22 August 2026, Volume 39 Issue 4

    

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  Strategies and techniques for surgical rescue

  Ren Jian'an

  Journal of Abdominal Surgery. 2026, 39(4): 249-253. https://doi.org/10.3969/j.issn.1003-5591.2026.04.001

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  Surgical rescue refers to a series of surgical interventions adopted to manage complications arising from surgery and interventional procedures. The principal strategies of surgical rescue are damage control surgery and early rapid intervention. The main techniques include early warning and diagnosis of complications, resuscitation and de-resuscitation therapy, organ support techniques, surgery centered on damage control, accurate identification of pathogenic organisms and rational use of anti-infective agents, individualized and appropriate use of sedatives, analgesics, and neuromuscular blocking agents, parenteral and enteral nutritional support, prevention and treatment of coagulation disorders, assessment of treatment failure and reintervention, and prevention and treatment of persistent critical illness and chronic critical illness. The surgical rescue failure rate refers to the mortality rate of patients actively rescued by surgeons and can reflect the overall surgical capability of a hospital. Surgical rescue techniques have promoted the development of acute care surgery and are its core technologies. Rescue strategies and techniques will continue to evolve and contribute to further improvements in the treatment of critically ill surgical patients.
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  Early identification of critically ill patients in abdominal surgery

  Wu Changliang, Wang Peige

  Journal of Abdominal Surgery. 2026, 39(4): 254-260. https://doi.org/10.3969/j.issn.1003-5591.2026.04.002

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  Critically ill patients in abdominal surgery may result from severe trauma, massive hemorrhage, intra-abdominal infection, intestinal ischemic necrosis, major surgery, or decompensation of underlying diseases. Their condition progresses rapidly and often involves multiple systems, including the circulatory, respiratory, renal, and coagulation systems. The main difficulty in early clinical recognition lies not with patients who present with obvious signs such as shock or massive bleeding, but with those whose vital signs remain temporarily stable, whose abdominal findings are atypical, yet whose underlying condition is still deteriorating. For such patients, history taking and high-risk warning signs should be integrated with dynamic assessment of changes in vital signs, abdominal signs, imaging findings, and laboratory indicators. Particular attention should be paid to serial changes in lactate, urine output, coagulation function, inflammatory markers, and organ function indices. Diagnosis and treatment should proceed in parallel, with timely resuscitation and enhanced monitoring, so as to determine as early as possible whether lesions requiring etiologic control, such as perforation, hemorrhage, obstruction, or ischemic necrosis, are present. Early recognition and prompt intervention help reduce multiple organ dysfunction and improve patient outcomes.
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  Early warning of surgical infection： from static indicators to trend-based assessment

  Wu Xiuwen, Fu Xinya, Ren Jian'an

  Journal of Abdominal Surgery. 2026, 39(4): 261-264. https://doi.org/10.3969/j.issn.1003-5591.2026.04.003

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  Surgical infection is a common disease in general surgery. Its mortality varies according to the type of infection, comorbidities, and the severity of organ dysfunction, and may be as high as 50% in some cases. Accurate diagnosis and treatment of surgical infection urgently require early warning; however, no "gold standard" indicator or method for infection warning currently exists. Based on the pathophysiology of surgical infection, this article first analyzes the sensitivity and specificity of common inflammatory markers and scoring systems for infection warning. Traditional methods that rely on a single measurement or static threshold to identify infection often fail to accurately capture real-time changes in a patient's condition. Therefore, this article emphasizes dynamic trend-based assessment and evaluates the performance of machine learning and deep learning algorithms in developing multimodal dynamic early warning models.
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  Source control in critically ill surgical patients： timing and methods

  Ren Huajian, Ren Jian'an

  Journal of Abdominal Surgery. 2026, 39(4): 265-270. https://doi.org/10.3969/j.issn.1003-5591.2026.04.004

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  Source control is a core component of treatment for critically ill surgical patients. For postoperative critically ill patients in particular, determining the optimal timing and approach for source control remains a common clinical challenge. This article systematically reviews the epidemiological background, definition and principles, timing of implementation, major interventions, and outcome assessment strategies for source control in critically ill surgical patients. It emphasizes that surgeons should lead the entire treatment process, and that the acute care surgery （ACS） model——encompassing general surgery, intensive care, and trauma care—represents an important direction for improving outcomes in this patient population.
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  Construction of an abdominal pain center： from process reengineering to intelligent enablement

