Correlation analysis between the changes in plasma ghrelin level and weight loss after sleeve gastrectomy combined with fundoplication.

BACKGROUND: Laparoscopic sleeve gastrectomy combined with fundoplication (LSGFD) can significantly control body weight and achieve effective anti-reflux effects. The aim of this study is to investigate the correlation between the alteration in Ghrelin levels and weight loss following SGFD, and to compare Ghrelin levels, weight loss and metabolic improvements between SG and SGFD, with the objective of contributing to the existing body of knowledge on SGFD technique in the management of patients with obesity and gastroesophageal reflux disease (GERD). METHODS: A retrospective analysis was conducted on the clinical data of 115 obese patients who underwent bariatric surgery between March 2023 and June 2023 at the Department of Minimally Invasivew Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region. The subjects were divided into two groups based on surgical methods: sleeve gastrectomy group (SG group, 93 cases) and sleeve gastrectomy combined with fundoplication group (SGFD group, 22 cases). Clinical data, such as ghrelin levels before and after the operation, were compared between the two groups, and the correlation between changes in ghrelin levels and weight loss effectiveness after the operation was analyzed. RESULTS: Three months after the operation, there was no significant difference in body mass, BMI, EWL%, fasting blood glucose, triglyceride, cholesterol, and uric acid levels between the SG and SGFD groups (P > 0.05). However, the SGFD group exhibited a significant decrease in body weight, BMI, and uric acid levels compared to preoperative levels (P < 0.05), while the decrease in ghrelin levels was not statistically significant (P > 0.05). Logistic regression analysis indicated that ghrelin levels three months after the operation were influential in postoperative weight loss. CONCLUSION: The reduction of plasma Ghrelin level in patients after SGFD is not as obvious as that in patients after SG, but it can make obese patients get the same good weight loss and metabolic improvement as patients after SG. Ghrelin level at the third month after operation is the influencing factor of postoperative weight loss.

[Analysis of weight loss, metabolism, and anti-reflux effect of sleeve gastrectomy combined with fundoplication as treatment of obesity complicated by gastroesophageal reflux disease].

Objective: To explore the weight-loss, metabolism, and anti-reflux effect of laparoscopic sleeve gastrectomy combined with fundoplication (SGFD) as treatment of obesity complicated by gastroesophageal reflux disease (GERD) with the aim of identifying the best treatment for such patients. Methods: This was a retrospective cohort study. Relevant clinical data of 140 patients with obesity (body mass index≥30 kg/m2) complicated by GERD (confirmed by preoperative GerdQ score, gastroscope, upper gastrointestinal radiography, 24-hour pH monitoring of esophagus, and high-resolution esophageal manometry) who had undergone bariatric surgery in the Minimally Invasive Surgery, Hernia and Abdominal Surgery Department of the People's Hospital of Xinjiang Uygur Autonomous Region from January 2019 to February 2023 were collected. The participants were allocated to the following groups according to surgical procedure performed: sleeve gastrectomy group (SG group, 92 cases) versus SGFD (SGFD group, 48 cases). SGFD, a new type of anti-reflux weight loss surgery that achieves both anti-reflux and weight loss effects by a procedure involving "cutting first and then folding", was developed by our team. In this study, our main aim was to compare and analyze differences in outcomes between the SG and SGFD groups in terms of weight loss and improvements in metabolism and reflux 3 and 6 months postoperatively. Results: The 140 patients comprised 50 men and 90 women of average age 36.0±9.6 years and preoperative body mass index (BMI) (38.5±6.5) kg/m2. The average preoperative GERD score was 10.2±1.6. There were no significant differences in baseline characteristics between the SGFD and SG groups (all P>0.05). There were also no significant differences in postoperative hospital stay, intraoperative blood loss, or postoperative complications between the two groups (all P>0.05). However, the operation time was longer in the SGFD than SG group (137.5±10.5 minutes vs. 105.3±12.6 minutes, t=-15.131, P<0.001). Compared with preoperative values, fasting blood glucose, cholesterol, body mass, BMI, and GERD score were all lower 3 months postoperatively (all P<0.05). Six months postoperatively, triglyceride, uric acid, and DeMeester score were lower in the SGFD than SG group; however, the lower esophageal sphincter resting pressure was higher in the SGFD group (all P<0.05). There were no significant differences in weight loss indexes (body mass, BMI, percentage of excess body mass loss) or metabolic indexes (fasting blood glucose, triglyceride, cholesterol, and uric acid concentrations) between the SG and SGFD groups 3 and 6 months postoperatively (all P>0.05). However, anti-reflux indexes (GerdQ score, DeMeester score, and lower esophageal sphincter resting pressure) were all significantly better in the SGFD than SG group 6 months postoperatively (all P<0.05). Conclusion: Obese patients with GERD get good weight loss, metabolism improvement and anti-reflux effect after SGFD. SGFD is a safe and feasible surgical method, and its anti-reflux effect is better than SG at the 6th month after operation, so it is feasible.

