BACKGROUND: There have been some prospective, randomized, controlled studies regarding the feasibility and safety of laparoscopic gastrectomy for gastric cancer, but controversy exists.OBJECTIVE: To systemically assess the feasibility and safety of laparoscopic gastrectomy for gastric cancer.METHODS: A computer-based online research of prospective, randomized, controlled studies addressing laparoscopic gastrectomy versus open gastrectomy published between January 1994 and December 2009 was performed in PubMed, Ovid Medline, Web of Knowledge, EMbase, Chinese Journal Full-text Database and Wanfang Database. Meta analysis of acquired data was performed through the use of RevMan 5.0 software. The inverse variance method was used to test the significance of continous data, while the Mantel-Haenszel method was used for dichotomous data. The chi-square test was used for evaluation of data heterogeneity. Homogenous data was calculated using the fixed effect model, and heterogeneous data was calculated using freedom model. Statistical data was expressed as 95% confidence interval. Funnel plot was used for sensitivity analysis to show potential publication bias.RESULTS AND CONCLUSION: Five papers that corresponded to inclusion criteria were included in this study. Among 326 cases included, 164 underwent laparoscopic gastrectomy and 162 received open gastrectomy. Meta analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy (both P ＜ 0.01), but for early-stage gastric cancer, laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay (P ＜ 0.01). But there was no significant difference in terms of time to resumption of oral intake, postoperative complications,postoperative morbidity rate, and tumor recurrence. Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node. The five papers adopted two different modes to remove lymph nodes, so subgroup analysis was also used. Results showed that for D1 lymph node dissection, laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy. All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.

Objective To investigate the effectiveness of laparoscopic mesh repair of parastomal hernia. Methods Laparoscopic mesh repair was performed in 7 patients with parasromal hernia from September 2004 to December 2005 in this hospital.Results Laparoscopic mesh herniorrhaphy was successfully performed in 6 patients, while a conversion to open herniorrhaphy was required in 1 patient because of extensive intraperitoneal adhesion. The operating time was 45~180 mi (mean, 109 min), and the hernial diameter was 4~6 cm (mean, 5.6 cm). Transient abdominal distention happened in 2 patients. Five patients complained of a pain in operative area within 3 weeks. Seroma occurred in 4 patients and was cured by needle aspiration and pressure bandaging for 2~ 4 times. No hematoma or surgery-related infection was seen. The length of postoperative hospital stay was 3~8 d (mean, 5.1 d). Postoperative follow-up for 2~15 months (mean, 8.3 months) revealed no recurrence. Conclusions Laparoscopic mesh repair of parastomal hernia is safe, effective, and feasible.

Obesity and related comorbidities have become serious health threats all over the world. Bariatric surgery has been shown to be an effective method for severe obesity in both the short and long term. Patients experience significant and sustained weight loss after bariatric surgery. Moreover, the preexist obesity associated comorbidities have been improved or resolved in most patients. A series of clinical researches have demonstrated the safety and validity of bariatric surgery. The clinical applications of surgery therapy provide an alternative for obesity and related comorbidities.

Objective To explore the causes and treatments for complications of laparoscopic incisional hernia repair.Methods A total of 110 patients with incisional hernia(42 men and 68 women,aged 33 to 89 years with a mean of 65)were treated with laparoscopic mesh repair in our hospital from March 2004 to May 2007.The clinical records of the patients were analyzed retrospectively.Results The laparoscopic repair was completed in all of the patients expect in one,who was converted to open surgery because of intraperitoneal adhesion.After the operation,15(13.6%)patients developed abdominal distension,86(78.2%)had severe pain in the operative area(not less than 6 weeks in 2 cases),23(20.9%)had seroma,6(5.4%)had urinary retention,2(1.8%)had acute gastric dilation,2(1.8%)had intestinal fistula,2(1.8%)had respiratory dysfunction,and 2(1.8%)showed recurrence of the hernia.Conclusion Most of the complications of laparoscopic incisional hernia repair are caused by insufficient preoperative preparation,intraperitoneal adhesion,difficulty in exposure of the visual field,improper use of electrocoagulation,small-sized masses,or weak fixation.

Objective To evaluate the efficacy of gasless laparoscopy for totally extraperitoneal(TEP) hernia repair.Methods Between April and August 2007,totally 82 patients with inguinal hernia received TEP in our hospital,in 30 of them the surgery was completed with gasless laparoscopy,while in the other 52,pneumoperitoneum was used for the operation.The operation time,medical cost,hospital stay,complications,and follow-up data of the two groups were compared.Results The gasless group had a longer operation time [(65.3?19.4) min vs(43.6?21.9) min,t=4.501,P=0.000],but less medical cost [(6186.7?1283.7) RMB vs(8391.8?850.8) RMB,t=-9.347,P=0.000].No significantly difference was observed in the hospital stay and rate of complications between the two groups [(2.1?0.8) d vs(1.8?0.9) d,t=1.513,P=0.134;and 6.7%(2/30) vs 5.8%(3/52),?2=0.027,P=0.870].Conclusion Gasless laparoscopy is effective and safe for totally extraperitoneal(TEP) hernia repair.

