ObjectiveTo investigate the effects of single anastomosis sleeve ileal (SASI) bypass on weight loss, metabolic improvements, and postoperative safety in patients with obesity and its metabolic comorbidities (such as type 2 diabetes and hyperlipidemia). MethodsA retrospective analysis was conducted. The clinical data of patients with obesity [body mass index (BMI) ≥32.5 kg/m² or BMI ≥27.5 kg/m² with metabolic diseases] who underwent SASI bypass in the Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2023 to December 2023. Weight loss outcomes, including the percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess BMI loss (%EBMIL), were recorded at 6 and 12 months postoperatively. Metabolic disease remission and complications at 12 months postoperatively were also documented. ResultsA total of 82 patients were included in the study. At 12 months postoperatively, the reductions in %TWL, %EWL, and %EBMIL were significantly greater than those observed at 6 months postoperatively [%TWL: (27.1±4.6)% vs. (23.6±3.8)%, t=2.379, P=0.026; %EWL: (72.1±5.8)% vs. (56.6±7.3)%, t=2.593, P<0.001; %EBMIL: (71.6±6.7)% vs. (58.3±4.9)%, t=2.607, P<0.001], remission was observed in 40 out of 48 patients (83.3%) with comorbid hypertension, 49 out of 51 patients (96.1%) with comorbid type 2 diabetes mellitus, and all patients with comorbid hyperlipidemia (33 cases) and obstructive sleep apnea syndrome (29 cases) achieved complete remission. Within 12 months after SASI bypass, 3 patients (3.7%) experienced melena, 2 patients (2.4%) developed incomplete intestinal obstruction, and 10 patients (12.1%) showed malnutrition. ConclusionThe findings of this study indicate that SASI bypass demonstrates significant weight loss and metabolic improvement effects in patients with obesity and metabolic diseases, with a controllable safety profile.
ObjectiveTo compare the effect of ileal transposition (IT) and Roux-en-Y gastric bypass (RYGBP) on blood glucose and expression of glucagon-like peptide-1 (GLP-1) in Goto-Kakizaki (GK) rats with non-obese type 2 diabetes mellitus (T2DM). MethodsThirty male GK rats were randomized divided into three groups:IT group (n=10), RYGBP group (n=10), and Sham group (n=10). The mortality and complication were observed after surgery. The levels of fasting blood glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), and GLP-1 were determined before operation, and 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months after operation in the GK rats of 3 groups. Results① Mortality and morbility. There was no death and complication occurred in IT group and Sham group, only 5 rats of RYGBP group suffered from complication, and 2 of them died. The mortality and morbility were higher in RYGBP group than those of IT group and Sham group (P < 0.05). ② FBG. Compared with before operation in the same group, the FBG levels of IT group and RYGBP group in 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation were all lower (P < 0.05). In 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation, FBG levels of IT group and RYGBP group were all lower than those of Sham group at the same time point (P < 0.05), but there was no significant difference between IT group and RYGBP group at the 6 time points (P > 0.05). ③ FINS and HbA1c. Compared with before operation in the same group, the FINS levels of IT group and RYGBP group in 3 months and 6 months after operation were higher than those of Sham group (P < 0.05), HbA1c levels of IT group and RYGBP group were both lower at the 2 time points (P < 0.05). In 3 months and 6 months after operation, FINS levels of IT group and RYGBP group were both higher, and HbA1c levels were both lower than corresponding indexes of Sham group at the same time point (P < 0.05), but there was no significant difference between IT group and RYGBP group at the 2 time points (P > 0.05). ④ GLP-1. Compared with before operation in the same group, the GLP-1 levels of IT group and RYGBP group in 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation were all higher (P < 0.05). In 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation, GLP-1 levels of IT group and RYGBP group were both higher than those of Sham group at the same time point (P < 0.05), but there was no significant difference between IT group and RYGBP group at the 6 time points (P > 0.05). ConclusionIT and RYGBP have a significant hypoglycemic effect on non-obese T2DM GK rats, but IT has lower mortality and morbility, which is more effective and safer, comparing with RYGBP.
