Endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus:feasibility and efficacy / 实用医学杂志

Objective To investigate the feasibility and efficacy of endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus. Methods From August 2015 to August 2017,27 cases of elderly patients with acute sigmoid volvulus received treatment of endoscopic placement of ileus tube combined enterectomy in Pudong New Area Gongli Hospital.Retrospectively collected clin-ic parameters of pre-catheterization,post-catheterization,enterectomy and postoperative follow-up;the success rate of catheterization and enterectomy,compression efficiency,post-operative complications,and efficacy of the com-bined therapy were analyzed. Results Emergency catheterizations of anorectal ileus tube were succeeded in 27 (100%)patients;one patient who developed intestinal gangrene received emergency enterectomy,the hemogram and internal environmental disturbance of the 26 cases were significantly relieved,and the efficacy rate of decom-pression was 96.3%. The success rate of was enterectomy was 100%;the incidence of severe complications and mortality were 22.2% and 3.7%,respectively. During the follow-up,2(7.4%)patients developed ileus,and the efficacy rate of the combined therapy was 85.2%. Conclusions The catheterization of ileus tube could effectively depress intestinal pressure. The success rate of enterectomy was significantly improved and postoperative mortality was reduced. The therapy of endoscopic ileus tube catheterization combined enterectomy is a safe and effective method for the treatment of acute sigmoid volvulus in the elderly.

Laparoscopic resection of gastrointestinal stromal tumors (gist) / Ressecção laparoscópica de tumores estromais gastrintestinais (gist)

Background : Gastrointestinal mesenchymal or stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection. Several laparoscopic techniques, from gastrectomies to segmental resections, have been used successfully. Aim : Describe a single center experience on laparoscopic GIST resection. Method : Charts of 15 operated patients were retrospectively reviewed. Thirteen had gastric lesions, of which ten were sub epithelial, ranging from 2-8 cm; and three were pure exofitic growing lesions. The remaining two patients had small bowel lesions. Surgical laparoscopic treatment consisted of two distal gastrectomies, 11 wedge gastric resections and two segmental enterectomies. Mechanical suture was used in the majority of patients except on six, which underwent resection and closure using manual absorbable sutures. There were no conversions to open technique. Results : Mean operative time was 1h 29 min±92 (40-420 min). Average lenght of hospital stay was three days (2-6 days). There were no leaks, postoperative bleeding or need for reintervention. Mean postoperative follow-up was 38±17 months (6-60 months). Three patients underwent adjuvant Imatinib treatment, one for recurrence five months postoperatively and two for tumors with moderate risk for recurrence . Conclusion : Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe and acceptable technique.

Racional: Os tumores estromais ou mesenquimais gastrointetinais (GIST) são lesões originárias da parede do tubo digestivo cujo tratamento requer remoção cirúrgica. Diversas técnicas por via laparoscópica - gastrectomias e ressecções segmentares - têm sido empregadas com sucesso. Objetivo: Apresentar a experiência de um serviço de cirurgia com ressecção laparoscópica de GIST. Métodos: Foram avaliados 15 pacientes com GIST operados revisados retrospectivamente. Treze tiveram lesões gástricas, das quais 10 eram subepiteliais entre 2-8 cm. Três eram lesões exofíticas puras. Dois apresentavam lesões no intestino delgado. O tratamento cirúrgico por laparoscopia consistiu de duas gastrectomias distais; 11 ressecções gástricas em cunha e duas enterectomias segmentares. Sutura mecânica foi utilizada na maioria dos doentes, exceto em seis com suturas absorvíveis manuais. Não houve conversões para laparotomia. Resultados: O tempo médio das operações foi de 89±92 min (40-420). A hospitalização média foi de três dias (2-6). Não houve fístula, sangramento pós-operatório ou necessidade de reintervenção por complicação cirúrgica. O seguimento médio pós-operatorio foi de 38±17 meses (6-60). Três pacientes foram encaminhados para terapia adjuvante com mesilato de imatinib, um deles por recidiva precoce aos cinco meses, e os outros dois por apresentarem risco moderado para recidiva. Conclusão: A ressecção laparoscópica de GIST, mesmo os maiores de 5 cm, é procedimento factível e seguro.

Metabolic effects of an entero-omentectomy in mildly obese type 2 diabetes mellitus patients after three years

BACKGROUND: Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied. METHODS: Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m² underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation. RESULTS: All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m². No major surgical or nutritional complications occurred. CONCLUSIONS: Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile.

Laparoscopic partial gastrectomy and enterectomy for morbid obesity / 中华普通外科杂志

Objective To explore the short-term result and safety of laparoscopie sleeve gastrectomy and partial enterectomy for the treatment of morbid obesity.Methods Ten patients underwent laparoscopic sleeve gastrectomy,omentectomy,and partial enterectomy as a treatment option for weight reduction between December 2006 and September 2007.The procedure included 70%-75%vertical (sleeve)gastrectomy,omentectomy,and 1/3 to 2/5 enterectomy preserving proximal jejunum and most of the ileum. Results Laparoscopy was completed in all patients,no conversion to open surgery.The operation time averaged at 3.1 hours(range 2.5-3.5 hours),and there was no postoperative complications.The median postoperative hospital stay was 7 days(range 6-8 days).Mean preoperative BMI was 36.1(32.0-40.5)kg/m2.Mean decrease in BMI was 4.1(3.0-4.7)ks/m2,5.6(3.2-9.0)kg/m2,and 7.3(3.2-10.7)kg/m2 respectively,and mean weight loss at postoperative 1,3,and 6 months was 11.7(7-15)kg,17.5(8-25)kg,and 22.0(8-32)kg respectively.Conclusion Laparoscopic sleeve gastrectomy with omentectomy and partial enterectomy is an effective and safe surgical option for the treatment of morbid obesity.

Laparoscopic-assisted Resection of the Small Intestine for Stromal Tumors:Report of 15 Cases / 中国微创外科杂志

Objective To evaluate the efficacy of laparoscopic-assisted resection of the small bowel for stromal tumors.Methods From January 2003 to May 2007,laparoscopic abdominal exploration was carried out under general anesthesia on 10 patients with space occupying lesion and 5 patients with abdominal pain and hemafecia of unknown origin.After an intestinal lesion was found,a small incision was made at the proper site on the abdominal wall according to the location of the lesion.The diseased intestine was resected outside the abdominal cavity,and then end-to-end anastomosis was performed.Pneumoperitoneum was rebuilt after closing the abdominal cavity in order to observe the blood circulation of the small bowel and intra-abdominal hemorrhage.Results The operation was completed in all the 15 cases.The postoperative pathological examination showed stromal tumors with CD117 positive in 14 cases(93%)and CD34 positive in 9(60%).Three(20%)of the patients were at very low risk,5(33%)at low risk,4(27%)at moderate risk,and 3(20%)at high risk.The mean diameter of the tumors was(2.44?0.63)cm(ranged from 1.5 to 3.6).The operation time was 38 to 72 minutes with a mean of(57.8?10.4),and mean blood loss was(20.1?6.5)ml(10 to 30).The patients were discharged 4 to 7 days after the operation [mean,(5.3?1.1)days],and were followed up for 5 to 36 months [mean,(24.3?8.4)months].No patient had postoperative complications or recurrence in this series.Conclusion Laparoscopy is effective for resection of small bowel stromal tumors.