Laparoendoscopic single site surgery(LESS), which has been applied in gastrointestinal surgery domestically and abroad, is the most feasible "scarless" operation at present. Combined with our expierience the problems and strategies of laparoendoscopic single site surgery in gastrointestinal surgery are reviewed and discussed in this paper. Inline vision, chopsticks effect and equipment congestion are the difficulties in LESS, especially when it is used in gastrointestinal surgery. Improving skills, selecting appropriate apparatus, fixed operating team and flexible exposure method can ensure the safety of LESS. In order to ensure that LESS is accepted, the safety and effectiveness of LESS used in the operation of gastric and colorectal cancer need assessment. As a new surgical technique, the further development of LESS in gastrointestinal surgery is not possible without concept recognition, breakthrough of technical limitation and equipment innovation.
Digestive System Surgical Procedures ; Gastrointestinal Diseases ; surgery ; Humans ; Laparoscopy

Tunnel endoscopy is a new therapeutic technique developed from natural orifice endoscopic transluminal surgery and endoscopic submucosal dissection. With the quick development in the passing 5 years, tunnel endoscopy has been applied in the treatment of clinical diseases. In this article, our aim was to clarify the indication and method, evaluate the efficacy and safety of tunnel endoscopy for the treatment of esophagogastric diseases, including esophageal achalasia and submucosal tumors originating from the muscularis propria layer.
Endoscopy, Digestive System ; adverse effects ; methods ; Esophageal Diseases ; surgery ; Humans ; Stomach Diseases ; surgery

Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.
Male ; Humans ; Aged ; Anal Canal/surgery* ; Colon/surgery* ; Colectomy ; Anus Diseases/surgery* ; Adenocarcinoma/surgery* ; Digestive System Abnormalities/surgery*

Harmonic scalpel, one of the most commonly used energy tools, have been recognized as an important revolutionary development in surgical device. Due to its convenience in cutting, coagulating, and dissecting harmonic scalpel has been increasingly used to performed surgery by more and more surgeons. In gastrointestinal surgeries, however, many manipulationssuch as dissecting soft connective tissues off the stomach or colon, isolating and cutting particular vessels, would require proper techniques in handling harmonic scalpels. Thus, based on our experiences of using harmonic scalpel in laparoscopic gastrointestinal surgeries, we summarized a "nine-word tactics", which may be helpful for beginners to use harmonic scalpels in a proper and efficient manner.
Digestive System Surgical Procedures ; instrumentation ; Gastrointestinal Diseases ; surgery ; Humans ; Laparoscopy ; Surgical Instruments ; Ultrasonics ; instrumentation

Laparoscopic surgery for gastrointestinal diseases had a remarkable achievement in the past 20 years. To ensure the high quality of minimally invasive gastrointestinal surgery, several issues should be addressed, including correct guidelines and standard based on the consensus, high quality evidence from multi-center randomized control studies, proper training system for the technique, and constant innovations to improve the technique. We believe that with the great efforts of gastrointestinal surgeons, the minimally invasive gastrointestinal surgery in China is promising in the near future.
China ; Digestive System Surgical Procedures ; Gastrointestinal Diseases ; surgery ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures

OBJECTIVETo explore the clinical application of laparoscopy in gastrointestinal abdominal emergency.

METHODSClinical data of 44 cases with undefined acute abdomen undergoing laparoscopic surgery from October 2008 to October 2011 were analyzed retrospectively. Sixty-five cases treated by regular surgery during the same period were enrolled as controls.

RESULTSIn laparoscopic surgery group, 42 cases were diagnosed under laparoscopy(95.5%, 42/44). Thirty-four (77.3%,34/44) patients received operation successfully after diagnosis, including 20 of total laparoscopy, 14 of assistant small incision. Compared with control group, laparoscopic group had shorter length of incision[(6.7±2.2) cm vs. (15.8±3.4) cm], less blood loss[(51.4±30.3) ml vs. (117.9±49.5) ml], faster recovery of postoperative gastrointestinal function[postoperative oral intake(15.0±6.1) d vs. (30.5±8.4) d], shorter hospital stay[(5.6±4.2) d vs. (8.4±4.8) d] (all P<0.05), lower complication rate, and less surgical cost(P>0.05).

CONCLUSIONLaparoscopy is safe and effective in treating gastrointestinal abdominal emergency and therapeutic operation can be performed after a definite diagnosis.

