Bariatric surgery can cure or alleviate metabolic syndrome,of which the mechanism is unclear,however.Several existing hypotheses including decreased caloric intake following the surgeries,foregut and hindgut hypothesis,serum bile acid and bacterial flora changes cannot completely explain the reasons of improvement of metabolic syndrome by various bariatric surgical procedures.Now the bariatric surgeries available are associated with stomach.The gastric center hypothesis is proposed in this article.There would be some particular cells in the gastric wall to secrete unknown hormones,which would be changed with decrease or deletion of stomach irritaion from food after bariatric surgeries,leading to remission of metabolic diseases.Focusing on the upstream stomach in the research on mechanism of bariatric surgery for metabolic syndrome,the fundamental cause of improvement of metabolic syndrome may be found out.

Bariatric surgery is one of the most rapid,effective and sustained treatment options for obesity.In recent years,laparoscopic sleeve gastrectomy (LSG) has become increasingly popular due to simple manipulation,maintaining gastrointestinal structures,high safety and significant efficacy.Several published studies have reported an increased rate of gastroesophageal reflux disease (GERD) after the operation,or it can aggravate the preexisting symptoms.The mechanisn of GERD is very complex and controversial.

[Summary] Obesity is the most important risk factor of essential hypertension.Obesity-related hypertention has become a worldwide problem.Many clinical studies show that bariatric surgery has significant therapeutic effect on essential hypertension, but the specific mechanism of the condition remains to be fully understood.This paper tried to explain the mechanism of the treatment of bariatric surgery for essential hypertension from the following two aspects: the reversal of the sympathetic disorder and the decline of plasma leptin.

Objective To compare the degree of trauma, postoperative pain, and cosmetic outcomes of endoscopic-assisted thyroidectomy (EAT), transthoracic endoscopic thyroidectomy (TET), and conventional thyroidectomy (CT), and to explore the characteristics of EAT and TET. Methods Forty-five patients with thyroid nodules were divided into three groups (n=15 in each) to underwent EAT, TET, or CT. The plasma levels of C-reactive protein(CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-?), and T-lymphocyte subgroups (CD3, CD4+, CD8+, and CD4+/CD8+) were determined before and 24 and 72 hours after the operations. The degree of operative trauma was compared after the operation. Postoperative pain and cosmetic outcomes were evaluated by visual analogue score (VAS) and 5-degree evaluation respectively. Results The VAS in the EAT group was 2.2?1.7 and 1.1?1.1 on the first and third day postoperation, which were significantly lower than those in the TET group (3.6?1.4 and 2.2?0.7, respectively; q=3.698, P0.05).Compared to preoperation, the level of CD4+/CD8+ lymphocyte in the CT group was decreased at 24 hours after the operation (q=4.076, P0.05). The levels of CRP determined at 24 and 72 hours postoperation were both significantly higher than that before the operation in the three groups (EAT group: m=21, P

Objective To discuss the clinical value of transluminal endoscopic surgery (TUES), and to find a simple and safe no-scar surgical approach. Methods A total of 13 cases of TUES, including 1 case of hepatic abscess fenestration, 1 abdominal exploration, 5 appendicectomy, and 6 cholecystectomy, were carried out in our hospital. Among the cases, 3 were accomplished using upper-digestive endoscopy, and 10 were performed using triple-channel catheter technique by modified instruments.Results All the operations were completed successfully without conversion to routine laparoscopic surgery or open surgery. The operation time was 90-150 min in the 6 cases of cholecystectomy, 15-40 min in the 5 cases of appendectomy, 90 min in the hepatic abscess fenestration, and 50 min in the abdominal exploration. The abdominal exploration showed peritoneal abrasion around the bladder, and the hemorrhage was controlled by electric coagulation. No complications including hemorrhage and biliary fistula occurred in this series. No abdominal scar was found after the operation except in the skinfolds around the hilum. Conclusions The TUES is a simple, safe, and feasible technique. Since the TUES for cholecystectomy is difficult, the patients should be selected carefully.

