OBJECTIVETo evaluate the efficacy of sacral nerve stimulation (SNS) therapy for fecal incontinence.

METHODSClinical researches which evaluated the efficacy of SNS and were published between 1946 and 2016 were systematically searched from electronic databases, including PubMed, Ovid Medline, Web of Science, Wanfang database and Chinese Journal Full-text Database. Grey area literatures were also searched. Influence of SNS therapy on fecal incontinence episodes (FIE) or Wexner incontinence score (WIS) was systematically evaluated. The statistical analysis was performed by RevMan5.2.

RESULTSA total of 6 studies including 270 patients (147 patients in SNS group and 123 patients in control group) with fecal incontinence were enrolled in this systematic review. SNS therapy was associated with a significant reduction in FIE (SMD=-0.69, 95%CI: -0.97 to -0.41, P<0.001) and a significant reduction in WIS (SMD=-5.05, 95%CI: -8.73 to -1.36, P=0.007). Sensitivity analysis showed that the results of this study were stable and the direction and significance of results were not changed (P=0.000 for both). Publication bias was not found by funnel picture in this study.

CONCLUSIONSNS significantly improves the outcome of patients with fecal incontinence.

Complete excision of the left gastroepiploic mesentery and complete dissection the No.4sb lymph nodes is the entrance and one of important steps of splenic hilar lymph node dissection. 4K laparoscopy has a higher level of surgical vision and more subtle degree of local anatomical recognition.Following the concept of mesentery anatomy and with the help of the unique advantages of 4K laparoscopy, the lymph node dissection of left gastroepiploic region is more thoroughly, the operation time is shorter, and there is no bleeding or micro-bleeding. At the same time, the maximum protection of the surrounding important organs and blood vessels, can further improve the radical and safety of the operation. The authors investigate the lymph node dissection along the left gastroepiploic vessels region from intermediate approach in 4K laparoscopic radical gastrectomy.