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*

Construction of research-based surgery department includes standardizing surgical practices, collecting and analyzing clinical data, discovering problems in clinical practices, designing and conducting reliable and high-level clinical research, improving and innovating surgical technologies according to research conclusions, working out technical specifications and promoting them through clinical education, and creating new clinical research needs arised by innovative and cutting-edge technologies and theories. By integrating technology, research, standardization, promotion and evaluation, and making close connections between different parts of clinical practices, scientific research and clinical teaching, it helps achieve coordinated development of surgical practices and translational research, and will finally promote the cultivation of medical talents and the progress of medical technologies. Since 2010, the General Surgery Department of Nanfang Hospital has established the basic idea of subject construction of "research-oriented surgery with data as the core, minimally invasive surgery with laparoscopic as the characteristic, and specialized surgery with high-efficiency service as the guidance", and has taken a series of measures to build it into a well-known research-based gastrointestinal surgery in China. The achievements of this speciaty have emerged from nothing, research platforms from few to many, the talent echelon from following to leading, and the influence from regional to international. The discipline construction has achieved a leap from quantitative to qualitative changes.
Biomedical Research ; standards ; China ; Digestive System Surgical Procedures ; standards ; Gastrointestinal Diseases ; surgery ; Hospitals ; standards ; Humans ; Minimally Invasive Surgical Procedures ; standards ; Program Development ; Surgery Department, Hospital ; standards

OBJECTIVE: To find the pathogenies and risk factors related to surgical intensive care unit (SICU) readmission for patients who underwent hepatobiliary-pancreatic surgery, and to develop a predictive model for determining patients who are likely to be readmitted to SICU. METHODS: The patients who admitted to SICU of the Affiliated Hospital of Qingdao University from January 2013 to August 2018; who first stayed in SICU after hepatobiliary-pancreatic surgery; who were assessed and discharged from SICU by surgeons and SICU physicians after treatment, and then transferred to SICU again because of the change of their condition were enrolled. The unintended return to SICU within 3 days and 7 days were recorded. Patients who returned to SICU within 7 days were studied for the pathogenies, risk factors and predictive model of returning to SICU, and non-returning patients were enrolled according to 1:1 as the controls. A total of 43 indicators were divided into five categories, including general clinical data, medical history, surgical indicators before first admission of SICU, length of first SICU stay, and other indicators on the day of first discharge from the SICU. Logistic regression was used to screen the risk factors associated with SICU readmission, then the Nomogram diagram was drawn by using the R 3.4.1 software for predicting SICU readmission, and the classification performance of Nomogram was evaluated by self-help sampling test. RESULTS: Of the 763 patients discharged from the SICU, 2.10% (16/763) of them were readmitted within 3 days and 3.28% (25/763) were readmitted within 7 days to the SICU unexpectedly. The pathogenies of SICU readmission within 7 days included infection [56.00% (14/25)], heart failure [16.00% (4/25)], infarction [12.00% (3/25)], bleeding [12.00% (3/25)], and sutures splitting [4.00% (1/25)]. The pathogenies of SICU readmission within 3 days included infection [56.25% (9/16)], heart failure [18.75% (3/16)], infarction [12.50% (2/16)], and bleeding [12.50% (2/16)]. Nomogram analysis showed that the risk factors associated with unplanned SICU readmission were length of first SICU stay, history of hypertension, and activity of daily living (ADL) score, white blood cell count (WBC), arterial partial pressure of oxygen (PaO₂), prothrombin time (PT), fibrinogen (FIB) on the day of first SICU discharge. Self-help sampling test was carried out on the Nomogram map, and the results showed that the coherence index (C-index) was 0.962 [95% confidence interval (95%CI) = 0.869-1.057]. The classification performance of the model was good. CONCLUSIONS The common pathogenies of SICU readmission for patients who underwent hepatobiliary-pancreatic surgery were infection, heart failure, infarction and bleeding. Risk factors of readmission after SICU discharge included the length of first SICU stay, history of hypertension, and ADL score, WBC, PaO₂, PT, FIB on the day of first SICU discharge. The model consisted of above risk factors showed a good performance in predicting the probability of readmission after SICU discharge for patients who underwent hepatobiliary-pancreatic surgery.
Biliary Tract Diseases/surgery* ; Digestive System Surgical Procedures/adverse effects* ; Humans ; Intensive Care Units ; Liver Diseases/surgery* ; Models, Statistical ; Pancreatic Diseases/surgery* ; Patient Readmission/statistics & numerical data* ; Postoperative Complications/therapy* ; Risk Factors

Through continuous development, metabolic and bariatric surgery (MBS) has become widely recognized in academic and medical circles. In China, the volume of MBS operations has increased year by year. Therapeutic goals of MBS have evolved from treating obesity to treating Type 2 diabetes mellitus, and further to treating a series of obesity-associated metabolic diseases (including conditions in the endocrine system, circulatory system, respiratory system, reproductive system, and etc). Surgical approach of MBS has also been evolving continuously. Currently the common surgical procedures include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB) and bilio-pancreatic diversion with duodenal switch (BPD-DS). All surgical procedures have pros and cons, and the choice of surgical procedures should be based on the conditions of patients, the surgeon's technical ability, and benefits and operative risks. With the development of MBS, the proportions of different surgical procedures also changed in China. In recent five years, the proportion of AGB has decreased continuously and LAGB is no longer a common procedure. The proportion of LSG has increased rapidly, rising from 9% in 2010 to 55% in 2015. The proportion of RYGB has increased from 57% to 64% between 2010 and 2013, and remained at 45% afterwards. Since 2010, most MBS operations are laparoscopic surgery. 3D Laparoscopic surgery, laparoendoscopic single-site surgery and da Vinci Robotic Surgery have also been introduced in MBS. This review discusses the status quo and changes of MBS in china, as well as the new technology in MBS, aiming to strengthen the information and comprehension of MBS in china.
Bariatric Surgery ; methods ; statistics & numerical data ; trends ; Biliopancreatic Diversion ; statistics & numerical data ; trends ; China ; Diabetes Mellitus, Type 2 ; surgery ; Disease Management ; Endoscopy, Digestive System ; statistics & numerical data ; trends ; Gastrectomy ; statistics & numerical data ; trends ; Gastric Bypass ; statistics & numerical data ; trends ; Humans ; Laparoscopy ; statistics & numerical data ; trends ; Metabolic Diseases ; surgery ; Obesity ; surgery ; Robotic Surgical Procedures ; statistics & numerical data ; trends

