Objective This study aims to assess the effectiveness of a modified Chen's pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy （LPD）. Methods A retrospective analysis was conducted on the clinical data of 121 patients who underwent LPD at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2023 and October 2024. The patients were divided into two groups： traditional surgery group （63 patients） and modified Chen's pancreaticojejunostomy （modified surgery group） （58 patients）. Gender, age, body mass index （BMI）, operation time, pancreatojejunostomy time, intraoperative blood loss, postoperative hospital stay, and the incidence of postoperative complications like pancreatic fistula, abdominal infection, intra-abdominal bleeding, gastrointestinal dysfunction, and mortality were compared between groups. Additionally, moderate-to-high risk patients for pancreatic fistula were identified using the alternative pancreatic fistula risk score system （a-FRS）. The risk of pancreatic fistulas between groups was compared. Quantitative data adhering to a normal distribution were expressed as $\bar{x}±s$ ; otherwise, they were expressed as quartiles [M（Q₁,Q₃）]. Count data were presented as the number of instances. Results Patients in the modified surgery group showed significantly shorter operation time（311.8±55.0 min vs. 357.5±84.5 min,P=0.001）and pancreatojejunostomy time [15.5 （13.8,18.0） min vs. 26.0 （23.0,29.0） min,P<0.001] compared to the traditional surgery group. The incidence of clinically relevant postoperative pancreatic fistula was also significantly lower in the modified surgery group than in the traditional surgery group [3.4% （2/58） vs. 15.9% （10/63）, P=0.022]. There were no significant differences between the two groups in the age, gender, BMI, proportion of patients at moderate-to-high risk for pancreatic fistula, intraoperative blood loss, postoperative hospital stay, rates of abdominal infection, intra-abdominal bleeding, and gastrointestinal dysfunction （P>0.05）. There were no perioperative deaths in both groups. Among the 62 patients at a moderate-to-high risk for pancreatic fistula using the a-FRS model （34 in the traditional surgery group and 28 in the modified surgery group）, those in the modified surgery group still showed significantly shorter operation and pancreatojejunostomy times （P<0.05） and a lower incidence of postoperative pancreatic fistula （P=0.036）. Conclusion The modified Chen's pancreaticojejunostomy simplifies the procedure, decreases the duration of pancreatojejunostomy, and reduces the occurrence of pancreatic fistulas. This technique is effective for patients assessed as having a moderate-to-high risk of developing pancreatic fistulas.

Objective To analyze the prognostic factors and recurrence patterns of locally advanced gastric cancer （LAGC） patients who underwent D2 radical gastrectomy after receiving neoadjuvant chemotherapy combined with immunotherapy. Methods A total of 76 LAGC patients who received neoadjuvant chemotherapy combined with immunotherapy followed by D2 radical gastrectomy at the Department of Gastrointestinal Surgery, Union Hospital, Huazhong University of Science and Technology, from January 2020 to October 2023, were enrolled. According to postoperative recurrence, patients were divided into the recurrence group （22 cases） and non-recurrence group （54 cases）. Clinical and follow-up data were collected. Results There were 14 patients with a single recurrence mode （63.6%）, and the proportion of patients with local recurrence, regional recurrence, abdominal metastasis and distant metastasis was 4.5%, 4.5%, 4.5%, and 50.1%, respectively. Statistically significant differences were found between the recurrence and non-recurrence groups in terms of nerve invasion, vascular invasion, posttreatment pathological tumor （ypT） staging and posttreatment pathological lymph node （ypN） status（all P<0.05）. Univariate analysis revealed that signet-ring cell carcinoma, nerve invasion, vascular invasion, ypT stage, and ypN status were significantly related with disease-free survival （DFS） after D2 radical gastrectomy in LAGC patients receiving neoadjuvant chemotherapy and immunotherapy （all P<0.05）. Multivariate analysis showed that signet-ring cell carcinoma （P=0.048） and ypN status （P=0.035） were independent factors affecting DFS after D2 radical gastrectomy. Additionally, there was a significant difference in the incidence of double recurrence between the ypN0 group and the ypN₊ group patients. Conclusion Signet-ring cell carcinoma and ypN status are independent prognostic factors for LAGC after neoadjuvant chemotherapy combined with immunotherapy and surgery. Preventing distant recurrence after neoadjuvant chemotherapy combined with immunotherapy and surgery is an important approach to further improve the long-term prognosis of LAGC.

Greated the limbs of small bowel has been a key link during Roux-en-Y gastric bypass （RYGB）. However, there is still no consensus on a proper length of small bowel exclusion. In current era of precision medicine, through accurately measuring the length of small bowel, appropriate length of small bowel exclusion may be individualized for optimizing surgical efficacies and lowering the occurrence of postoperative complications. Summarizing the effects of different small bowel exclusion lengths during gastric bypass on surgical outcomes, this review was intended to provide new rationales for future clinical practices and research designs.

Spontaneous rupture of hepatocellular carcinoma（HCC） is a life-threatening acute complication in HCC patients,clinically manifested as spontaneous tumor rupture and intra-abdominal hemorrhage.Although classified in T₄ by the TNM staging system,targeted treatment strategies can significantly improve the survival prognosis of spontaneous rupture of HCC.This review comprehensively analyzed the epidemiological characteristics,risk factors,pathophysiological mechanisms,and the efficacy differences of various treatment modalities for spontaneous rupture of HCC.It focused on the timing of surgery,perioperative management strategies,and the application of postoperative prognostic prediction models,aiming to provide evidence-based guidance for clinical treatment.Additionally,by integrating recent research advancements,we discussed the importance of redefining the staging of spontaneous rupture of HCC to optimize diagnostic and therapeutic strategies,thereby improving the survival and quality of life.The review also incorporated the previous experience of our center to present the clinical experience in managing spontaneous rupture of HCC at Liver Center,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology.

Pancreaticojejunostomy is the preferred method of pancreatic digestive tract reconstruction,serving as the most critical step in pancreaticoduodenectomy.It largely determines the occurrence of postoperative pancreatic fistula and other related complications.With the rapid development of pancreatic surgery,the method of pancreaticojejunostomy has undergone different improvements.This article reviewed the characteristics and development trends of common pancreaticojejunostomy in recent years, and proposed a modified pancreaticojejunostomy, namely parallel pancreaticojejunostomy,emphasizing the key points and advantages of the operation, and providing a certain reference for colleagues to perform pancreaticojejunostomy.

