Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry / 中华医学杂志(英文版)

BACKGROUND@#Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.@*METHODS@#To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks.@*RESULTS@#A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor.@*CONCLUSIONS@#Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

Postoperative complications of endoscopic thyroidectomy via breast areola vs conventional open thyroidectomy / 中华普通外科杂志

Objective To compare postoperative complications between endoscopic thyroidectomy via breast areola approach and open thyroidectomy.Methods From June 2011 to June 2014,475 patients underwent thyroidectomy.Patients were divided into traditional open group (251 cases) and endoscopic thyroidcctomy group (224 cases).Postoperative complications were recorded and compared.Results All operations were successfully completed.There was no case in endoscopic thyroidectomy group converted to traditional open surgery.There was no serious postoperative complication occurred,including injury to trachea,mediastinal emphysema,intraoperative massive hemorrhage and cardiopulmonary accidents.The difference of postoperative complication between two groups had no statistical significance (all P ＞0.05) as to permanent recurrent laryngeal nerve injury,Homer syndrome,permanent hypoparathyroidism,chyle leakage,postoperative hemorrhage and infection of incision.However,postoperative ecchymosis was more often in endo group (P ＜0.05).Conclusions Compared to traditional open thyroidectomy,endoscopic thyroidectomy via breast areola approach has significant cosmetic advantages without increasing the incidence of major postoperative complications.

The correlation of serum interleukin-6, interleukin-10 and tumor necrosis factor-α concentrations and the prognosis of sepsis in children / 中国小儿急救医学

Objective To investigate the correlation of serum concentrations of interleukin(IL)-6,IL-10 and tumor necrosis factor(TNF)-α and the prognosis of sepsis in children.Methods Fifty-seven septic patients in PICU were enrolled in the study,of whom 44 patients survived(sepsis survival group),13 patients died(sepsis dead group).Another 65 cases of non-sepsis patients served as control(non-sepsis group).The critical illness score,the number of damaged organs,and serum levels of IL-6,IL-10,TNF-α,IL-6/IL-10,TNF-α/IL-10 in each group were compared.Results The critical illness score was decreased and the number of damaged organs was more in sepsis dead group than those in non-sepsis group and sepsis survival group.Compared with non-sepsis group and sepsis survival group,the expression of IL-6 and IL-10 increased,TFN-α/IL-10 ratio significantly decreased in sepsis dead group(P ＜ 0.05),but the difference between the sepsis survival group and non-sepsis group was not statistically significant(P ＞ 0.05).The serum levels of TNF-α and IL-6/IL-10 ratio showed no significant difference among three groups(P ＞ 0.05).Conclusion In sepsis patients,the serum concentrations of IL-6,IL-10 are higher and the TNF-α/IL-10 ratio is smaller,the prognosis is worse.