  Tan Kanglian, Chen Zhiqiang

  Journal of Abdominal Surgery. 2026, 39(4): 271-274. https://doi.org/10.3969/j.issn.1003-5591.2026.04.005

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  Acute abdominal pain is a common clinical emergency. It has an abrupt onset, complex etiologies involving multiple organ systems, and is difficult to differentiate diagnostically, with a relatively high risk of misdiagnosis and missed diagnosis; in severe cases, it may even be life-threatening. The traditional discipline-based diagnosis and treatment model has problems such as fragmented resources and poor workflow coordination, resulting in patients being shuttled between departments and low diagnostic and treatment efficiency, making it difficult to meet the need for rapid and accurate care. To address this challenge, this article, based on clinical practice, proposes a construction pathway for an abdominal pain center centered on process reengineering and supported by intelligent enablement. By integrating multidisciplinary resources, optimizing diagnostic and treatment workflows, and building an intelligent platform, it promotes the evolution of the abdominal pain center toward a new patient-centered, data-driven care ecosystem, with the aim of improving diagnostic accuracy and efficiency, reducing misdiagnosis rates, and providing a reference for the standardized and intelligent development of abdominal pain centers.
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  The role and significance of the high dependency unit in abdominal acute care surgery

  Lin Yunzhen, Zheng Tao

  Journal of Abdominal Surgery. 2026, 39(4): 275-278. https://doi.org/10.3969/j.issn.1003-5591.2026.04.006

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  Acute care surgery is an emerging discipline that integrates emergency trauma care, acute abdomen management, and intensive care unit（ICU）. Patients in this field often present with complex, severe, and rapidly changing conditions, and many continue to require a high level of monitoring and supportive care even after treatment. Under the traditional “ICU-general ward” model, some patients cannot receive a level of care matched to their clinical condition, resulting in prolonged treatment duration, increased complication rates, and reduced healthcare efficiency. As a transitional monitoring unit between the ICU and the general ward, the high dependency unit （HDU） can accommodate patients whose conditions have improved after ICU treatment but who still require close observation, while providing a higher level of care than a general ward. This helps optimize the allocation of medical resources, reduce mortality, and improve patient outcomes. At present, HDU development in China remains in the exploratory stage and faces prominent challenges such as inconsistent construction standards and an unclear functional positioning. This article briefly describes the role of the HDU within the abdominal acute care surgery system and shares advanced experience in HDU development at home and abroad, with the aim of providing a basis for promoting standardized HDU construction.
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  Construction of an abdominal pain center and an abdominal pain green channel

  Hao Shuai, Ren Jian'an

  Journal of Abdominal Surgery. 2026, 39(4): 279-283. https://doi.org/10.3969/j.issn.1003-5591.2026.04.007

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  Acute abdomen is a common reason for visits to the emergency department and is mostly a time-sensitive condition. The traditional sequential model of “triage-consultation-treatment” is difficult to meet the need for rapid care. This article systematically analyzes the challenges in the diagnosis and treatment of acute abdomen, the rise of acute care surgery, and its development pathway in China. It focuses on the practical exploration conducted by the General Hospital of the Eastern Theater Command of the Chinese People's Liberation Army, centered on the abdominal pain center and the abdominal pain green channel, as well as the "Eastern Theater General Hospital model." By establishing a management committee and multidisciplinary team, optimizing the workflow of the abdominal pain green channel, implementing full-process perioperative management standards based on surgical rescue, and building a goal-oriented quality control system, this model has significantly shortened preoperative waiting time and reduced the incidence of complications and mortality. On this basis, a regional collaborative treatment network supported by specialty alliances, the surgical rescue network, telemedicine collaboration, and tiered diagnosis and treatment has initially taken shape. Based on these practices, this article proposes the EAST treatment concept—Efficient workflow, Accurate decision-making, Systematic whole-course management, and Target-oriented management—and looks ahead to the future development of standard systems, intelligent solutions, talent training, and a fully covered network. This model provides a reproducible practice reference for improving the management and treatment of acute abdomen in China.
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  Prevention and treatment of chronic critical illness in surgery

  Liu Peizhao, Wu Xiuwen, Ren Jian'an

  Journal of Abdominal Surgery. 2026, 39(4): 284-290. https://doi.org/10.3969/j.issn.1003-5591.2026.04.008