OBJECTIVETo explore the efficacy of partial resection of puborectalis combined with mutilation of internal anal sphincter(IAS) in the treatment of puborectalis syndrome with high anal pressure.

METHODSTwenty-five cases of puborectalis syndrome with high anal resting pressure in the preoperative examination received the operation of partial resection of puborectalis combined with mutilation of IAS in Zhongnan Hospital of Wuhan University between January 2013 and May 2015. The position of puborectalis was confirmed by touching with the exposure under the transfixion device, and a transverse incision was made by electrotome between 3 and 5 o'clock direction of puborectalis, then partial puborectalis was lifted by vessel clamp at 5 o'clock direction, and about 0.5 cm of muscular tissue was resected. Between 8 to 10 o'clock direction of anal tube, about 1 cm length of transverse incision was made by electrotome, then partial IAS was lifted by vessel clamp and cut off. Preoperative and postoperative 3-month anorectal manometry and defecography were carried out. Wexner constipation score and Cleveland Clinic incontinence score were implemented before surgery and 3, 6, 12 months after operation. This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-ORB-16007695).

RESULTSOf the 25 cases, 18 were male and 7 were female, the average age was 55 years old and the average course of disease was 9 years. Compared with pre-operation, the postoperative 3-month anal resting pressure and maximal squeeze pressure were significantly decreased [(53.56±9.05) mmHg vs. (92.44±7.06) mmHg, (142.80±20.35) mmHg vs. (210.88±20.56) mmHg, respectively, both P=0.000]; anorectal angulation at resting state and forced defecation state increased significantly [(102.32±4.96)degree vs. (95.88±4.01)degree, (117.88±5.95)degree vs. (89.52±3.25)degree, respectively, both P=0.000]. Wexner constipation score of postoperative 3-month, 6-month, 12-month (8.28±3.91, 7.40±3.64 and 8.04±4.74) was significantly lower than the preoperative score (16.00±3.69, all P<0.05), while the score was not significantly different among 3 time points after operation (P>0.05). Cleveland Clinic incontinence score was 0 at postoperative 6 and 12 months, and revealed 20 cases were effective among all the surgical patients(80%).

CONCLUSIONPartial resection of puborectalis combined with mutilation of internal anal sphincter can effectively reduce anal pressure and improve symptoms of outlet obstruction, which is an effective method in the treatment of puborectalis syndrome with high anal pressure.

Anal Canal ; physiopathology ; surgery ; Constipation ; surgery ; Defecation ; Defecography ; Digestive System Surgical Procedures ; methods ; Female ; Gastrointestinal Diseases ; surgery ; Humans ; Male ; Manometry ; Middle Aged ; Muscle Hypertonia ; surgery ; Pelvic Floor ; physiopathology ; surgery ; Pressure ; Treatment Outcome

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications

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

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 investigate the risk of postoperative complications in elderly colorectal cancer patients over 65 years with comorbid cardiovascular diseases.

METHODSA total of 381 elderly colorectal cancer patients over 65 years were pathologically diagnosed as colorectal adenocarcinoma and underwent the first surgery in Beijing Hospital during January 2013 and December 2014. Patients were divided into comorbid cardiovascular disease group (258 cases) and non-cardiovascular disease group (123 cases) according to the existence of comorbid cardiovascular disease. The morbidity of postoperative complication was compared between two groups.

RESULTSThere was no significant difference in the morbidity of postoperative complication between two groups [27.9%(72/258) vs. 29.3%(36/123), P>0.05]. According to the Clavien-Dindo classification of postoperative complications, the morbidities of complication at all levels between two groups were not significantly different(all P>0.05). But in terms of cardiovascular complications, the morbidity of comorbid cardiovascular disease group was significantly higher than that of non-cardiovascular disease group [7.4%(19/258) vs. 0.8%(1/123), χ=6.678, P=0.010], while no significant differences in pulmonary and abdominal complications were found between two groups(all P>0.05). The morbidities of other complications (deep vein thrombosis, urinary tract infection and renal complications, etc.) of comorbid cardiovascular disease group were lower than those in non-cardiovascular disease group [2.7%(7/258) vs. 8.1%(10/123), χ=5.733, P=0.017]. Different types of cardiovascular diseases, different levels of cardiac risk index and American Society of Anesthesiologists(ASA) rating were not significantly related to the patient's occurrence of postoperative complications(all P>0.05).

CONCLUSIONSSurgery treatment for elderly colorectal cancer patients over 65 years with comorbid cardiovascular diseases is safe. However, strict cardiovascular monitoring should be performed and necessary measures should be carried out in time.

Adenocarcinoma ; complications ; surgery ; Aged ; Aged, 80 and over ; Cardiovascular Diseases ; complications ; Colorectal Neoplasms ; complications ; surgery ; Comorbidity ; Digestive System Surgical Procedures ; adverse effects ; Female ; Humans ; Male ; Postoperative Complications ; epidemiology ; Risk Factors

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