Objective To establish and validate a nomogram prediction model based upon Objective factors for predicting gangrenous/perforated appendicitis （GPA） in children with acute appendicitis （AA）. Methods Between January 2010 and September 2024, the relevant clinical data were retrospectively reviewed for 350 AA children. And patients admitted between January 2010 and December 2019 were allocated into study group （n=225） while those admitted between January 2020 and September 2024 were selected as validation group（n=125）. Appendectomy was performed after a definite diagnosis. They were assigned into two groups of non-gangrenous/perforated appendicitis （N-GPA） and gangrenous/perforated appendicitis （GPA） according to the postoperative results of pathological examination. A comparison was made between two groups. And independent risk factors for GPA were identified through LASSO regression and multivariate Logistic regression analysis. Then these factors were utilized for constructing a nomogram prediction model. Internal validation of nomogram model was conducted with validation group. The area under the receiver operating characteristic curve （AUC） and Hosmer-Lemeshow （H-L） goodness-of-fit test were applied for assessing the model's discrimination and calibration. Results Preoperative computed tomography （CT） findings of fecalith within appendiceal lumen, leukocyte count, duration of symptoms, body temperature and appendiceal diameter as measured by preoperative CT were identified as independent risk factors for GPA in AA children （P< 0.05）. AUC for nomogram prediction model was 0.896 （95%CI： 0.848-0.943） in study group and 0.899 （95%CI： 0.825-0.972） in validation group, indicating an excellent discriminatory power. H-L test results were P=0.459 （χ2=6.72） for study group and P=0.272 （χ2=9.91） for validation group, indicating that nomogram model had a decent predictive accuracy. Conclusion The nomogram prediction model developed here demonstrates high accuracy and it may be readily applied for early identification and risk prediction of GPA in AA children.

An Objective measurement of surgical outcome quality has long been a daunting challenge for researchers. Technical skill of a surgeon is a crucial influencing factor of clinical outcomes. Assessing surgical skills is not only vital for education, training and professional growth of surgeons but also has profound implications for enhancing surgical quality, ensuring patient safety and advancing medicine. Gradually the assessment of surgical skills has evolved from an initial experiential evaluation model by panels of surgical experts to a data-based Objective assessment tool model, including global rating scales, procedure-specific assessment tools and error-based evaluation instruments. In recent years, with a growing integration of medical and engineering fields, some automated assessment tools equipped with automatic recognition capabilities have started to emerge. This article summarized the development, current status, advantages and limitations of different types of laparoscopic skill assessment tools in conjunctions with a literature review.

Objective To evaluate the efficacies and risk factors of metabolic and bariatric surgery for obesity hypoventilation syndrome （OHS）. Methods Between January 2018 and June 2022, retrospective review was conducted for 957 OHS patients undergoing metabolic and bariatric surgery.Clinical data of baseline profiles, arterial blood gas analysis, sleep study and anthropometric parameters were collected retrospectively for preoperative assessments and 2-year postoperative follow-ups. Perioperative changes of body mass index （BMI）, arterial blood gas, sleep study and anthropometric parameters were compared. The relationship between OHS resolution and variables was examined. Multivariate analysis was utilized for identifying the risk factors for OHS resolution. Results Among them, 105 were preoperatively diagnosed as OHS [BMI （40.1±7.2） kg/m², partial pressure of carbon dioxide in arterial blood（PaCO₂）（48.5±4.0） mmHg].At 2-year postoperative follow-up 89 cases （84.8%） fulfilled the criteria for OHS resolution. BMI dropped to（28.9±5.4） kg/m²（P<0.001,vs.BMI in preoperation period） and PaCO₂ declined to （44.4±4.8） mmHg （P<0.001, vs. PaCO₂ in preoperation period）. Percentage of total weight loss （%TWL） was lower in non-resolution group than that in OHS resolution group[（25.8±7.9）% vs. （27.7±8.9）%,P=0.017].Multivariate analysis revealed that preoperative arterial blood pH<7.35（OR=3.227,95% CI：1.002-10.392,P=0.049） and preoperative hypertension（OR=5.018,95%CI：1.476-17.064,P=0.010） were independent risk factors affecting OHS resolution after metabolic and bariatric surgery. Conclusion Metabolic and bariatric surgery is efficacious for OHS. And resolution of OHS depends upon achieving a certain level of ∆BMI and %TWL. Preoperative decompensation may be an independent risk factor for postoperative non-resolution of OHS.

Objective To explore the clinical value of Apfel score in predicting postoperative nausea and vomiting（PONV） after laparoscopic sleeve gastrectomy（LSG）. Methods Between January 2022 and March 2023, the relevant clinical data were collected from 80 morbidly obese patients undergoing LSG. They were assessed by the Apfel scoring system, including such factors as gender, smoking history, history of motion sickness or PONV and postoperative opioid use. PONV occurrences within 72 h post-LSG were assessed by visual analogue scale（VAS）, verbal descriptor scale（VDS） and PONV frequency score. Spearman's correlation was utilized for examining the relationship between Apfel and VAS/VDS/PONV frequency scores. Receiver operating characteristic（ROC） curve was plotted for evaluating the predictive value of Apfel score for PONV occurrence/severity and the area under the curve（AUC） calculated. Results Mean Apfel score was （1.76±0.96）. Within 72 h post-LSG, mean VAS/VDS/PONV frequency scores were （4.19±2.96）, （1.09±0.77） and （2.68±1.81）.Spearman's correlation coefficients between Apfel and VAS/VDS/PONV frequency scores were 0.3639, 0.3563 and 0.2985, all denoting a positive correlation （P<0.05）. Apfel score had the highest predictive value for VDS in predicting the occurrence of PONV （AUC=0.741,P<0.05） while it offered the best predictive value for VAS in predicting the severity of PONV （AUC=0.706, P<0.05）. Conclusion Apfel score is correlated with PONV score after LSG. However, its predictive value for VAS/VDS/PONV frequency score varies when assessing the occurrence/severity of PONV. Clinically Apfel score should be utilized with a consideration of specific predictive goals.