ObjectiveTo sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital (PUMCH). MethodsSix cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed. Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope, colonoscopy, abdominal CT scan, arteriography, 99Tcm radionuclide imaging, and double-balloon intestinal endoscope. None was made a definite diagnosis before operation with only one uncertain case. All cases received operation and pathological examination. Results All cases admitted were male. The chief complaints included intestinal bleeding, abdominalgia, intestinal obstruction, and abdominal mass. Five out of six patients received gastroscope, colonoscopy, and abdominal CT scan while three received mesenteric arteriography, but none was found any suggestion for ileal duplication. Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding. Three received doubleballoon intestinal endoscope, paying attention that only one discovered with ileal duplication. In a concluding, none was made a definite diagnosis before operation with only one uncertain case. All the cases received operation. The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation. Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications． Two cases were found with ectopic gastric mucosa, another two with diverticulum, and one with ectopic pancreas， in addition the remaining with inflammatory fibrous pseudotumor. Prognosis were good for all after operation. ConclusionsIleal duplications are rarely seen in adults, gender prefer male． Without specific clinical symptoms and inspections, definite diagnosis before operation is hard to make. But maybe doubleballoon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result. Surgeons should be aware of this condition when performing abdominal exploration. Once discovered, resection is necessary.
ObjectiveTo compare effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and single anastomosis sleeve ileal (SASI) bypass on weight loss and glucose regulating as well as difference in micronutrient deficiency in obese rats with type 2 diabetes mellitus. MethodsThirty-six Spraque-Dawley rats fed with high fat diet combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg) for 1 month were used to induce obese rats with type 2 diabetes mellitus, then were randomly averagely divided into 3 groups: SADI-S group, SASI group, and sham operation (SO) group. Eight rats from numbered rats of each group were randomly selected to carry out experimental observation. The rats’ body weight, food intake, and fasting blood glucose (FBG) were measured from before operation to postoperative 1–6 months. Meanwhile blood was collected before surgery, as well as at month 1 and 6 after surgery for oral glucose tolerance testing (OGTT) and insulin resistance testing (ITT). Serum glucagon-like peptide (GLP-1), hemoglobin, and albumin levels, as well as vitamin B12, calcium, and ferrum concentrations were measured before surgery as well as at month 1 and 6 after surgery. Results① The body weight, food intake (except 5–6 months), and FBG level in the SADI-S group and SASI group were lower than the SO group (P<0.05) from 1- to6-month after operation, and all obviously decreased at month 1 after operation (P<0.05), but there was no statistical differences between the SADI-S group and SASI group (P>0.05). ② The postoperative OGTT and ITT blood glucose levels in the SADI-S group and SASI group were lower than those in the SO group (P<0.05) and were lower than those in the preoperative levels (P<0.05), and the SADI-S group had a lower OGTT blood glucose level than the SASI group at month 6 after operation (P<0.05). ③ The GLP-1 levels of the SADI-S group and SASI group were higher than that of the SO group (P<0.05), and higher than before operation at month 6 after operation (P<0.05) , but there was no statistical difference was found between the SADI-S group and SASI group after operation (P>0.05). ④ The postoperative albumin levels of the SADI-S group and SASI groups= were lower than of the SO group (P<0.05) and were lower than before operation, and albumin level of the SADI-S group was lower than of the SASI group at postoperative month 6 (P<0.05); while the hemoglobin had no statistical differences among the 3 groups (P>0.05). ⑤ The ferrum concentration of the SADI-S group was lower than that of the SASI group and SO group at 1 month after operation (all P<0.05), while it increased slightly at month 6 after operation and had no statistical difference between the SADI-S group and SASI group (P>0.05); the calcium concentrations of the SADI-S group and SASI group only at 6 month after operation were lower than those of the SO group (P<0.05), and were lower as compared with before operation (P<0.05) , but no statistical difference was found between the SADI-S group and SASI group (P>0.05); the vitamin B12 had no statistical differences among the 3 groups (P>0.05). ConclusionsFor obese rats with type 2 diabetes mellitus, SADI-S and SASI have similar weight loss effect. Long-term glucose reduction of SADI-S shows a advantage than SASI, but influence of postoperative micronutrients of SASI is inferior to SASI.
ObjectiveTo compare the postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) and single-anastomosis sleeve ileal bypass (SASI), and to explore the risk factors for PONV. MethodA total of 220 patients at the Affiliated Hospital of Xuzhou Medical University from June 2022 to December 2022 were prospectively collected, and were randomly divided into the LSG group and the SASI group; the general condition of the patients was recorded. PONV was assessed on the POD0, POD1, POD2, POD30, POD60, POD90, using the Rhodes index score.ResultsThe total Rhodes index score in the LSG group was higher than that in the SASI group [(25.56±13.54) vs. (16.06±11.28), P＜0.05]. The results of multiple linear regression analysis showed that female (P=0.014), LSG (P＜0.001), young age (P=0.050), and low BMI (P=0.019) were risk factors for PONV. ConclusionsCompared with LSG, the Rhodes index score after SASI is low. For young women with low BMI, special attention should be paid to the prevention and treatment of PONV after LSG.
