BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Objective:To evaluate the clinical effectiveness of the standardized peripherally inserted central catheter (PICC) implantation procedure in the management of parenteral nutrition infusion routes.Methods:Patients were enrolled from January 2018 to January 2020 and were divided into the study and control groups, receiving standard operating procedures of PICC or insertion through below elbow with or without ultrasonic guidance. The differences in the success rate of PICC insertion, catheter indwelling time, incidence rate of complications, and patient satisfaction were compared.Results:A total of 943 subjects were included. The study group and the control group were comparable in terms of baseline characteristics such as disease type, body mass index and prevalence of nutritional risk. The overall success rate was 100% in both groups. The first-attempt success rate in the study group was higher compared with the control group (92.6% vs 72.2%, χ 2 = 66.229, P < 0.001), and the catheter indwelling time was longer ([25.4 ± 2.3] d vs [21.6 ± 3.1] d, t = 21.271, P < 0.001). The incidence rate of short-term complications in the study group was significantly lower than that in the control group (3.50% vs 11.52%, χ 2 = 21.490, P <0.001), while there was no significant difference in the incidence rate of long-term complications between the two groups (6.78% vs 8.85%, χ 2 = 1.388, P = 0.239). Conclusion:Establishing and implementing the standardized operating procedure of PICC is an effective method to improve the management of parenteral nutrition infusion routes.

Objective:To analyze the correlation between nutritional status and frailty and sarcopenia in geriatric inpatients (GIPs) planning to receive major hepatopancreatobiliary (HPB) surgery.Methods:From December, 2020 to September, 2022, GIPs who were planning to receive major HPB surgery were recruited. Nutritional assessment was performed using nutritional risk screening 2002 (NRS-2002) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty and sarcopenia assessment were performed using Fried frailty phenotype (FFP) and Asian Working Group for Sarcopenia (AWGS) 2019 consensus on sarcopenia diagnosis and treatment. The prevalence and concurrence of malnutrition, frailty and sarcopenia were investigated, and the correlation between nutritional status and frailty and sarcopenia was analyzed.Results:A total of 144 participants at the mean age of (70.10±7.44) years were included. The prevalence of nutritional risk, malnutrition, and severe malnutrition were 73.6% ( n ?=?106), 68.1% ( n ?=?98), and 34.7% ( n ?=?50) respectively. The prevalence of frailty was 20.8% ( n ?=?30) and that of sarcopenia was 35.4% ( n ?=?51). The prevalence of severe malnutrition increased significantly in older participants and the prevalence of nutritional risk, malnutrition and severe malnutrition decreased significantly with higher BMI. The prevalence was 35.4% (51/144) for concurrent sarcopenia and malnutrition, 19.4% (28/144) for frailty and malnutrition, 14.6% (21/144) for sarcopenia and weakness, and 14.6% (21/144) for sarcopenia, malnutrition, and weakness. There was a positive correlation between nutritional risk and frailty ( r = 0.603, P < 0.001). The risk of pre-frailty and frailty in the nutritional risk group was higher than that in the non-nutritional risk group ( χ 2 = 31.830, P < 0.001). The risk of pre-frailty and frailty in the malnutrition group was higher than that in the normal nutrition group ( χ 2 = 36.727, P < 0.001). Logistic regression analysis showed that the risk of frailty in patients with severe malnutrition was 12.303 times higher than that in patients with normal nutrition status (95% CI: 2.592 to 58.409, P = 0.002). The risk of sarcopenia in the nutritional risk group was higher than that in the non-nutritional risk group ( χ 2 = 13.982, P < 0.001). The risk of sarcopenia in the malnutrition group was higher than that in the normal nutrition group ( χ 2 = 37.066, P < 0.001). Conclusions:The prevalence and concurrence rate of malnutrition, frailty, and sarcopenia are high in GIPs undergoing major HPB surgery. GIPs with malnutrition are susceptible to frailty.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