双肝外胆管畸形在临床上极为罕见,此文报道了1例由2条独立的肝外胆管相互汇合后进入十二指肠且无异位引流的双肝外胆管畸形病例,探讨双肝外胆管畸形的临床特征和超声声像图特点,并与手术、T管造影进行对照,结合相关文献进行总结分析。双肝外胆管畸形是一种少见的先天性胆道畸形,临床表现不典型,极易漏诊误诊,彩色多普勒超声等影像学检查在双肝外胆管畸形诊断方面具有重要意义。

2023年10月24日武汉大学中南医院肝胆胰外科收治1例71岁女性罕见胆囊肉瘤样癌合并Ⅰ型神经纤维瘤、胃肠间质瘤病人,该例病人因“上腹痛4 d,加重半天”就诊。腹部增强CT示,胆囊壁不均匀增厚并腔内软组织影并周围渗出、积液并脓肿形成,胆囊癌可能;左侧腹腔见类圆形软组织密度影。病人既往诊断Ⅰ型神经纤维瘤。于2023年10月31日行胆囊切除术+小肠部分切除术。术后病理及免疫组织化学诊断为胆囊肉瘤样癌、胃肠间质瘤。病人术后行放化疗及靶向治疗,2024年6月8日因肝转移瘤-结肠瘘合并腹腔感染死亡。胆囊肉瘤样癌临床罕见,与其他类型胆囊癌鉴别困难,需综合病理和免疫组织化学才能明确诊断,尚未有确切的诊疗指南,预后不佳。Ⅰ型神经纤维瘤老年病人建议常规筛查消化道肿瘤。

With rapid advances of metabolic and bariatric surgery（MBS）, decision-making process is becoming more and more complex regarding its application in patients with obesity and specific comorbidities. Efficacy and safety of MBS in high-risk cohorts, including those with cirrhosis, renal insufficiency and across an age spectrum from elders to adolescents, has remained controversial subjects. An expert consensus on optimal surgical approaches for these individuals has yet to be established, necessitating further investigations and validations. This paper focused upon the intricacies of conducting MBS in patients with unique metabolic and bariatric profiles.The authors critically assessed the risks and benefits associated with these procedures and offered a comprehensive overview of clinical considerations. There were four major issues of special weight considerations, age-related factors, challenging comorbidities and transitional procedures. The Objective was to contribute valuable insights to the existing body of knowledge and aid clinicians in making informed decisions when contemplating MBS for patients with special needs.

此文回顾性分析了1例63岁男性直肠神经内分泌癌病人的临床特点及治疗过程,以提高对此类疾病的认识。该例病人入院完善CT检查及结肠镜检查之后行腹腔镜直肠癌根治+回肠造口术,术后出现吻合口漏、右侧阴囊及右侧腹股沟区出现坏死性筋膜炎,行右侧腹股沟、右侧阴囊坏死性筋膜炎扩创术+封闭式创面负压吸引术,右上腹肋缘下出现坏死性筋膜炎,局部麻醉下行间断切开引流,给予亚胺培南西司他丁抗感染治疗,坏死性筋膜炎区域肉芽组织新鲜后缝合切口出院。病人术后因颈椎转移瘤压迫脊髓引起相关症状,生存2.5个月后死亡。直肠神经内分泌癌是一种罕见的直肠恶性肿瘤,侵袭性强、易发生转移、预后差。

Intrahepatic cholangiocarcinoma（ICC） is the most common biliary malignancy, serving as the top 2 primary hepatocellular carcinoma only secondary to hepatocellular carcinoma.Its onset is insidious and progresses rapidly,and surgical resection is the only curable approach.However,ICC is featured by a high degree of malignancy, and difficulty in the early diagnosis, and many patients are found in the middle and advanced stages that cannot be surgically treated. Therefore,the long-term survival of ICC is low,showing a poor prognosis,and the 5-year survival of advanced ICC of only 5%-10%.In recent years,systemic chemotherapy,hepatic arterial perfusion chemotherapy,and hepatic arterial chemoembolization have shown good results in ICC treatment.The advent of targeted and immunotherapy has brought a new hope for unresectable ICC.This paper reviewed the research progress of chemotherapy,local therapy,radiotherapy,targeted therapy and immunotherapy in the treatment of advanced ICC,so as to provide new ideas for ICC treatment.

With the continuous advancement of functional anatomy of the liver and the widespread use of fluorescence laparoscopic equipment, indocyanine green fluorescence imaging-assisted anatomical liver resection has gradually become a main stream for treating liver tumors. It effectively compensates for the difficulty of accurately marking deep liver segment boundaries in traditional liver resection. This article, combining domestic and international research progress, reviewed the application of indocyanine green fluorescence imaging for liver segment identification in anatomical liver resection. It also discussed the advantages and limitations of different staining techniques and provided an outlook on the future development.

In recent years, the surgical management of gastrointestinal tumors has undergone progressive standardization and refinement, with increasing consensus on operative strategies and resection margins. The advent of advanced laparoscopic techniques and the Da Vinci robotic-assisted surgical system has revolutionized the surgical treatment paradigm, bringing new breakthroughs in the treatment of gastrointestinal tumors. Beyond technical advancements, the integration of perioperative chemotherapy, radiotherapy, targeted therapy, and multidisciplinary team strategies has contributed to the prognosis improvement of gastrointestinal tumors. Moreover, advancements in molecular biology have further driven the evolution of gastrointestinal oncologic surgery toward precision medicine.

Restorative proctocolectomy with ileal pouch-anal anastomosis （IPAA） is preferred for patients with medically refractory ulcerative colitis （UC） and familial adenomatous polyposis （FAP）. While many reports have discussed postoperative surgical and inflammatory complications of pouch, functional pouch disorders are poorly understood. Two complicating factors are a great variability of defining functional outcomes after IPAA and a lack of standardization for reporting symptoms. Normal pouch function has yet to be adequately defined. The underlying etiologies for poor functional outcomes are quite diverse, such as pelvic sepsis, pouchitis, anastomotic complications and pouch volvulus, etc. However, some patients manifest poor pouch function even without such complications. It is possibly due to non-optimal pouch physiology or such specific patient factors as age, gender, body mass index （BMI） and dietary habits. Therefore it is imperative to explore the normal physiological function of pouch and better manage the functional complications to enhance the postoperative quality-of-life.