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  Chronic critical illness CCI is one of the most challenging problems encountered in acute care surgery. With advances in intensive surgical care, the acute-phase survival of patients with severe trauma, intra-abdominal infection, complex postoperative complications, and sepsis has improved significantly. However, some patients, after surviving the early critical stage, continue to experience persistent organ dysfunction, unresolved infection, nutritional depletion, sarcopenia, and impaired functional recovery, gradually progressing into a chronic critical state. CCI in surgery has distinct specialty-specific features. Its development is associated not only with persistent inflammation, immunosuppression, and catabolism, but also closely related to inadequate source control, anastomotic leak, enteric fistula, postoperative intra-abdominal infection, open abdomen, intra-abdominal hypertension, and repeated surgical insults. At present, CCI still lacks a unified diagnostic standard and specific pharmacologic treatment. Therefore, prevention and management should be moved earlier, to the perioperative period and the early ICU phase, emphasizing etiologic identification, source control, de-escalation of anti-infective and fluid therapy, nutritional and metabolic support, early rehabilitation, and continuous multidisciplinary management. This article reviews the concept, pathogenesis, early recognition, and comprehensive prevention and treatment strategies for CCI in surgery, with the aim of providing a reference for improving the long-term prognosis of critically ill surgical patients.
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  Clinical summary of 21 cases of remote multi-specialty surgery performed using a domestic surgical robot

  Xiang Bohan, Leng Chao, Dong Wei, Zhang Ni, Wang Guihua, Hu Junbo, Wang Shaogang, Chen Lin, Zhu Peng, Chen Xiaoping

  Journal of Abdominal Surgery. 2026, 39(4): 291-295. https://doi.org/10.3969/j.issn.1003-5591.2026.04.009

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  Remote robotic surgery has become a promising direction in minimally invasive surgery; however, its application across multiple specialties under different distance and latency conditions remains insufficiently explored. Based on the platform of the 2026 Annual Meeting of the Chinese Chapter of the International Hepato-Pancreato-Biliary Association, this study included 21 patients who underwent remote robotic surgery using the domestic EDGE or Toumai robotic surgical system over a 5G/dedicated line network. The procedures covered hepatobiliary and pancreatic surgery （10 cases）, urology （7 cases）, gastrointestinal surgery （3 cases）, and thoracic surgery （1 case）, with a distance gradient ranging from the same city （22 km） to intercontinental transmission （17,000 km）. All 21 procedures were successfully completed, with no conversion to open surgery or local surgery. According to network latency stratification, 16 cases （76.2%） had latency < 100 ms, and the surgeons reported smooth operation without obvious lag; 2 cases （9.5%） had latency of 100-200 ms; and 3 cases （14.3%） had latency > 200 ms, with perceptible delay （0.5-1.0 s）, yet all procedures remained technically feasible. Packet loss occurred in 5 cases but did not affect surgical completion. The results indicate that domestic remote robotic surgery systems demonstrated reliable safety and feasibility across multiple specialties and under a wide range of distance and latency conditions. A latency of ≤ 200 ms ensured optimal surgical performance, whereas for latency > 200 ms, low-complexity procedures could still be completed with appropriate compensatory strategies. This study provides empirical support for the broader clinical application of remote surgery.
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  Epidemiologic analysis of the etiologic spectrum of acute abdomen cases in the Surgical Rescue Network Registry Database

  Zhang Jinpeng, Wu Xiuwen, Ren Huajian, Zheng Tao, Ke Jia, Chen Yao, Li Ranran, Yin Wei, Zhou Shaoying, Wang Liuhua, Zeng Qingjun, Dong Jianzhong, Ren Jian'an

  Journal of Abdominal Surgery. 2026, 39(4): 296-304. https://doi.org/10.3969/j.issn.1003-5591.2026.04.010