Objective Owing to limitations in issues of access,tissue manipulation,and secure tissue approximation/closure,natural orifice transluminal endoscopic surgery(NOTES)has been developed slowly over the years.In this study,we employed a new approach,transumbilical endoscopic surgery(TUES)to treat 26 patients with gallbladder diseases.Methods A total of 26 patients including 21 cases of gallbladder stone and 5 cases of polyps underwent TUES cholecystectomy in our hospital.Two 5-mm trocars were placed through an infra-umbilicus incision.A mini grasper was placed at the right upper abdomen to grasp the fundus of gallbladder,so that the gallbladder can be dissected and removed by using conventional laparoscopic instruments.Results The operation was completed in all the cases except in one,who was converted to conventional laparoscopic surgery because of intraoperative bleeding.The operation time was between 25 and 50 minutes with a mean of 35 minutes.No postoperative bleeding or bile leakage occurred in this group of patients.Satisfying cosmetic results were achieved on the abdomen.Conclusions Double trocar transumbilical endoscopic cholecystectomy is feasible,and is simpler and safer than NOTES technique.Patients should be carefully selected at the beginning stage.

Objective The aim of this study is to verify the feasibility of transumbilical endoscopic cholecystectomy by using the tri-channel trocar technique.Methods Eight domestic pigs were submitted to transumbilical endoscopic cholecystectomy using the tri-channel trocar technique.After establishment of pneumoperitoneum,a tri-channel trocar was placed through an infra-umbilical incision.A fine grasper of 2 mm in diameter was inserted through a small skin incision on the right upper abdomen into abdominal cavity to grasp the fundus of the gallbladder.Then the cystic duct was dissected with a flexible hook.Once the cystic duct and artery were free,they were clipped by a clip fixing device,and the gallbladder was separated from the liver bed using flexible hook dissection.The specimen was then extracted through the umbilical trocar.Results All the gallbladders were removed successfully in the eight pigs without severe bleeding during dissection,or intraoperative and postoperative complications.The operation time was from 1.5 to 2.5 hours and decreased with experience.Postmortem examination revealed that the gallbladder fossa was clean,and the clips on the cystic duct and artery were secure.Neither bile leakage nor hemorrhage was found at the operative field.Conclusions Transumbilical endoscopic cholecystectomy is feasible and safe without leaving obvious abdominal scars.

Objective To assess the feasibility of endoscopic endoluminal surgery. Methods Six pigs were used in the experiments. Percutaneous channels entering the gastric cavities were established and endo-gastric suturing was conducted under laparoscopy. Results All the six pigs had tolerated the surgery smoothly. Postoperative examinations by laparotomy found no leakage on suture or injuries of organs. The time for establishing endo-gastric channels, completing the suturing and total surgery were 60.5?12.2 min, 26.5?5.78 min and 92.1?15.0 min, respectively. Conclusions Endoscopic endoluminal surgery is technically feasible.

0.05), whereas a significant improvement in SF-36 score, symptomatology, and emotional and physiological status was noted at 4 weeks after operation (P0.05). The SF-36 score, symptomatology, and physiological and social status of the Group MC were significantly improved 8 weeks after operation than preoperation (P

Objective To investigate the feasibility of "non-scar" total laparoscopic cholecystectomy trough the transumbilical approach by using modified instruments.Methods Trocars(5 and 3 mm in diameter respectively)without the proximal seal system on the sleeves were designed for this procedure.The maximum diameters of the trocars were reduced to 8 and 5 mm respectively.The instruments used in this study were 5 cm longer than commercially available instruments.10 cases of total laparoscopic cholecystectomy were performed by using the tools.Results All the gallbladders were removed successfully without massive bleeding during dissection.A mini port was placed on the right upper abdomen to assist retraction in one case because of technical difficulty.The mean operation time was(62?25)minutes(range,45 to 110 minutes)in this series.No intra-and postoperative complications occurred.All the patients were satisfied with the abdominal cosmetic results.They were discharged in 48 hours after the operation,and then back to work in a week.Follow-up was available in the patients for 1 to 5 months.None of them showed complication or recurrence during the period.Conclusions The interference between trocars and surgical instruments can be partially avoided by using the modified tools."Non-scar" total laparoscopic cholecystectomy is feasible by using the technique.