As the ideal window for surgical intervention in necrotizing enterocolitis （NEC） lies between the onset of intestinal gangrene and perforation, an accurate assessment of bowel injury severity and timely surgical intervention are critical for improving outcomes. Portal venous gas（PVG） is a significant marker of advanced NEC, particularly in extremely low birth weight（ELBW） infants, where its presence correlates with a markedly increased risk of extensive intestinal necrosis（> 75%-80% bowel involvement）. Pneumatosis intestinalis（PI） is commonly associated with NEC. Besides, linear PI may indicate a benign course, whereas cystic PI with fixed bowel loops raises suspicion for necrosis. Notably, the extent of PI does not directly correlate with bowel injury severity. Fixed bowel loops（FBL）,identified on serial radiographs, are associated with higher surgical and mortality rates, necessitating close clinical and imaging monitoring. Ascites, particularly complex ascites with debris on ultrasound, may be the sole sign of perforation. Most of scoring systems for assessing surgical indications for NEC have not been widely adopted. It is essential for further developing precise, dynamic risk assessment models, thus achieving the goal of transforming the experience-driven decision mode to data-driven mode.

Objective To explore the impacts of laparoscopic sleeve gastrectomy （LSG） combined with jejunal-jejunal bypass （JJB） on metabolic indicators in obese patients. Methods The medical records of 36 obese patients in Xiaolan People's Hospital of Zhongshan from July 2020 to July 2023 were retrospectively analyzed. According to the different surgical methods, patients were divided into the observation group （n=18, LSG+JJB） and control group （n=18, LSG）. The weight loss-related indicators, lipid metabolism, glucose metabolism, quality of life and complications were compared between groups before surgery and 12 months after surgery. Results At 1 year postoperatively, the body mass index （BMI）, waist circumference, abdominal circumference, and hip circumference in both groups were significantly reduced compared to preoperative levels, which were significantly lower in the observation group than the control group （all P<0.05）. Postoperative lipid metabolism indicators, glucose metabolism indicators, and quality of life in both groups were significantly improved compared to preoperative levels, which were more pronounced in the observation group than the control group （all P<0.05）. Severe postoperative complications were not reported in both groups, and there was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion For patients with obesity, LSG+JJB treatment can enhance the effect of weight loss, improve the function of glucolipid metabolism, and increase the quality of life, without increasing the risk of postoperative complications. It has a high safety profile and can be used as a good choice for weight loss surgery.

Objective To investigate the clinical characteristics， diagnostic methods， and treatment strategies for liver abscess complicating laparoscopic appendectomy in children. Methods A rare case of a boy at 6 years and 11 months with liver abscess following laparoscopic appendectomy for acute appendicitis was reported. The child was admitted to the Affiliated Children's Hospital of Xi'an Jiaotong University on August 6， 2024， presenting with fever for 4 days， and 26 days after laparoscopic appendectomy for acute appendicitis. Initial blood tests revealed a leukocyte count of 15.07×10⁹/L.Color Doppler ultrasound and CT confirmed a right hepatic lobe abscess. A literature review was conducted by searching key words of "acute appendicitis" "appendectomy" "liver/hepatic abscess" and "children" in both Chinese and English languages in the PubMed， Medline， Springer Link， The Cochrane Library， Wanfang， and CNKI databases. Articles published up to December 2024 were included for analysis， and the related cases were analyzed and summarized. Results The patient underwent ultrasound-guided percutaneous catheter drainage， anti-infective therapy， and oral traditional Chinese medicine.The liver abscess significantly resolved， and the child was discharged after 16 days of hospitalization， without a recurrence during a 3-month follow-up. Including this case， 8 pediatric cases were reviewed. In details，comprising 4 males and 4 females aged 5 to 14 years.Seven patients underwent laparoscopic appendectomy while one had open appendectomy；three cases involved gangrenous appendicitis and five involved perforated suppurative appendicitis. Diagnosis occurred between 1 week and 4 months post-appendectomy， with the primary clinical manifestations being fever and abdominal pain emerging 1 to 4 weeks after surgery， confirmed by color Doppler ultrasound or abdominal CT. In terms of treatment，4 received ultrasound-guided percutaneous drainage combined with antibiotics，2 received antibiotics alone，1 underwent anti-infective therapy + abscess drainage + exploratory laparotomy， and 1 underwent laparoscopic stone removal + drainage + antibiotics. Length of hospital stay ranged from 8-49 days， with all cases achieving a full recovery. Conclusion Postoperative liver abscess is a rare complication of acute appendicitis in children. Early ultrasound-guided percutaneous drainage combined with antibiotic therapy yields favorable outcomes.

Abdominal hernia is a common surgical condition that is divided into primary and secondary abdominal wall hernias. The former includes umbilical hernia, white line hernia, semimeniscus hernia, and lumbar hernia, and the latter refers to incisional hernia. It is generally believed that immediate surgery should be performed even in the absence of any clinical manifestations, and surgery is the only effective treatment for abdominal wall hernias. Commonly used surgical modalities include open sublay, laparoscopic intraperitoneal onlay mesh （IPOM）, mini/less open sublay MILOS/endoscopic mini/less open sublay technique （eMILOS）, transabdominal preperitoneal （TAPP）, laparoscopic totally extra-peritoneal hernia repair （TEP）, enhanced-view totally extraperitoneal （eTEP）, and transabdominal partial extraperitoneal tape. In recent years, endoscopic sublay repair （ESR） has become widely used. It is divided into transabdominal sublay （TAS） and totally extraperitoneal sublay （TES）, which are evolved from TAPP and TEP, respectively. Its practicality and effectiveness require a large number of clinical data to verify. This article reviewed the relevant literatures on ESR in the treatment of abdominal wall hernia, discussed the application and research progress of ESR in the treatment of abdominal wall hernia, and analyzed the feasibility and superiority of ESR.

