investigation for public acceptance of laparoendoscopic single-site surgery

Laparoendoscopic single-site surgery [LESS] is the latest innovation in minimally invasive surgery with unconfirmed advantages. The public perception of LESS is the basis of carrying out the surgery. Participants from the outpatient department were invited to rate, on a 5-point Likert scale, the important factors including scar, complications, cost, pain and hospital stay in choosing surgery. In addition, those who preferred LESS would continue to make their choices as the risks of LESS in above mentioned aspects rose. About 85% of the questionnaires were included in the analysis. Complication was the most important factor with an average score of 4.77 +/- 0.43, followed by pain [3.84 +/- 0.96], scar [3.57 +/- 1.17], cost [3.41 +/- 0.87] and hospital stay [3.04 +/- 0.86]. Of the 196 participants, 132 [67%] preferred LESS with younger age [35.3 +/- 10.64 versus 40.4 +/- 9.6, P=0.001]. Better cosmesis was the only factor that made the participants choose LESS [3.78 +/- 1.11 versus 3.13 +/- 1.19, P < 0.005]. Almost 90% of the participants could accept the hypothesis [incision length of 3.5cm, cost up to 120%, pain up to 120%, hospital stay of 5 days], while only 50% of participants could accept the risk of complications of 6%. Complication is the most important factor that the public are concerned about in choosing surgery. LESS is preferred by young who care more concerned about the cosmesis, even with moderately elevated risks of extending incision and increasing hospital cost, postoperative pain and hospital stay

Maintenance effect of polyglycosides of Tripterygium wilfordii on remission in postoperative Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To observe the maintenance effect of polyglycosides of Tripterygium wilfordii (GTW) on remission in postoperative Crohn disease (CD).</p><p><b>METHODS</b>From 2005 to 2007, 45 adult cases of postoperative Crohn disease were randomly divided into two groups, GTW group and mesalazine group, which received GTW and mesalazine treatment respectively. CD activity index (CDAI) and clinical markers were collected at 0, 3, 6, 12 months or at the onset of symptoms. Ileocolonoscopy was performed at the end of the trial (1 year after operation) or at the onset of symptoms, and recurrence score were recorded.</p><p><b>RESULTS</b>No clinical recurrence was ascertained in both groups at 3 months. Four patients (18.2%) in GTW group relapsed and 5 (21.7%) in mesalazine group relapsed at 6 months (P=0.530). Seven patients (31.8%) in GTW group and 9 (39.1%) in mesalazine group relapsed at one year (P=0.421). Ten patients (45.5%) in GTW group had endoscopic recurrence compared with 14 (60.9%) in mesalazine group at one year(P=0.231). There were no significant differences between two groups.</p><p><b>CONCLUSION</b>GTW is similar to mesalazine in maintenance of remission of postoperative Crohn disease.</p>

Congenital choledochal cysts in adults: twenty-five-year experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults.</p><p><b>METHODS</b>The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed.</p><p><b>RESULTS</b>Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients (50%) had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination; ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy. There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct (Chi square test, P = 0.000; odds ratio, 7.800; 95% confidence interval, 2.450 to 24.836).</p><p><b>CONCLUSIONS</b>ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type I or type IV cysts. For type V cyst (Caroli's disease) with recurrent cholangitis, liver transplantation should be considered.</p>