ObjectiveTo compare the short-term outcomes between Ivor Lewis esophagectomy and McKeown esophagectomy under thoracoscopy and laparoscopy for thoracic middle-lower esophageal carcinoma and to investigate the optimal approach.MethodsThe relevant literatures (from database foundation to March 2016) comparing minimally invasive Ivor Lewis esophagectomy and minimally invasive McKeown esophagectomy were searched through PubMed, EMbase, The Cochrane Library, CBM, CNKI, Wanfang Data and VIP. RevMan 5.3 software was used for data analysis.ResultsA total of 870 patients in 5 studies were reviewed and data were pooled for analysis. The score of Newcastle Ottawa for the literatures was 7-8 points. The results showed that compared with the McKeown group, Ivor Lewis group had shorter operation time (WMD=–34.67, 95% CI –53.70 to –15.65, P=0.000 4), less recurrent laryngeal nerve injuries (OR=0.23, 95% CI 0.12 to 0.44, P<0.000 01), anastomotic leakage (OR=0.24, 95% CI 0.14 to 0.41, P<0.000 01), anastomotic stenosis (OR=0.30, 95% CI 0.16 to 0.55, P=0.000 01), and pulmonary complications ( OR=0.25, 95% CI 0.15 to 0.43, P<0.000 01). There was no significant difference between the two groups in intraoperative blood loss, postoperative stay, hospitalization cost and chylothorax incidence. The McKeown group was associated with much more lymph nodes dissection (WMD=–1.16, 95% CI –2.00 to –0.31,P=0.007) than the Ivor Lewis group.ConclusionCompared with McKeown esophagectomy combined with thoracoscopy and laparoscopy, Ivor Lewis esophagectomy combined with thoracoscopy and laparoscopy has some advantages for thoracic middle-lower esophageal carcinoma, but a greater number of lymph nodes are dissected in McKeown procedure.
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.