, glucocorticoid and prevention of postoperative nausea and vomiting.③ Postoperative management:managements of drainage tube, nasogastric intubation and urinary catheter, postoperative analgesia, prevention of thromboembolism, and measures of intestinal function recovery (including early mobilization, feeding and chew gum). ConclusionUse of a series of effective measures in ERAS has an effective result, could reduce surgical stress and complications, enhance recovery, shorten hospital stay.
On December 11, 2023, the American Diabetes Association (ADA) promulgated the Standards of Care in Diabetes (2024). For a long time, the ADA promulgated the Standards of Care in Diabetes had been regarded as the international guide in the field of diabetes, which has a great reference value for the diagnosis and treatment of diabetes in various countries. The new standard continues to emphasize the transformation of the diagnosis and treatment model from the glucose reduction to the patients, highlighting the importance of reasonable control of glucose, weight management, and improvement of cardiac and renal prognosis as the comprehensive management of diabetes patients, meanwhile continues to affirm the advantages of new hypoglycemic drugs such as glucagon like peptide-1 receptor agonist and metabolic surgery in the comprehensive management of type 2 diabetes mellitus.
Objective To evaluate the clinical effectiveness of laparoscopic and open appendectomy. Methods Literatures relating to randomized controlled trials in English and Chinese on the comparison of clinical effectiveness after laparoscopic and open appendectomy in appendicitis from PubMed，Wiley Online Library，Medline，Embase，Cochrane，CNKI，VIP，CBM databases were extracted，and methodological quality was evaluated by two reviewers independently with designed extraction form. The Cochrane Collaboration’s RevMan 4.2.2 software was used for data analysis. The wound infection，hospitalization time，operation time，hospitalization expenses，and peritoneal abscess were compared between laparoscopic and open appendectomy. Results Eight published reports of eligible studies were extracted. Compared with the open appendectomy， laparoscopic appendectomy had significant differences in lower wound infection rate 〔OR=0.19，95%CI （0.09，0.38），P＜0.000 01〕， longer operation time 〔WMD=3.66，95%CI （0.50，6.82），P=0.02〕，and more hospitalization expenses〔WMD=503.96，95%CI （337.23，670.70），P＜0.000 01〕.But there were no significant differences in hospitalization time〔WMD=-0.11，95%CI （-3.64，3.43），P=0.95〕 and incidence rate of peritoneal abscess 〔OR=1.40，95%CI （0.23，8.64），P=0.71〕 between laparoscopic and open appendectomy. Conclusions The wound infection rate is lower，but the operation time is longer，the hospitalization expenses is more in laparoscopic appendectomy as compared with open appendectomy. There are no statistically significant differences of hospitalization time and incidence rate of abdominal abscess between laparoscopic and open appendectomy.
Objective To summarize and analyze the application value of triple stomach shaping technique in laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of patients undergoing simple LSG with triple stomach shaping technique carried out by the General Surgery Obesity and Metabolic Diseases Center of Chengdu Third People’s Hospital from January to December 2021 were retrospectively collected, recording the operative time and the occurrence of recent complications such as postoperative nausea/vomiting, gastric leakage, bleeding, obstruction/torsion within 30 days after operation. Results A total of 966 patients were collected, including 294 males and 672 females. The age was 16–65 years, average age was (32.8±8.6) years. Body mass index was 27.5–47.2 kg/m2, average was (34.2±3.5) kg/m2. All operations were successfully completed without conversion to laparotomy. The operative time was 45–170 min, average was (100.2+33.4) minutes. Postoperative nausea/vomiting occurred in 484 cases (50.10%), bleeding in 2 cases (0.21%, intraperitoneal bleeding in 1 case, intragastric bleeding in 1 case), gastric leakage in 1 case (0.10%, grade B leakage), and no perioperative death occurred. Hospitalization time was 4–24 d, average was (7.55±2.47) d. Two patients (0.21%) were hospitalized again due to nausea and vomiting within 30 days after operation, they were relieved and discharged after conservative medical treatment. Conclusion Triple gastric shaping technology is more physiological, safe and suitable for promotion.
目的探讨经脐单孔腹腔镜联合胃镜治疗微小胃间质瘤(gastric stromal tumors, GIST)的可行性和临床疗效。 方法回顾性分析我院2010年10月至2011年5月期间行经脐单孔腹腔镜联合胃镜治疗微小GIST 30例患者的临床资料。 结果30例病灶直径（1.0±0.2） cm（0.5～2.0 cm），术后病理检查均证实为极低危险程度GIST。 24例在单孔腹腔镜辅助下成功完成内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）； 3例因ESD术中发生胃壁穿孔而改行内镜全层切除术（endoscopic full-thickness resection, EFR），其中2例继续在单孔下完成穿孔修补术，1例于左上腹壁另加一 Trocar，在双孔下完成穿孔修补术； 另3例因ESD剥离瘤体困难，改行胃局部切除术，其中2例继续在单孔下完成手术，1例在双孔下完成手术。 ESD成功率为80.0%（24／30），经脐部单孔完成率为93.3%（28/30）。手术时间（87.5±10.3） min （45～150 min）。 全组术后（4.3±0.5） d （3～8 d）出院。术后随访期3～7个月（平均4.6个月），均无病变复发。 结论经脐部单孔腹腔镜联合胃镜治疗微小GIST是安全可行的，早期疗效令人满意。
ObjectiveTo summary and analyze the actuality of application for the fast track (FT) in China. MethodsThe clinical literatures of FT in China were collected and obtained from the WanFang database and China Hospital Knowledge Database (from Jan. 2006 to Dec. 2014), and then the actuality of application for the 22 items of FT was analyzed. ResultsA total of 62 literatures were collected, and there were 58 hospitals and 2 944 cases who underwent colorectal operation included. In all of the 62 literatures, the programmes were carried out 15 items at most, and there were only 3 items (average 10.06 items) at least. There were some important FT programmes were poorly developed (less than 60.00%) which included:normal preoperative feeding (45.16%, 28/62), intake carbohydrate drinks up until 2 hours before operation (54.84%, 34/62), thoracic epidural analgesia (58.06%, 36/62), avoid the opioids (35.48%, 22/62), minimally invasive operation (58.06%, 36/62), no nasogastric intubation (53.22%, 33/62), establish discharge criteria (27.42%, 17/62), follow-up (14.52%, 9/62), and audit of clinical outcomes (1.61%, 1/62). And that, there were serious distortions to some FT programmes, such as:distorted the surgery with epidural anesthesia to the thoracic epidural analgesia (46.77%, 29/62), distorted the early remove nasogastric intubation postoperative to avoidance the nasogastric intubation (17.74%, 11/62), and the minimally invasive surgery was independent of FT (6.45%, 4/62)/control the fluid therapy intraoperatively only (6.45%, 4/62). ConclusionThe current situation of the FT is not optimistic in China, it has existed that the concept of FT is fuzziness, the measures are not standardized and the application of some important programmes are deficient.