Objective To investigate factors for surgical difficulty and complications following closure of temporary ileostomy for rectal cancer. Methods The clinical data of 103 patients with low rectal cancer treated with closure of temporary ileostomy from January 2014 to July 2017 in the Northern Theater Command General Hospital were retrospectively analyzed. The associated factors of surgical difficulty and postoperative complications were identified by the univariate and multivariate logistic regression analyses. Results In this study, there were 11 (10.7%) patients with surgical difficulty (operation time >100 min) in the 103 patients. The multivariate logistic regression analysis showed that the history of previous abdominal surgery ［OR=5.272, 95% CI (1.325, 20.977), P=0.018］ and minimally invasive surgery ［OR=0.166, 95% CI (0.037, 0.758), P=0.020］ were the independent influencing factors of the difficulty of surgery. The complications following closure of temporary ileostomy included 16 (15.5%) patients with the incision infection, 5 (4.9%) patients with the intestinal obstruction, and 3 patients with the pulmonary infection (2.9%). The multivariate logistic regression analysis showed that the diabetes ［OR=4.855, 95% CI (1.133, 20.804), P=0.033］, operation time >100 min ［OR=11.914, 95% CI (2.247, 63.171), P=0.004］, and peristomal dermatitis ［OR=18.814, 95% CI (3.978, 88.988), P<0.001］ were the independent influencing factors for the incision infection. Conclusions History of previous abdominal surgery is main cause for difficulty of surgery and minimally invasive surgery can reduce difficulty of surgery. Diabetes mellitus, longer operation time, and peristomal dermatitis are main causes of postoperative incision infection.
ObjectiveTo evaluate the efficacy, safety, and feasibility of fecal drainage technique on rectal anastomosis for preventing anastomotic leakage after operation for middle-low rectal cancer.MethodsThe retrospective analysis was used to collect the middle-low rectal cancer which completed operation in this hospital from 2014 to 2019. According to the way of preventing annstomotic leakage, the patients were divided into two groups: fecal drainage on rectal anastomosis group (Abbreviation: fecal drainage group) and end ileum prophylactic stoma group (Abbreviation: ileostomy group). The incidence of anastomotic leakage after operation and the different treatment methods following leakage were compared between the two groups.ResultsA total of 231 cases were recorded, including 84 cases in the fecal drainage group, 147 cases in the ileostomy group. There were no significant differences in the baseline data such as the gender, age, preoperative complications, operation mode, etc. between the two groups (P>0.050). There were no significant differences in the operation time, intraoperative blood loss, incision infection, postoperative intestinal obstruction, total hospitalization cost, death, anastomotic leakage (overall, each grade, treatment, and outcome) between the two groups (P>0.050). Although the length of hospital stay except the patients with anastomotic leakage in the fecal drainage group was significantly longer than that in the ileostomy group (P<0.001), there was no significant difference in the total length of hospital stay between the two groups (P>0.050), and the incidence of anastomotic stenosis in the fecal drainage group was significantly lower than that in the ileostomy group (P=0.029).ConclusionAccording to the results of this study, fecal drainage technique on rectal anastomosis is effective, safe, and feasible in preventing anastomotic leakage after operation for middle-low rectal cancer.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
ObjectiveThis study aimed to discuss the risk factors associated with the delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.MethodsClinical data were collected retrospectively on 130 consecutive patients undergoing defunctioning ileostomy following sphincter-preserving surgery for rectal cancer, between January 2014 and December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University. According to the reversal time of ileostomy, the patients were divided into two groups, including the delay reversal ileostomy group (≥120 d, n=72) and the normal ileostomy group (<120 d, n=58).ResultsOne hundred and thirty patients were studied (median time to reversal 132 d, range 39–692 d). Logistic regression model showed that adjuvant chemotherapy (OR=14.106, P=0.002), distance of tumor from the anal verge (OR=0.019, P=0.002), and anastomotic leakage (OR=32.440, P=0.001) were significant independent risk factors for delayed reversal. Time to reversal was significantly longer in those patients who had adjuvant chemotherapy, anastomotic leakage, and short distance of tumor from the anal verge.ConclusionAdjuvant chemotherapy, short distance of tumor from the anal verge, and anastomotic leakage are the independent risk factors for delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.
目的 探讨胃袖状切除附加改良空回肠旁路术的减肥效果及其在临床中的应用价值。方法 分析我院1例行胃袖状切除附加改良空回肠旁路术治疗的病态性肥胖患者的临床资料。结果 术后随访12个月，多余体重减少达70.8%，无胃肠功能紊乱、营养障碍等并发症。结论 胃袖状切除附加改良空回肠旁路术治疗病态性肥胖近期减重效果确切、安全。