Objective To summarize the evidence and indicators related to perioperative pain management in patients of laparoscopic hepatectomy and provide references for standardized and systematic pain management in this group. Methods According to 6S evidence pyramid model, the relevant guideline websites at home and abroad and Chinese and English databases were systematically searched until April 15,2024.The quality of the literature was evaluated separately by two researchers. Then evidence extraction was completed. Results Among 16 articles, 19 pieces of evidence were summarized with 4 dimensions,including pain education （3 pieces of evidence）,contained education content, forms and subjects; pain evaluation（4 pieces of evidence）, such as preoperative evaluation, evaluation timing and evaluation content; management team（3 pieces of evidence）, including team composition, member responsibilities and continuing education; analgesic strategies（9 pieces of evidence）,contained preventive analgesia,multi-modal analgesia and personalized analgesia. Conclusion Based upon the guidance of evidence-based methodology, this paper systematically summarizes the best evidence of perioperative pain management in patients of laparoscopic hepatectomy. It provides references for medical professionals to carry out the relevant practices.

Objective To explore the risk factors of acute appendicitis （AA） with perforation. Methods From January to June 2023, a total of 212 hospitalized AA patients were selected as study subjects. According to the observation of appendix and pathological results, they were assigned into two groups of non-perforated （n=169） and perforated （n=43）. Demographic profiles （e.g. gender, age & duration of onset）, blood test parameters （e.g. blood routine, total bilirubin & D-dimer） and imaging findings （whether or not fecalith within appendix and ascites in abdominal cavity） were compared between two groups. The influencing factors of perforated AA were examined by multivariate Logistic regression analysis and receiver operating characteristic （ROC） curve. Results There were 43 cases of perforated AA with a perforation rate of 20.3%. Longer symptomatic duration, fever （axillary temperature ≥ 38 ℃）, appendiceal fecalith on imaging, ascites on imaging and elevated level of C-reactive protein （CRP） were independent risk factors for perforated AA were examined by single factor and multiple factor Logistic regression （P< 0.05）. The area under the ROC curve of longer symptomatic duration, ascites and CRP level were 0.827, 0.853 and 0.810 （P< 0.05）. When all parameters were combined for prediction, AUC was 0.962 with a sensitivity of 0.884 and a specificity of 0.893. Conclusion Longer symptomatic duration, fever （axillary temperature ≥ 38 ℃）, appendiceal fecalith on imaging, ascites on imaging and elevated CRP level are independent risk factors for perforated AA. There is a higher value when all parameters are combined for assessments.

Pancreatic cancer is a highly aggressive malignancy of the digestive system. Over 80% of patients are diagnosed at an advanced stage. The majority of pancreatic cancer patients progresses to cancer cachexia, characterized by uncontrolled weight loss, muscle wasting, and a systemic inflammatory response. To date, effective therapeutic strategies for managing cancer cachexia are scant.This article aims to provide an in-depth review of the latest research advancements both domestically and internationally, systematically elucidate the pathophysiological mechanisms and etiology of pancreatic cancer-associated cachexia.

Objective To observe the efficiency of ultrasound-guided percutaneous transhepatic gallbladder drainage（PTGBD） and laparoscopic cholecystectomy（LC） in patients with moderate-level acute moderate cholecystitis. Methods Clinical data of patients with moderate-level acute cholecystitis in the Qingdao Municipal Hospital from March 2021 to December 2023 were retrospectively analyzed. According to the different treatment methods, they were divided into the LC group（LC treatment） and PTGBD+LC group （LC treatment after PTGBD）.The propensity score matching （PSM） at 1∶ 1 matching was performed with a caliper of 0.01,and 65 cases were included in each group. The surgical indicators, incidence rates of complications, liver function indicators （alkaline phosphatase [ALP], indirect bilirubin [IBIL], direct bilirubin [DBIL]）, serum inflammatory factors（tumor necrosis factor-α[TNF-α],C-reactive protein [CRP], interleukin-6[IL-6]） and 30-day mortality before and after treatment were compared between groups. Results In comparison to LC group,the intraoperative blood loss （31.13± 7.95 mL vs.44.86± 9.63 mL）,surgical time（62.47± 11.13 min vs.81.32± 10.52 min）,rate of intraoperative drainage （80.00% [52/65] vs.98.46%[64/65]）,and rate of LC conversion to laparotomy（0 vs.9.23% [6/65]） were significantly lower in the PTGBD+LC group （all P< 0.05）.The incidence of surgical complications in the PTGBD+LC group was significantly lower than that of the LC group （4.62%[3/65] vs.15.38%[10/65],P< 0.05）.Compared with preoperative values,ALP,IBIL,DBIL,CRP,and IL-6 at 72 h postoperatively were significantly reduced in both groups （all P< 0.05）. The above liver function indexes and serum inflammatory factors in the PTGBD+LC group at 72 h postoperatively were significantly lower than those of the LC group （all P< 0.05）. There was no significant difference in the 30-day mortality rate between the two groups（P> 0.05）.No cholecystitis recurred during the follow-up period. No significant difference in the 36-Item Short Form Health Survey （SF-36） score was found between groups （P> 0.05）. Conclusion PTGBD combined with LC can reduce intraoperative bleeding and shorten operation time, promote the postoperative recovery of AC patients, quickly relieve the inflammatory state, and improve the liver function. It has few surgical related complications, good therapeutic effect and important clinical application value.

Pancreaticoduodenectomy has been a golden standard for treating benign and malignant lesions of duodenum, distal bile duct and pancreatic head. Postoperative pancreatic fistula may significantly affect the survival and prognosis of patients. Pancreaticojejunostomy is one of the risk factors of postoperative pancreatic fistula. Researchers have modified anastomotic modes and auxiliary materials for minimizing the occurrence of postoperative pancreatic fistula. It may guide clinical decision-making for individualization to provide theoretical rationales for further lowering the incidence of postoperative pancreatic fistula.