Abdomen, Acute ; surgery ; Digestive System Surgical Procedures ; Gastrointestinal Diseases ; surgery ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

The incidence of inflammatory bowel disease in China is rising on a yearly basis, followed by an increased number of patients who require surgery and those who suffer from maneuver postoperative complications. Surgical treatment is important in the management of patients with inflammatory bowel diseases. Management and prevention of postoperative complications is also a key factor to the success of surgical treatment if it is not more important than the surgical procedure itself. In this article, the most recent literatures in this field will be reviewed combined with our own clinical experiences. The types, risk factors, preoperative prevention strategies as well as postoperative management of surgical complications of patients with inflammatory bowel disease will be discussed.
China ; Digestive System Surgical Procedures ; adverse effects ; Humans ; Incidence ; Inflammatory Bowel Diseases ; surgery ; Postoperative Complications ; prevention & control ; therapy ; Risk Factors

OBJECTIVETo systematically assess the effect of early enteral nutrition support after gastrointestinal operation on prognosis.

METHODSThe Cochrane Library, PubMed, CBM, CNKI, Wanfang, and VIP databases were retrieved via computer system for randomized controlled trails(RCTs) with early enteral nutrition support to patients undergoing gastrointestinal operation. Quality of studies was evaluated by the Cochrane Jadad rating scale. Nutrition indexes, bowel function indices, postoperative complications, health-economics indices were collected. Meta-analysis was conducted with RevMan 5.2.

RESULTSEleven relevant RCTs studies with 1087 cases were enrolled, including 541 patients in the study group(early enteral nutrition) and 546 in the control group. Meta-analysis showed that patients in the study group had significantly higher levels of plasma albumin and prealbumin than those in the control group(WMD=2.87, 95%CI:1.03-4.71; WMD=0.04, 95%CI:0.02-0.05). The time of postoperative bowel ventilation in the study group was significantly shorter than that in the control group(WMD=4.10, 95%CI:-5.38--2.82). The postoperative complication rate in the study group was significantly lower as compared to the control group(RR=0.64, 95%CI:0.44-0.93).

CONCLUSIONEarly enteral nutrition support after gastrointestinal operation is safe and effective, which can improve the nutritional status, promote bowel function return, and reduce postoperative complication rate.

Digestive System Surgical Procedures ; Enteral Nutrition ; Gastrointestinal Diseases ; surgery ; Humans ; Postoperative Complications ; Prognosis ; Randomized Controlled Trials as Topic

Duodenal diverticula are common, but perforated duodenal diverticulum is rare. Because of the disease rarity, there is no standard management protocol for perforated duodenal diverticulum. To properly manage this rare complication, a clear preoperative diagnosis and clinical disease severity assessment are important. An abdomino-pelvic CT is an unquestionably crucial diagnostic tool. Perforation is considered a surgical emergency, although conservative treatment based on fasting and broad-spectrum antibiotics may be offered in some selected cases. Herein, we report two cases of perforated duodenal diverticulum, one case managed with surgical treatment and one with conservative treatment.
Aged ; Diverticulum/complications/*diagnosis/surgery ; Duodenal Diseases/complications/*diagnosis/surgery ; Endoscopy, Digestive System ; Humans ; Intestinal Perforation/*diagnosis/etiology/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo explore the feasibility of three-cavity clearance (TCC) in the treatment of perianal abscess.

METHODSA retrospective study of patients with perianal abscess in our center from July 2013 to March 2015 were carried out. Clinical data of 25 patients undergoing TCC (TCC group) were analyzed. At the same time, based on matched gender, age and location of abscess, 25 patients undergoing incision and drainage (incision group) and 25 undergoing cutting seton (seton group) were enrolled. Postoperative pain visual analogue scale (VAS) score (the first defecation,1 week later), rate of fistula formation, fecal incontinence(Wexner score) and wound healing were compared among groups.

RESULTSOne week after operation, VAS score in seton group was 6.5±1.3, which was significantly higher than 1.3±0.5 in TCC group and 1.2±0.4 in incision group(P<0.01), while there were no significant differences of VAS among groups at the first defecation(P>0.05). Time of wound healing was (45.8±19.9), (49.2±23.1) and (53.5±24.1) days in TCC, incision and seton group respectively, without significant difference(P>0.05). Rate of fistula formation was 48.0% (12/25) in incision group, which was significantly higher than 12.0% (3/25) in TCC group and 12.0%(3/25) in seton group (all P<0.01). There was no patient with faecal incontinence in TCC group and incision group, while 2 patients with fecal incontinence were found in seton group.

CONCLUSIONThree-cavity clearance is feasible in treatment of perianal abscess, and can decrease the rate of fistula formation, ameliorate postoperative pain and protect anal function.

Abscess ; surgery ; Anus Diseases ; surgery ; Defecation ; Digestive System Surgical Procedures ; methods ; Drainage ; Fecal Incontinence ; Humans ; Postoperative Period ; Retrospective Studies ; Wound Healing