Objective:To evaluate the effect of surgical resection on the prognosis of patients with China Liver Cancer Staging (CNLC)-Ⅱ hepatocellular carcinoma.Methods:Patients with CNLC-Ⅱ hepatocellular carcinoma between 2004 and 2015 from the SEER database were included. A total of 3 764 patients were enrolled, with the age (64±11)(18-93) years, including 2 935 males and 829 females. Among them, 2 825 patients underwent non-surgery treatment (NST), 510 patients underwent liver resection (LR), and 429 patients underwent local ablation (LA). The effects of different treatment modalities on overall survival (OS) and cancer-specific survival (CSS) were evaluated by using Kaplan-Meier analysis, propensity score matching analysis, and subgroup analysis. Cox regression were used to analyze the prognosis.Results:The 1-, 3- and 5-year overall survival rates of LR group were 76.3%, 51.9% and 34.0% respectively, which were significantly higher than those in LA group (71.7%, 34.8% and 24.9%, χ 2=18.50, P<0.001), and those in NST group (46.8%, 16.1% and 8.4%, χ 2=276.00, P<0.001). Similarly, the 1-, 3-, and 5-year cancer-related survival rates of LR group were 80.2%, 58.9%, and 41.8% respectively, which were significantly higher than those in LA group (75.9%, 42.8%, and 32.6%, χ 2=15.20, P<0.001), and those in NST group (52.3%, 21.5% and 12.7%, χ 2=245.00, P<0.001). Cox regression analysis showed that age, tumor size, chemotherapy, pathological grade, AFP levels, and surgical modalities were independent prognostic factors (all P<0.05). Propensity score matching analysis further showed that the prognosis of LR patients was significantly better than NST group [median OS: 52 months (95% CI: 38-60) vs. 10 months (95% CI: 7-16), P<0.001; median CSS: 59 months (95% CI: 44-77) vs. 11 months (95% CI: 8-18), P<0.001]. However, subgroup analysis showed no clinical benefit from surgical resection when the tumor size exceeded 10.0 cm. Conclusions:It was suggested that surgical resection could improve the OS and CSS of patients with CNLC-Ⅱ hepatocellular carcinoma.

Abdomen/diagnostic imaging* ; Artificial Intelligence ; Body Composition ; Magnetic Resonance Imaging ; Practice Guidelines as Topic

Objective:To evaluate three-dimensional visualization technology (3D technic) used in laparoscopic spleen-preserving distal pancreatectomy for pancreatic benign or low-grade malignant tumors.Methods:Data of 28 patients with laparoscopic distal pancreatectomy at Beijing Hospital from Aug 2016 to Dec 2021 were retrospectively analyzed.Results:There were 12 patients assigned in 3D attempt compared to 16 patients undergoing ordinary laparoscopy. In 3D group, all 12 patients underwent successful spleen preserving distal pancreatectomy. While in control group only 5 cases were successful in spleen preserving procedure, the remaining 11 cases failed in spleen preserving ending up in distal pancreatectomy combined with splenectomy. The spleen preserving pancreatectomy rate in 3D group was higher than control group ( P<0.05). There was no significant difference in the operation time (202±53.8) min vs. (186.8±48.3) min, intraoperative blood loss (107.5±141.2) mL vs. (160.6±184.4) ml and the incidence of pancreatic leakage between the two groups ( P>0.05). Nor there was difference in the average postoperative hospital stay between the two groups [(9.6±2.5) d vs. (19.1±40.6) d] ( P>0.05). Conclusion:Three dimensional visualization technology can improve the success rate and safety of laparoscopic spleen preserving distal pancreatectomy in cases of benign and low-grade malignant distal pancreatic tumors.