Bariatric surgery is the most effective treatment for obesity and its comorbidities, but mechanisms of bariatric surgery remain unknown. In addition to volume restriction and malabsorption, gut hormones, bile acids, adipokines, intestinal microbiome and central nervous system may be the potential mechanisms.
Bariatric Surgery ; Gastrointestinal Hormones ; Humans ; Intestines ; microbiology ; Microbiota ; Obesity

Objective To study and summarize the successful experience and the safety, easibility, practicality and operation skills of totally laparoscopic extraperitoneal herniorrhaphy (TEP). Methods From October 2006 to May 2008,225 patients in our two hospitals were performed TEP (265 totally laparoscopic extraperitoneal hernia repairs for inguinal hernia), including 55 direct inguinal hernia, 197 indirect inguinal hernia and 13 complex inguinal hernia operations. Among the 225 patients, 185 patients had unilateral hernia and 40 patients had bilateral hernias, including 29 recurrent hernia. Results The operations were lasted for 30 to 182 minutes(the average operating duration was 48 minutes for unilateral hernia and 106 minutes for bilateral hernia). The patients stayed in hospital for 2 to 8 days(the average inpatient hospital stay was 3.0 ± 1.2 days). The most common complication was scrotum bematomas,which appeared in 18 cases. Urinary re-tention appeared in 21 cases. Inguinal pain appeared in 5 cases. Bladder injury appeared 1 case. All the pa-tients were followed up for 3 months- 3 years. There was only 1 case of recurrence. Conclusions The proce-dure of TEP is safe,with faster postoperative recover,less pain,lower incidence of pain,better comfort quality and lower recurrence rate. TEP should be the main laparoscopic procedure for inguinal hernia repair.

Objective To explore the clinical significance of ? catenin expression in pancreatic carcinoma.Methods The immunohistochemical staining was performed to detect the expression of ? catenin in the specimens of 46 patients with pancreatic carcinoma and the results were statistically analyzed. Results The abnormal expression rate on the membrane was 54.3%, the poorer the differentiation, the higher the abnormal expression rate. The levels of the cases in whom metastasis occurred were much higher than those without metastasis. The abnormal cytoplasm expression rate was 21.7%,which had not significant correlation with the clinical indexes, such as staging, tumor size, grading and metastasis. In 23 patients who accepted intervention chemotherapy before operation, the cytoplasm expression rate in those with tumor mass smaller was 0, which was evidently lower than that of those without tumor mass change (33.3%). Moreover, the abnormal membrane and cytoplasm expression rates had remarkable concordance (63.0%).Conclusion The abnormal membrane expression of ? catenin may accelerate metastasis, and the abnormal expression of ? catenin in cytoplasm may result in cell proliferation.

European Hernia Society issued a guideline for the prevention and treatment of parastomal hernias in 2017, which is the first international guideline for the parastomal hernia. This guideline proposed 12 problems about incidence, diagnosis and treatment, and discussed these problems in depth. The main contents of this guideline are summarized as follows: (1) End colostomy is associated with a higher incidence of parastomal hernia compared to other types of stomas. (2) Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. (3) The use of the European Hernia Society classification for uniform research reporting is recommended. (4) There is insufficient evidence on the policy in watchful waiting. (5) There is insufficient evidence on the route and location of stoma construction, and the size of the aperture. (6) The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present.(7) It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. (8) So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, most data in this guideline were retrospective without high level evidence. A lot of questions remain controversial and more high-level evidence are expected to solve these problems.
Colostomy ; Hernia, Ventral ; prevention & control ; surgery ; Humans ; Postoperative Complications ; Retrospective Studies ; Surgical Mesh ; Surgical Stomas

Objective:To investigate the relationship between age-adjusted Charlson comorbidity index (aCCI) and ischemic stroke in patients with ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO).Methods:A single center retrospective cohort study. Seventy-four patients with OAO or RAO diagnosed by ophthalmology examination in Shenzhen Second People's Hospital from June 2004 to December 2020 were included in the study. The baseline information of patients were collected and aCCI was used to score the patients' comorbidity. The outcome was ischemic stroke. The median duration of follow-up was 1 796.5 days. According to the maximum likelihood ratio of the two-piecewise COX regression model and the recursive algorithm, the aCCI inflection point value was determined to be 6, and the patients were divided into low aCCI group (<6 points) and high aCCI group (≥6 points). A Cox regression model was used to quantify the association between baseline aCCI and ischemic stroke.Results:Among the 74 patients, 53 were males and 21 were females, with the mean age of (55.22±14.18) (19-84) years. There were 9 patients of OAO and 65 patients of RAO. The aCCI value ranges from 1 to 10 points, with a median of 3 points. There were 63 patients (85.14%, 63/74) in the low aCCI group and 11 patients (14.86%, 11/74) in the high aCCI group. Since 2 patients could not determine the time from baseline to the occurrence of outcome events, 72 patients were included for Cox regression analysis. The results showed that 16 patients (22.22%, 16/72) had ischemic stroke in the future. The baseline aCCI in the low aCCI group was significantly associated with ischemic stroke [hazard ratio ( HR)=1.76, 95% confidence interval ( CI) 1.21-2.56, P=0.003], and for every 1 point increase in baseline aCCI, the risk of future ischemic stroke increased by 76% on average. The baseline aCCI in the high aCCI group had no significant correlation with the ischemic stroke ( HR=0.66, 95% CI 0.33-1.33, P=0.247). Conclusions:aCCI score is an important prognostic information for patients with OAO or RAO. A higher baseline aCCI score predicts a higher risk of ischemic stroke, and the association has a saturation effect.