Objective To explore the potential categories and influencing factors of grazing behavior among patients undergoing metabolic and bariatric surgery （MBS）. Methods From January to June 2024, MBS outpatients were selected by convenience sampling. Baseline Demographic Information Questionnaire, Chinese version of Repetitive Eating Questionnaire[Rep（eat）-Q], 21-item Three-Factor Eating Questionnaire（TFEQ-R21） and Chinese Version of Depression Anxiety and Stress Scale-21（DASS-21） were administered. One-way ANOVA and Logistic regression analyses were performed for identifying the factors associated with potential categories of grazing behavior. Results Among a total of 236 questionnaires, 230 valid ones were returned with an effective recovery rate of 97.5%. Grazing behavior occured in 178 patients （77.4%）. Grazing behaviors among MBS patients were divided into 3 latent classes of "low risk of grazing behavior-regular"（48.3%）,"medium risk of grazing behavior-compulsive"（37.4%） and "high risk of grazing behavior-repetitive"（14.3%）. As compared with "medium risk of grazing behavior-compulsive", patients with postoperative time <12 month, postoperative time 12-<24 month and lower scores of uncontrolled eating were more likely to be classified as "low risk of grazing behavior-regular"（OR=0.256,P=0.003;OR=0.311,P=0.020; OR=1.195,P<0.001）;As compared with "high risk of grazing behavior-repetitive", patients with no-depression, restricted eating and uncontrolled eating were more likely to be classified as "low risk of grazing behavior-regular"（OR=0.184,P<0.001;OR=0.670,P<0.001;OR=1.261,P=0.001）. Conclusion The incidence of grazing behavior in MBS patients is at a high level with distinct characteristics of classification. Healthcare professionals may design personalized intervention strategies according to the influencing factors of different latent classes of grazing behavior.

Gastric cancer is one of the most common malignancies worldwide, and standardized surgical treatment plays a crucial role in improving its survival and prognosis. Clinical research provides scientific evidence for establishing standardized surgical treatment systems, while clinical practice continuously validates and refines research outcomes during their practical application. This article explored the core value of clinical research in driving the evolution of surgical approaches in gastric surgery, and highlighting the core value of clinical research in clinical practice. Moreover, we discussed implementation strategies for high-quality clinical research in surgery, and identified challenges and future directions in clinical research. Furthermore, this article elucidated the significant role clinical research plays in developing standardized treatment systems, aiming to provide theoretical support and practical references for designing and conducting future high-quality clinical research.

The clinical application of immune checkpoint inhibitors （ICIs） has significantly improved cancer treatment outcomes, yet ICI-induced hyperprogressive disease （HPD） has become a critical issue affecting the prognosis. This review systematically summarized research advances in HPD, focusing on controversies in its definition, underlying mechanisms, and clinical management strategies. Currently, the absence of unified diagnostic criteria for HPD leads to substantial heterogeneity in evaluation systems based on tumor growth kinetics and imaging characteristics, resulting in incidence variations ranging from 4.8% to 37.3% across studies. Mechanistic investigations revealed that HPD development is closely associated with multifactorial interactions involving oncogenic pathway abnormalities, immune microenvironment remodeling, and cytokine dysregulation. We proposed establishing multidimensional predictive models that integrate clinical features, genomic biomarkers, and radiomics, and exploring targeted intervention strategies to optimize immunotherapy decision-making.

Objective To explore the clinical efficacy of transanal anastomotic drainage for colorectal anastomotic leakage and examine its impact on anal function and quality-of-life. Methods From January 1, 2007 to December 31, 2023, the relevant clinical data were retrospectively reviewed for 1 016 patients undergoing colorectal anastomosis. Postoperative anastomotic leakage occurred in 218 patients and colostomy was repeated in 15 patients due to severe abdominal infection and diffuse peritonitis. And 115 patients of anastomotic leakage improved after conservative measures and 10 cases could not be followed up due to missing data. Finally the relevant clinical data were retrospectively reviewed for 78 patients of anastomotic leakage. They were assigned into two groups of transanal drainage （study, n=18） and simple transabdominal drainage （control, n=60）. They were examined by assessment scales of low anterior resection syndrome （LARS） and Wexner fecal incontinence and European Organization for Research and Treatment of Cancer （EORTC）. And EORTC Quality-of-Life Scale （EORTC QLQ-C30） was employed for assessing postoperative quality-of-life and anal function. Results After colorectal operation, 78 patients of anastomotic leakage were cured and discharged from hospital. No obvious diffuse peritonitis or abdominal infection occurred. Both groups were followed up for 3 months post-discharge. There was no recurrence of tumor, anastomotic stenosis or scar hyperplasia. Anal function： As compared with control group, the scores of LARS [（20.28±9.95） vs. （25.55±11.71） points] and Wexner [（10.56±2.36） vs. （13.00±2.52） points] were lower in study group pre-catheterization and the differences were statistically significant （all P<0.05）. However, there was no significant inter-group difference post-catheterization （all P>0.05）. EORTC QLQ-C30 quality-of-life： Prior to catheterization, study group demonstrated worse performance in the domains of role function, social function and respiratory symptoms than those in control group. And the differences were statistically significant （all P<0.05）. However, no significant inter-group difference existed in EORTC QLQ-C30 score post-catheterization （all P>0.05）. Conclusion Catheter irrigation and drainage through anal anastomotic leakage may be an important treatment for patients of anastomotic leakage after colorectal surgery. As anal function is restored after surgery, quality-of-life improves, rate of anastomotic stenosis drops and the chance of a second stomy is minimized. This safe treatment is worthy of wider clinical applications

Objective To explore the effects of different types of metabolic and bariatric surgery on body weight （BW）, body mass index（BMI）, ovarian morphology, follicle number, menstrual cycle, androgens and anti-mullerian hormone （AMH） in obese patients with polycystic ovary syndrome （PCOS）. Methods From February 2021 to June 2023,70 obese patients with PCOS and 60 obese patients without PCOS admitted were assigned into two groups. For obese patients with PCOS, sleeve gastrectomy （SG, n=35） and Roux-en-Y gastric bypass （RYGB,n=35） were performed. And for obese patients without PCOS, SG（n=30） and RYGB（n=30） were performed. The changes of BW, BMI, ovarian morphology, follicle number, menstrual cycle and androgen/AMH level of two groups were recorded. Results BW and BMI at post-operation were significantly lower than those at pre-operation. Ovarian volume and follicle number declined markedly, menstrual cycle became obviously shortened and AMH/androgen level dropped significantly as compared with those at pre-operation. SG/RYGB demonstrated marked weight loss in both PCOS and non-PCOS obese patients and no significant difference existed in weight loss effect.And RYGB was superior to SG in long-term weight loss, long-term regulation of follicle volume/quantity, long-term improvement of androgen level, short-term adjustment of menstrual cycle and lowering the level of AMH. Conclusion SG/RYGB may significantly relieve PCOS in obese patients.

