Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective To explore the application value of endoscopic ultrasonography (EUS) in the diagnosis of suspected obstructive jaundice in acute biliary pancreatitis and its effect on treatment outcomes. Methods Clinical data were retrospectively collected in 96 patients with acute biliary pancreatitis (ABP) who were suspected obstructive jaundice. Patients were divided into early EUS scanning group (EES) and delay EUS scanning group (DES). Clinical treatment results and test results were compared between the two groups. Results The diagnosis sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 96.43 %, 82.5 %, 90.63 %, 88.52 % and 96.29 %. Early EUS scan with 72 h could identify the etiology of ABP and subsequent treatment based on the EUS can easily decrease the white blood cell count, percentage of neutrophils, total bilirubin and serum amylase (P < 0.05). The pain relief rate in EEI group after 1 week treatment was significantly higher than that in the DES group (87.50 % vs 66.67 %, P = 0.027) and average length of hospitalization was shorter [(12.70 ±2.10) d vs (14.10 ± 3.00) d, P = 0.006]. Delay EUS scan were likely to have higher white blood cell count and total bilirubin, meanwhile seemed to increase the organ failure rate and necrotic infection of the pancreas. Conclusion ABP with suspected obstructive jaundice should be considered to have endoscopy intervention. Results of EUS are the basis for treatment decision, which can avoid the unnecessary endoscopy treatment.

Objective To investigate the strategies of nutritional therapy for severe acute pancreatitis (SAP) patients.Methods Two hundred and eight patients with SAP were randomly divided into early enteral nutrition (EEN) group,late enteral nutrition (LEN) group and total enteral nutrition (TPN) group.EEN group received enteral nutrition through nasojejunal tube feeding within 72 hours in the course of disease,LEN group received the same treatment after 6 d in the course of disease,TPN group received total enteral nutrition.The index of nutrition,incidence of complication were recorded,efficacy and safety were analyzed.Results EEN group included 67 cases,while 72 cases in LEN group and 69 cases in TPN group.The incidence rate of malnutrition after 14 d of treatment in EEN group and LEN group was significantly lower than that in TPN group [59.7％ (40/67),58.3％ (42/72) vs.84.1％ (58/69),P ＜0.05],but the difference between EEN group and LEN group was not statistically significant (P ＞ 0.05).There was no statistically significant difference in the incidence of hyperlipidemia and hyperglycemia among three groups (P ＞ 0.05).The expression level of albumin,prealbumin and retinol-binding protein after 14 d of treatment in three groups compared with those before treatment and the differences were statistically significant (P ＜ 0.05).The expression level of albumin,prealbumin and retinol-binding protein after 14 d of treatment in EEN group and LEN group compared with those in TPN group and the differences were statistically significant (P＜ 0.05),there was no statistically significant difference between EEN group and LEN group (P＞ 0.05).The incidence rate of total infections,abdominal infections,bloodstream infections,secondary superinfections in TPN group were significantly lower than those in EEN group and LEN group [62.3％(43/69) vs.25.4％ (17/67),19.4％(14/72) ;21.7％(15/69) vs.4.5％(3/67),6.9％ (5/72);39.1％(27/69) vs.14.9％(10/67),11.1％(8/72) ;33.3％ (23/69) vs.9.0％ (6/67),9.7％(7/72),P ＜ 0.05],there was no statistically significant difference in the incidence of peripancreatic infections,lung infections among three groups (P ＞ 0.05).There was no statistically significant difference in the incidence of total infections,different infections between EEN group and LEN group.There was no statistically significant difference in the incidence of noninfections among three groups (P ＞ 0.05).The rate of recovery in EEN group and LEN group was significanby higher than that in TPN group [91.0％ (61/67),94.4％ (68/72) vs.81.2％ (56/69),P ＜ 0.05],but the difference between EEN group and LEN group was not statistically significant (P ＞ 0.05).Conclusion Early enteral nutrition therapy for SAP patients is safe and effective,and could significantly improve the prognosis of patients.