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1.  Learning curve for hand-assisted laparoscopic D2 radical gastrectomy 
AIM: To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy (HALG) for the treatment of gastric cancer.
METHODS: The HALG surgical procedure consists of three stages: surgery under direct vision via the port for hand assistance, hand-assisted laparoscopic surgery, and gastrointestinal tract reconstruction. According to the order of the date of surgery, patients were divided into 6 groups (A-F) with 20 cases in each group. All surgeries were performed by the same group of surgeons. We performed a comprehensive and in-depth retrospective comparative analysis of the clinical data of all patients, with the clinical data including general patient information and intraoperative and postoperative observation indicators.
RESULTS: There were no differences in the basic information among the patient groups (P > 0.05). The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups, with the difference being statistically significant (P = 0.01). There were no differences in total operative time between the groups (P = 0.30). Postoperative intestinal function recovery time in group A was longer than that of other groups (P = 0.02). Lengths of hospital stay and surgical quality indicators (such as intraoperative blood loss, numbers of detected lymph nodes, intraoperative side injury, postoperative complications, reoperation rate, and readmission rate 30 d after surgery) were not significantly different among the groups.
CONCLUSION: HALG is a surgical procedure that can be easily mastered, with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.
doi:10.3748/wjg.v21.i5.1606
PMCID: PMC4316103  PMID: 25663780
Learning curve; Gastric cancer; Hand-assisted laparoscopic D2 radical gastrectomy; Operative time; Surgical quality indicators
2.  Stress-induced intestinal necrosis resulting from severe trauma of an earthquake 
AIM: To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.
METHODS: Three patients in our study were trapped inside collapsed structures for 22, 21 and 37 h, respectively. The patients underwent 3-4 operations after sustaining their injuries. Mechanical ventilation, intermittent hemodialysis and other treatments were also provided. The patients showed signs of peritoneal irritation on postoperative days 10-38. Small intestinal necrosis was confirmed by emergency laparotomy, and for each patient, part of the small bowel was removed.
RESULTS: Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively. The third patient who performed 4 operations was discharged and made a full recovery. Three patients had the following common characteristics: (1) Multiple severe trauma events with no direct penetrating gastrointestinal injury; (2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment; (3) Progressive abdominal pain and tenderness, and peritoneal irritation was present on post-traumatic days 10-38; (4) Abdominal operations confirmed segment ulcer, necrosis of the small intestine, hyperplasia and stiffness of the intestinal wall; and (5) Pathological examinations suggested submucosal hemorrhage, necrosis, fibrosis and hyalinization of the vascular wall. Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.
CONCLUSION: Intestinal necrosis is strongly asso-ciated with stress from trauma and post-traumatic complications; timely exploratory laparotomy maybe an effective method for preventing and treating stress-induced intestinal necrosis.
doi:10.3748/wjg.v18.i17.2127
PMCID: PMC3342613  PMID: 22563202
Intestinal necrosis; Stress; Trauma; Earthquake; Exploratory laparotomy; Fatty acid binding protein
3.  Three-step hand-assisted laparoscopic surgery for radical distal gastrectomy: an effective surgical approach 
Objective: Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical technique based on hand-assisted laparoscopic surgery (HALS) for the treatment of gastric cancer. This surgical approach is particularly easy and convenient for radical distal gastrectomy. In order to thoroughly understand the advantages of applying “three-step HALG” in distal gastrectomy, our center conducted a retrospective study to analyze data from patients who underwent HALG and laparoscopic-assisted D2 radical gastrectomy (LAG) during the corresponding time period. Methods: The HALG procedure is performed in three steps, namely the operation performed through an auxiliary incision under direct vision, hand-assisted laparoscopic operation, and gastrointestinal tract reconstruction through the auxiliary incision under direct vision. This study performed comprehensive, in-depth comparative analyses on the clinical data of two groups of patients who underwent HALG and LAG. Results: The auxiliary incision under the xiphoid was maximally utilized in the HALG procedure. The rate of conversion to open surgery in HALG group patients was significantly lower than in the LAG group (P = 0.03), and the operating time was significantly shorter in the HALG group than in the LAG group (P = 0.00). There was no significant difference in the pain rate score on postoperative day 2 and on the day of discharge between the HALG and LAG groups (P > 0.05). No statistically significant difference was found in the time to recovery of bowel function, postoperative hospital stay, or postoperative complications (P > 0.05), although the values were all lower in the HALG group than in the LAG group. Conclusion: “Three-step HALG” is a highly feasible surgical approach for radical distal gastrectomy.