Hepatoblastomas（HB） are usually found in a large size. Due to the immature, vulnerable tissues in children, a precise anatomy is particularly important that increases the surgical challenges. In recent years, artificial intelligence （AI） has played an important role in preoperative planning and intraoperative navigation of HB surgery. This article reviewed the development status of intelligent planning and surgical navigation of HB surgery, mainly including the following aspects： （1）AI-guidedsurgical planning： three-dimensional reconstruction and virtual simulation of medical images, and optimization of AI-driven resection path; （2）Surgery planning： Augmented reality （AR） navigation, intraoperative multimodal real-time navigation fusion and intelligent navigation of robotic surgery; （3）AI-guidedsurgical planning and navigation of HB in special sites： HB in the second hepatic portal and in the caudate lobe of the liver were mainly discussed.

Objective To investigate the clinical efficacy of totally laparoscopic surgery in the treatment of neonates with type I high jejunal atresia. Methods A total of 46 neonates with type I high jejunal atresia （within 10 cm of the ligament of Treitz） admitted to the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2024 were retrospectively analyzed. According to whether laparoscopic surgery was used or not, they were divided into laparoscopic procedure（LP） group （n=16） and open procedure （OP） group （n=30）.The general data, perioperative inflammation,operation time, intraoperative bleeding, the first defecation time,the first postoperative oral feeding time, postoperative full oral feeding time, postoperative abdominal drain removal time, postoperative complications, unexpected second operations,the length of hospital stay, and mortality were compared between the two groups. Continuous variables that followed or approximately followed a normal distribution were expressed as x±s, and compared by the t-test.Continuous variables that did not conform to a normal distribution were expressed as the median（Q1,Q3）.Count data were compared by the chi-square test. Results The operation was successfully completed in both groups. There were no significant differences in the gender,gestational age,weight,preterm birth rate,and abnormal prenatal diagnosis between groups（all P> 0.05）. Compared to the OP group, the LP group had significantly less intraoperative bleeding （2.00 [1.00,2.38] mL vs. 2.00 [2.00,5.25] mL）, shorter time to first defecation （2.25± 1.24 d vs. 3.20± 1.37 d）, shorter time to first postoperative oral feeding （7.19± 2.07 d vs. 9.00± 3.18 d）, shorter time to postoperative full oral feeding （15.56± 6.77 d vs. 23.43± 14.94 d）, shorter time to abdominal drain removal（10.43± 3.67 d vs.13.47± 4.98 d）, and shorter length of hospital stay （21.50± 7.30 d vs. 29.50± 14.21 d） （all P< 0.05）.There were no significant differences between the two groups in C-reactive protein（CRP）,operation time, postoperative complications, unexpected second operations, and mortality（all P> 0.05）. Conclusion Totally laparoscopy is safe and feasible in the treatment of neonatal type Ⅰ high jejunal atresia, and offering significant advantages in reducing bleeding, restoring gastrointestinal function as soon as possible, and shortening hospital stay.

Hepatocellular carcinoma（HCC） is a prevalent tumor of digestive system. Surgical removal has been a primary treatment. However, HCC patients have a high postoperative risk of recurrence, particularly within 2 years. Therefore elucidating the signaling pathways for early recurrence after HCC surgery aids in formulating early and effective intervention measures.Counter-measures help to prevent or delay early recurrences of HCC,thereby enhancing patient survival.This review focused upon primary signaling pathways for early recurrence after HCC surgery, aiming to enhance understanding and refine precise prevention and intervention strategies for early recurrence of HCC.

Marginal ulcer is a common complication after Roux-en-Y gastric bypass and its improper management may cause serious consequences, including perforation, hemorrhage and stenosis.This report described one female case of anastomotic marginal ulcer after Roux-en-Y gastric bypass. She initially underwent laparoscopic Roux-en-Y gastric bypass in April 2011 for metabolic syndrome.In September 2017, there was an onset of recurrent abdominal pain with altered stool consistency. After thorough examinations, marginal ulcer was diagnosed due probably to an enlargement of gastric pouch. Consequently,in October 2019,laparoscopic sleeve gastrectomy was performed along with partial small bowel resection. Despite regular postoperative dosing of antacids, recurrent abdominal pain, nausea and vomiting persisted. Follow-up gastroscopy revealed non-healing of anastomotic marginal ulcer. In June 2022, after completing thorough preoperative preparation, laparoscopic partial gastric-gastrointestinal anastomosis, nutritional branch jejunostomy and gastric bypass revision were performed. Postoperative symptoms improved markedly. Follow-up gastroscopy at Month 8 showed no sign of ulceration. This case illustrated the challenge of managing marginal ulcers since two revision operations over nearly 5 years were required for curing. Focusing upon the relevant literature on marginal ulcers after Roux-en-Y gastric bypass, this review summarized risk factors, treatments and prevention strategies to provide references for bariatric and metabolic surgeons.