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  Objective To analyze the etiologic composition and age distribution of acute abdomen cases registered in the Surgical Rescue Network, and to provide evidence for stratified management of acute abdomen and the development of a regional acute care surgery （ACS） system. Methods A retrospective analysis was performed using registry data from the Surgical Rescue Network from January 2024 to December 2025. Case contributions from participating centers and the composition of ACS-related cases were described. Diagnoses of acute abdomen were standardized and categorized. The major etiologies, baseline characteristics, and etiologic composition across different age groups were compared. Continuous variables are presented as median （interquartile range）, and categorical variables are presented as number of cases and percentage. Results A total of 24,877 ACS-related cases were registered, including 21,098 cases of acute abdomen （84.8%）. Acute appendicitis-related diseases were the most common （13,082 cases, 62.0%）, followed by gallbladder and biliary emergencies （2,915 cases, 13.8%）, gastrointestinal perforation （2,170 cases, 10.3%）, intestinal obstruction and hernia-related emergencies （1,857 cases, 8.8%）, and acute pancreatitis （591 cases, 2.8%）. These five categories accounted for 97.7% of all cases. Among 21,070 patients with non-missing age data, the proportion of acute appendicitis-related diseases decreased with increasing age, whereas the combined proportion of gallbladder and biliary emergencies, gastrointestinal perforation, and intestinal obstruction and hernia-related emergencies increased from 6.1% in the < 18-year group to 67.7% in the ≥ 80-year group. Etiologic groups such as perforation and intestinal obstruction/hernia-related emergencies carried a relatively higher anesthesia risk burden. Conclusion The acute abdomen cases registered in the Surgical Rescue Network exhibit two distinct features： a concentration of high-frequency diseases and an increased burden of complex etiologies and risk in older patients. Acute appendicitis-related diseases predominate in younger patients, whereas perforation, obstruction, and gallbladder/biliary emergencies increase markedly in older patients. These findings may inform stratified management of acute abdomen, pathway design for abdominal pain centers, and allocation of regional ACS resources.
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  Serum FOXK1 and RUNX3 levels in acute pancreatitis： association with disease severity and prognostic value for mortality

  Liu Shuozi

  Journal of Abdominal Surgery. 2026, 39(4): 305-311. https://doi.org/10.3969/j.issn.1003-5591.2026.04.011

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  Objective To evaluate the association of serum forkhead box k1 （FOXK1） and runt-related transcription factor 3 （RUNX3） levels with disease severity in acute pancreatitis （AP） and to determine their prognostic utility for mortality. Methods This retrospective study included 245 AP patients treated at Tangshan People's Hospital from January 2022 to June 2024, and 179 contemporaneous healthy controls.AP severity was classified per the Chinese Consensus on the Multidisciplinary Treatment （MDT） of Acute Pancreatitis into mild （n=67）,moderately severe （n=82）,and severe （n=96）.Outcomes at 3 months defined the survival group （n=203） and death group （n=42）.Serum FOXK1 and RUNX3 were measured by enzyme-linked immunosorbent assay （ELISA）.Spearman correlation evaluated relationships with disease severity.Multivariable Cox regression identified independent predictors of mortality.Receiver operating characteristic （ROC） analysis assessed the discriminatory performance of FOXK1 and RUNX3 for mortality risk. Results Compared with healthy controls, AP patients had significantly higher serum FOXK1 and lower serum RUNX3 （P< 0.05）.The severe AP group showed higher FOXK1 and lower RUNX3 than the moderately severe and mild groups （both P< 0.05）.Correlation analysis reported that serum FOXK1 was negatively correlated with disease severity （r=-0.655,P< 0.05）,and serum RUNX3 was positively correlated with disease severity （r=0.634,P< 0.05）.The death group had a greater proportion of severe AP,longer ICU stays,higher C-reactive protein （CRP） and FOXK1,and lower RUNX3 than the survival group （all P< 0.05）.Multivariate analysis identified disease severity,ICU length of stay,and serum FOXK1 and RUNX3 as independent predictors of mortality （P< 0.05）.The combined FOXK1 + RUNX3 model yielded an area under the curve （AUC） of 0.922 for mortality prediction,outperforming either marker alone （Z_{combined-FOXK1}=2.935;Z_{combined-RUNX3}=3.184;P< 0.05）. Conclusion Serum FOXK1 is elevated and RUNX3 reduced in AP patients, and both markers are closely associated with disease severity.Their combined assessment provides strong prognostic information for mortality risk in AP patients.
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  Research progress on clinical response after neoadjuvant therapy for rectal cancer

  Jin Lu, Hong Yonggang, Hao Liqiang, Wei Cailiu

  Journal of Abdominal Surgery. 2026, 39(4): 312-318. https://doi.org/10.3969/j.issn.1003-5591.2026.04.012

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  Neoadjuvant therapy can induce regression of rectal tumors. After neoadjuvant therapy, clinicians can assess a patient's clinical response using clinical examination methods. For patients who achieve a favorable clinical response after neoadjuvant therapy, an organ-preserving strategy that avoids rectal resection may be implemented. This strategy includes local excision and the non-surgical watch-and-wait approach. How to improve the clinical response rate and accurately evaluate the degree of clinical response so that as many patients as possible can undergo organ-preserving strategies is currently the focus and objective of research. This article reviews recent progress in the definition, assessment, improvement measures, molecular biology, and organ-preserving strategies related to clinical response.