It is the most important for surgeons to achieve surgical safety and oncological clearance in laparoscopic surgery for gastric cancer. With the widespread adoption oflaparoscopic surgery for gastric cancer, surgeons make great efforts to achieve better safety andlower morbidity. Common abdominal complications (intraoperative and postoperative) after laparoscopic radical gastrectomy include bleeding, anastomotic leakage, anastomotic stenosis, iatrogenic organ injury, pancreatic leakage, etc. The causes and prevention of the complications related with laparoscopic radical gastrectomy was discussed in this article.
Anastomotic Leak ; Constriction, Pathologic ; Gastrectomy ; adverse effects ; Humans ; Laparoscopy ; adverse effects ; Postoperative Complications ; prevention & control ; Stomach Neoplasms ; surgery

Objective To explore the feasibility of "immersion program" in French-taught surgical lessons,as to provide multiple educational methods and practical experiences for the application of bilingual education in clinical medicine.Methods Twenty-nine senior students of French-taught class were randomly divided into group A(n=15) and group B(n=14)."Immersion program" and "transitional bilingual education" were employed for group A and group B,respectively for the first half of teaching session,and "transitional bilingual education" and "immersion program" for the second half,respectively.The differences between the two bilingual education models were compared through quiz.Results In the prior 2 of the 4 quiz,the scores of French quiz and the total scores were much higher in "immersion program" group,and there were significant differences between the two groups(P0.05). Conclusion "Immersion program" helps to improve the ability of presentation,comprehension and application of French in the precondition of equal educational content,and it will be more beneficial when accessing the "immersion program" on the basis of "transitional bilingual education".

Adolescent ; Duodenum ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Superior Mesenteric Artery Syndrome ; surgery

OBJECTIVESTo investigate the impact of previous abdominal operations on the outcome of laparoscopic colorectal cancer surgery and to evaluate the feasibility and safety of laparoscopic reoperation in treatment for colorectal cancer.

METHODSAccording to the statistical standards, 653 consecutive patients treated from March 2002 and March 2009 were enrolled in this study. The patients were divided into three groups: upper abdominal surgery group (n = 48), middle-lower abdominal surgery group (n = 110) and non-previous abdominal surgery group (n = 495). Demographic, pathoanatomical and surgical data were compared among the three groups.

RESULTSThere was no significant differences in demographic, pathoanatomical data and post-operative complications among the three groups. Compared with the other two groups, middle-lower abdominal surgery subgroup had a higher intra-operative conversion rate due to intra-abdominal adhesion (4.2%, 11.8% and 3.8% in upper abdominal surgery group, middle-lower abdominal surgery group and non-previous abdominal surgery group, respectively). And no significant differences was found in operating time [(132 ± 36), (141 ± 42), (132 ± 36) min], intra-operation blood loss [(58 ± 50), (81 ± 99), (57 ± 57) ml], blood transfusion rate (6.3%, 10.9%, 7.9%), low sphincter-preserving surgery rate (47.1%, 44.7%, 55.2%), time of first flatus passage [(2.5 ± 1.4), (2.9 +/- 1.7), (2.5 ± 2.1) d], fasting time [(5 ± 4), (5 ± 4), (4 ± 3) d], hospital stay [(17 ± 9), (15 ± 8), (16 ± 10) d] between the three groups.

CONCLUSIONSThe history of previous abdominal operations should not be regarded as a contraindication for laparoscopic colorectal cancer reoperation. The laparoscopic reoperation for colorectal cancer is safe and feasible.

Abdomen ; surgery ; Aged ; Colorectal Neoplasms ; surgery ; Feasibility Studies ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Reoperation

OBJECTIVETo evaluate laparoscopic surgery for gastric and small intestinal stromal tumors.

METHODSThe clinical data of patients with laparoscopic resection of gastric and small intestinal tumors, admitted to our center from Dec. 2003 to Jul. 2006, were retrospectively analyzed. The data included the surgical procedure, operative time, blood loss, length of incision, time for passage of flatus, postoperative length of stay, operative complications, pathology and the results of follow-up.

RESULTSAll the 33 patients with gastric and small intestinal stromal tumors were treated by laparoscopic procedures successfully, including 8 laparoscopic gastric wedge resections, 8 laparoscopic transgastric tumor-everting resections, and 17 laparoscopic segmental resections of small intestine. The mean operative time was (73.1+/-27.0) min, the mean blood loss was (19.8+/-14.0) ml, the mean length of incision was (3.3+/-1.1) cm, the mean time for passage of flatus was (2.2+/-1.0) d and the postoperative length of stay was (8.1+/-2.0) d. The bleeding of intestinal anastomosis and gastric mucosa occurred on 3 patients (9.1%), who were healed with conservative therapy. No recurrence was found during 2-33 months follow-up.

CONCLUSIONLaparoscopic surgery is an effective, safe, less invasive procedure for treatment of gastric and small intestinal stromal tumors.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Intestine, Small ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo evaluate the clinical use of laparoscopy in diagnosis and surgical treatment in small intestinal tumors.