Objective To explore the changes of body composition in an early stage after bariatric surgery to formulate the nutrition and treatment plan. Methods From March 2019 to April 2022, retrospective analysis was performed for 106 patients undergoing laparoscopic sleeve gastrectomy （LSG）. Bioelectrical resistance analysis （BIA） was utilized for detecting body composition, obesity, muscle, water and nutritional parameters pre-operation and during follow-ups. Results LSG was all successfully performed. There were 40 （37.7%） males and 66 （62.3%） females with an average age of （28.4±7.2） year. 85 patients （80.2%）, 72（67.9%）, 65（61.3%） and 60（56.6%） were followed up at Month 1/3/6/12. Body weight, total body water （TBW）, protein, minerals, body fat mass （BFM）, soft lean mass and fat-free mass declined post-operation. Body weight and BFM dropped from （108.6±20.5） and （49.8±12.8） to （72.4±14.7） and （20.1±5.7） kg at Month 12 post-operation. Body mass index （BMI）, percent body fat （PBF）, waist-hip ratio, visceral fat area （VFA）, obesity degree and BFM of limbs/trunk showed a progressive decline. At Month 12 post-operation, BMI decreased from （38.6±5.9） to （26.2±4.6） kg/m², PBF dropped from （45.4±5.2）% to （26.9±6.2）% and VFA declined from （173±46） to （78±32） cm². Skeletal muscle mass, arm circumference, arm muscle circumference, muscle mass of upper limbs and trunk decreased in different degrees at Month 6 post-operation. Muscle mass of lower limbs decreased and stabilized at Month 1 post-operation. Intracellular water and extracellular water （ECW） declined while ECW/TBW rose at Month 3 post-operation. InBody score increased at Month 3 and 6 post-operation than that of the previous follow-up time point and body cell mass showed a lowering trend at Month 3 post-operation. Conclusion Body composition changes after bariatric surgery. Thus it may provide scientific rationales for weight control, muscle gain/loss and nutrition balance.

Objective To explore the efficacy of ultrasound-guided percutaneous dilatation catheter drainage for complicated intra-abdominal infection（cIAI） due to digestive tract perforation（DTP） in elders. Methods From October 2021 to June 2024, retrospective review was performed for 31 elders aged ≥80 year with cIAI due to DTP. After ultrasound-guided puncture, fascia dilator with gradually larger diameter（F8-F30） was successively utilized for expansion and followed by double-tube irrigation and negative pressure drainage. The changes of disappearance time of clinical symptom, body temperature and laboratory inflammatory parameters were recorded before and after drainage. Results Ultrasound-guided percutaneous dilatation and catheter drainage were performed.Average hospitalization stay was （31.12±9.13） day and average extubation time （26.91±7.84） day.Body temperature and leucocyte count dropped after the third day of puncture and the differences were statistically significant（P<0.05）. Eighteen patients（58.06%） recovered after ultrasound-guided puncture dilatation catheter drainage alone. Clinical symptoms were relieved（n=6,19.35%） and cured after sequential surgery. Five patients （16.13%） died from multiple organ failure due to septicemia and 2 patients（6.45%） were automatically discharged. For one case of massive abdominal hemorrhage,family members gave up further treatment. Another case requested to return to a local hospital for further measures due to economic reasons. Conclusion Ultrasound-guided puncture dilatation and catheter drainage may effectively improve clinical symptoms and rapidly lower inflammatory parameters for cIAI due to DTP in elders. With the advantages of easy handling, economy, mini-invasiveness and few complications, it is ideal for patients with relative surgical contraindications.

Objective To evaluate the feasibility and effectiveness of methylene blue staining via nasopancreatic tube during pancreatic enucleation. Methods A retrospective analysis was conducted on the medical records and follow-up data of 18 patients who underwent pancreatic enucleation with intraoperative methylene blue staining via nasopancreatic tube at the Pancreatic Surgery Department of Renmin Hospital of Wuhan University from May 2020 to September 2024. Among these patients,15 had tumors located in the pancreatic head and neck,and 3 in the body and tail.The maximum tumor diameter was 2.3±0.7 cm, and the shortest distance between the tumor margin and the main pancreatic duct was 2.2±0.6 mm. All patients had nasopancreatic tubes placed preoperatively under endoscopic guidance.During surgery,methylene blue solution was injected through the nasopancreatic tube after tumor enucleation to observe the staining of the pancreatic wound surface.Appropriate repair methods were selected based on the location of pancreatic juice leakage,and postoperative short-and long-term complications were recorded and analyzed,with a particular focus on the occurrence of postoperative pancreatic fistula（POPF）. Results Intraoperative injection of methylene blue solution revealed staining of the wound surface in 6 cases. According to the International Study Group on Pancreatic Fistula （ISGPF） criteria for POPF, a total of 10 patients experienced pancreatic fistula and biochemical leak postoperatively. Among these, there were 7 cases of biochemical leak and 3 cases of grade B POPF, without occurrences of grade C POPF. Conclusion The application of methylene blue staining via nasopancreatic tube during pancreatic enucleation is safe and feasible.It facilitates the timely and accurate detection of pancreatic juice leakage that may not be visible to the naked eye,enabling immediate repair and reducing the risk of postoperative complications, particularly pancreatic fistula.

Objective To investigate the short-term effect of preoperative neoadjuvant chemoradiotherapy combined with programmed cell death 1 （PD-1） inhibitors on the treatment of ulcerative colitis related colorectal cancer （UCRCC）. Methods Clinical data of UCRCC patients who received PD-1 inhibitors combined with neoadjuvant therapy and surgically operated in the Second Hospital of Nanjing from March 2021 to December 2023 were retrospectively collected. Patients were divided into the control group （n=46） and combination group （n=34） based on preoperative treatment regimens. Patients in the control group received two cycles of capecitabine + oxaliplatin chemotherapy preoperatively, followed by two cycles of radiotherapy after a 2-week rest. Those in the combination group received PD-1 inhibitors every 3 weeks for two cycles, plus clinical management as the same as in the control group. All patients underwent surgery （total colorectal resection with ileostomy or radical intestinal tumor resection） 4-6 weeks after neoadjuvant chemoradiotherapy. The effect of neoadjuvant therapy, tumor markers, drug toxicity, side effects, perioperative indicators and postoperative pathology were compared between the two groups. Results Disease control rate in the combination group was significantly higher than that of the control group （P<0.05）. The levels of carbohydrate antigen 242, carbohydrate antigen 72-4, carcinoembryonic antigen and carbohydrate antigen 199 in the combination group were significantly lower than those of the control group （P<0.05）, and the percentage of tumor regression grades 0 and 1 was significantly higher compared to the control group. There were no significant differences in the incidence of toxic and side effects and perioperative indexes between the two groups （P>0.05）. Conclusion Preoperative neoadjuvant chemoradiotherapy combined with PD-1 inhibitors demonstrates favorable efficacy in controlling UCRCC, reducing tumor marker levels, improving postoperative pathological outcomes, and exhibiting an acceptable safety profile.