PMCID: PMC4161561  PMID: 25232401
Hand-assisted laparoscopic surgery; three-step hand-assisted laparoscopic D2 radical gastrectomy; laparoscopic-assisted D2 radical gastrectomy; distal gastrectomy
4.  Transvaginal early fistula debridement and repair plus continuous vacuum aspiration via anal tube for rectovaginal fistula following rectal cancer surgery: report of four cases 
Objective: To investigate the feasibility and superiority of transvaginal early fistula debridement and repair plus continuous vacuum aspiration via anal tube for rectovaginal fistula following rectal cancer surgery. Methods: The clinical data of four cases of rectovaginal fistula following rectal cancer surgery were retrospectively analyzed in our center. After adequate preoperative preparation, the patients underwent transvaginal fistula debridement and repair plus continuous vacuum aspiration via anal tube under continuous epidural anesthesia. After surgery and before discharge, anti-infection and nutritional support was administered for 2 d, and fluid diet and anal tube vacuum aspiration continued for 7 d. Results: All the four cases healed. Three of them healed after one operation, and the other patient had obvious shrinkage of the fistular orifice after the first operation and underwent the same operation for a second time before complete healing. The duration of postoperative follow-up was 2, 7, 8 and 9 months respectively. No recurrence or abnormal sex life was reported. Conclusions: Early transvaginal fistula debridement and repair plus continuous vacuum aspiration via anal tube are feasible for rectovaginal fistula following rectal cancer surgery. This operation has many advantages, such as minimal invasiveness, short durations of operation, short treatment cycles, and easy acceptance by the patient. In addition, it does not necessitate colostomy for feces shunt and a secondary colostomy and reduction.
PMCID: PMC4161576  PMID: 25232416
Fistula; debridement and repair; anal tube; continuous vacuum aspiration; after rectal cancer surgery; rectovaginal fistula
5.  Therapeutic effect and mechanism of electroacupuncture at Zusanli on plasticity of interstitial cells of Cajal: a study of rat ileum 
Background
Electroacupuncture (EA) is one of the techniques of acupuncture and is believed to be an effective alternative and complementary treatment in many disorders. The aims of this study were to investigate the effects and mechanisms of EA at acupoint Zusanli (ST36) on the plasticity of interstitial cells of Cajal (ICCs) in partial bowel obstruction.
Methods
A Sprague Dawley rat model of partial bowel obstruction was established and EA was conducted at Zusanli (ST36) and Yinglingquan (SP9) in test and control groups, respectively. Experiments were performed to study the effects and mechanisms of EA at Zusanli on intestinal myoelectric activity, distribution and alteration of ICCs, expression of inflammatory mediators, and c-Kit expression.
Results
1) EA at Zusanli somewhat improved slow wave amplitude and frequency in the partial obstruction rats. 2) EA at Zusanli significantly stimulated the recovery of ICC networks and numbers. 3) the pro-inflammatory mediator TNF-α and NO activity were significantly reduced after EA at Zusanli, However, no significant changes were observed in the anti-inflammatory mediator IL-10 activity. 4) EA at Zusanli re-expressed c-Kit protein. However, EA at the control acupoint, SP9, significantly improved slow wave frequency and amplitude, but had no effect on ICC or inflammatory mediators.
Conclusions
We concluded that EA at Zusanli might have a therapeutic effect on ICC plasticity, and that this effect might be mediated via a decrease in pro-inflammatory mediators and through the c-Kit signaling pathway, but that the relationship between EA at different acupoints and myoelectric activity needs further study.
doi:10.1186/1472-6882-14-186
PMCID: PMC4096531  PMID: 24908398
Electroacupuncture; Plasticity; DOG1; Inflammatory mediators; c-Kit signaling

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