METHODSClinical data of 42 patients with small intestinal tumor undergoing laparoscopic diagnosis and surgical procedure from Sep. 2003 to Dec. 2005 were analyzed retrospectively. The operative time, blood loss,length of incision, time for passage of flatus, post-operative hospital stay and operative complications were evaluated.

RESULTSAll the patients were diagnosed and treated by laparoscopic procedure successfully, including 4 laparoscopic local resection of the tumors, 36 laparoscopy-assisted partial intestinal resections, 1 right hemicolectomy, and 1 laparoscopic exploration. The mean operative time was (73.1+/-32.9) min, the mean blood loss was (20.7+/-31.2) ml, the mean length of incision was (3.7+/-1.2) cm, the mean time for passage of flatus was (2.2+/-0.8) d, and the post-operative hospital stay was (8.0+/-3.1) d. Postoperative complications occurred in 2 patients (4.8% ) including anastomosis bleeding and adhesive intestinal obstruction in one case respectively. After follow-up from 3 to 30 months, no recurrent tumor was found except one patient with advanced intestinal carcinoma.

CONCLUSIONLaparoscopic exploration can diagnose small intestinal tumors accurately, and laparoscopy-assisted surgical treatment is safe with less trauma and fast recovery.

Adult ; Aged ; Female ; Humans ; Intestinal Neoplasms ; diagnosis ; surgery ; Intestine, Small ; Laparoscopy ; Middle Aged ; Retrospective Studies

Carcinoma, Hepatocellular ; metabolism ; pathology ; DNA-(Apurinic or Apyrimidinic Site) Lyase ; genetics ; metabolism ; Female ; Humans ; Liver Neoplasms ; metabolism ; pathology ; Male ; Middle Aged ; RNA, Messenger ; genetics

Objective To evaluate the safety,efficacy and advantages of laparoscopic colorectal surgery for elderly patients with colorectal cancer.Methods Operation safety,complications,and postoperative recovery of 35 patients aged 70 years and over who underwent laparoscopic colorectal surgery(LAPA group) were analyzed retrospectively and compared with those of 78 elderly patients performed with conventional open surgery(OPEN group) and 35 patients younger than 65 years performed with laparoscopic colorectal surgery(LAPB group) between December 2002 and December 2003.Results No surgery-related death occurred in LAPA group and LAPB group,but 2 deaths were found in OPEN group because of severe pulmonary infection and anastomotic leakage respectively.There were 33 (42.3%) cases of complications in the OPEN group which were significantly more than those in LAPA and LAPB group (P0.05).Local recurrence rate,metachronous metastases rate and cumulative survival probability at 30 months were similar in the LAPA and OPEN groups.Conclusions Laparoscopic colorectal surgery is safe and beneficial to the patients aged 70 years and over and it could be adopted widely.

Objective To evaluate the laparoscopic management in diagnosing and treating small intestinal stromal tumors.MethodsSeventeen patients with small intestinal stromal tumors,who underwent laparoscopic diagnosis and surgical procedures,were retrospectively analyzed with the size of tumor,operative time,blood loss,length of incision,time for passage of flatus,post-operative hospital stay,operative complications and result of follow-up.Results All the 17 patients were diagnosed and treated by laparoscopic partial intestinal resections.The mean diameter of tumors was(3.6?1.3)cm,operative time(62.1?25.7)min,blood loss(17.1?15.2)mL,length of incision(3.4?1.1)cm,time for passage of flatus(2.2?1.2)d and post-operative hospital stay(7.8?2.0)d.As for the complications,one(5.9%)anastomosis bleeding was found and was treated by non-surgical procedure.After follow-up for 2-34 months,no recurrent tumor was found.Conclusion Laparoscopic exploration is useful to diagnose small intestinal stromal tumor accurately,and laparoscopic partial intestinal resection is a safe,effective and less invasive procedure for small intestinal stromal tumors.

Objective To evaluate the clinical application of laparoscopic local resection for gastric tumors.Methods Twenty-three patients with gastric tumors who were performed laparoscopic gastric local resection were retrospectively analyzed with the size of tumor,location of tumor,operative time,blood loss during the operation,time for passage of flatus,post-operative hospital stay,operative complications,post-operative pathological findings and result of follow-up.Results Twenty-three patients were successfully performed laparoscopic local resection,including 8 laparoscopic wedge resection(LWR)and 15 intragastric mucosal resections(IGMR),with no conversion to open surgery.The mean size of gastric tumor was(2.8?1.3)cm,the mean operative time was(82.2?35.5)min,the mean blood loss was(26.5?15.3)mL,the length of incision was(3.1?1.1)cm,the time for passage of flatus was(2.1?0.9)d,and the mean post-operative hospital stay was(7.8?2.0)d.Two patients(8.7%)were found with postoperative gastric mucosal blee-ding and were recovered well through non-operative treatment.The median time of follow-up was 12 months(2-45 months),and no recurrent tumor was observed.Conclusion Laparoscopic local resection is a feasible,safe,effective and less invasive procedure for gastric tumors.