Objective:To investigate the regulation and mechanism of chronic Trichinella spiralis ( Ts) infection on liver immunopathology in mice co-infected with Plasmodium berghei ANKA( PbA). Methods:According to body weight, 64 specific pathogen free female Kunming mice (6 - 8 weeks old, weighting 22 - 25 g) were divided into 4 groups by using random number table method. Control group: uninfected; Ts group: mice were mono-infected with 30 Ts larvae by oral gavage on day 0; PbA group: mice were mono-infected with 1 × 10 6PbA-infected red blood cells in 0.1 ml of phosphate buffer (PBS) administered by intraperitoneal injection on day 121; co-infected ( Ts+PbA) group: mice were infected with 30 Ts larvae by oral gavage and intraperitoneal injected with 1 × 10 6PbA-infected red blood cells in 0.1 ml PBS on day 121 after Ts infection. There were 16 mice in each group, in which 10 mice in each group were monitored for the survival rate. The peripheral red blood cell parasitemia of PbA group and Ts + PbA group were monitored every other day by light microscope examination of Giemsa-stained thin tail-blood smears from day 3 after PbA infection. Mice were sacrificed at day 135 after Ts infection and/or at day 15 after PbA infection, the mouse body weight and liver weight were measured, and the liver index were calculated. Ts-infected mice were monitored by a light microscope examination of diaphragm compression slide. Under a light microscope, the liver pathology and liver fibrosis of mice were observed and compared with hematoxylin-eosin (HE) staining and Sirius red staining, respectively. The F4/80 + Kupffer cells in liver of mice were examined by immunohistochemical staining. Results:After infection with Ts or PbA, Ts larvae cysts were observed in diaphragm tissues and PbA were observed in red blood cells under the light microscope. After PbA infection, there was no significant difference in survival rate between PbA group and Ts+ PbA group ( P > 0.05). Compared with PbA group, the peripheral red blood cell parasitemia was significantly decreased in Ts+ PbA group on days 11 and 15 after PbA infection (%: 27.104 ± 7.623 vs 45.032 ± 9.849, 60.218 ± 2.776 vs 76.778 ± 6.351, P < 0.05), and the liver index and the liver pathology score were significantly decreased in Ts+ PbA group ( P < 0.05). Sirius red staining showed that the positive area of liver fibrosis in Ts+ PbA group was significantly higher than that in PbA group ( P < 0.05). Immunohistochemical staining showed that the average optical density value of F4/80 + Kupffer cells in Ts+ PbA group was significantly higher than that in PbA group ( P < 0.01). Conclusion:Chronic Ts infection may reduce the peripheral red blood cell parasitemia, increase F4/80 + Kupffer cells expression in liver, and attenuate liver pathology in mice co-infected with PbA.

Objective:To evaluate the perioperative safety of pancreaticoduodenectomy(PD)in elderly patients.Methods:Clinical data of 152 patients undergoing PD in Beijing Hospital between 2016 and 2019 were retrospectively analyzed.According to the age, patients were divided into the elderly group(age≥65 years)and the non-elderly group(age<65 years). The perioperative and postoperative parameters were compared between the two groups.Results:There was no significant difference in the operative time, intraoperative blood loss and intraoperative urine output between the elderly group and the non-elderly group(352.7±69.5)min vs.(359.0±94.4)min, (708.7±672.7) vs.(662.6±896.7)ml and(875.8±497.3)ml vs.(1010.6±568.2)ml, all P>0.05). The perioperative mortality, postoperative complications(Clavien-Dindo classification ≥ grade Ⅲ)and reoperation rate had no significant difference between elderly group and the non-elderly group(6.1% vs.1.2%, 21.2% vs.19.8%, 10.6% vs.8.1%, respectively, χ2=1.487, 0.048 and 0.272, all P>0.05). The incidences of operation-related complications, cardiovascular or cerebrovascular adverse events in elderly group were comparable to non-elderly group( P>0.05). The postoperative hospital stay had no significant difference between the elderly group and the non-elderly group[(28±19)d vs.(27±18)d, P>0.05]. Conclusions:PD is safe in elderly patients.Age is not a contraindication to pancreaticoduodenectomy.The comprehensive systemic evaluation, intraoperative delicate operation and enhanced perioperative management are necessary in the elderly patients undergoing PD.