Laparoscopic hiatal hernia repair for treating patients with massive hiatal hernia and iron-deficiency anaemia.

BACKGROUND: Massive hiatal hernias may result in extraoesophageal symptoms, including iron-deficiency anaemia. However, the role played by hiatal hernias in iron-deficiency anaemia is not clearly understood. We examined the prevalence of anaemia in patients with massive hiatal hernias and the frequency of anaemia resolution after laparoscopic hiatal hernia repair at long term follow-up. METHODS: Patients who underwent laparoscopic hiatal hernia repair from June 2008 to June 2019 were enrolled in this study. We collected the patients' demographic and clinical data from their medical records, and compared the pre-surgical and post-surgical findings (at 1 week and 3 months post-surgery). All patients with adequate documentation underwent post-surgical follow-up to evaluate improvements in clinical symptoms and signs. RESULTS: A total of 126 patients with massive hiatal hernias underwent laparoscopic hiatal hernia repair. Of these, 35 (27.8%) had iron-deficiency anaemia. Anaemia was resolution in all the patients and they had significantly reduced GERD-Q scores at 3 months postoperatively (P<0.01) .The mean follow-up period was 60 months. Iron-deficiency anaemia resolution after hiatal hernia repair was achieved in 93.9% of the patients. CONCLUSION: Anaemia is common in patients with massive hiatal hernias, and most of our patients were symptomatic because of their anaemia. Moreover, in patients with massive hiatal hernias, iron-deficiency anaemia resolution is likely after laparoscopic hiatal hernia repair.

[Clinical effects of robot-assisted esophageal hiatal hernia repair and laparoscopic esophageal hiatal hernia repair: a retrospective comparative study].

Objective: To analyze the short-term clinical effects of robot-assisted and laparoscopic repair of the hiatal hernia. Methods: The clinical data of 56 patients underwent minimally invasive hiatal hernia repair from January 2021 to January 2022 in the Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. There were 32 males and 24 females, aging (59.7±10.7) years (range: 28 to 75 years). All patients were divided into laparoscopy group (n=27) and robot group (n=29) according to surgical procedures. Perioperative conditions, hospital stay, and improvement in symptoms before and after surgery were compared between the two groups by the t test, Wilcoxon rank-sum test and χ2 test. Results: All surgical procedures were successfully completed, without conversion to laparotomy or change in operation mode. There were no serious complications related to the operation. The intraoperative blood loss of the robot group was less than that of the laparoscopic group (M (IQR)): (20 (110) ml vs. 40 (80) ml, Z=-4.098, P<0.01). The operation time ((111.7±33.6) minutes vs. (120.4±35.0) minutes, t=-0.943, P=0.350) and hospitalization time ((3.9±1.4) days vs. (4.7±1.9) days, t=-1.980, P=0.053) of the robot group and the laparoscopic group were similar. Follow-up for 12 months after the operation showed no postoperative complications and recurrence. The score of the health-related quality of life questionnaire for gastroesophageal reflux disease in the robot group decreased from 10.8±2.8 before the operation to 6.5±0.6 after the operation, and that in the laparoscopic group decreased from 10.6±2.1 before the operation to 6.3±0.6 after the operation. There was no difference in the influence of different surgical methods on the change in score (t=0.030,P=0.976). Conclusion: Compared with laparoscopic repair of the hiatal hernia, robot-assisted hiatal hernia repair has the advantages of less bleeding, rapid postoperative recovery and good short-term effect.

Gastroesophageal reflux related changes after sleeve gastrectomy and sleeve gastrectomy with fundoplication: A retrospective single center study.

Background: The worsening of gastroesophageal reflux disease (GERD) and "de novo" GERD after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the patient's quality of life; the incidence of GERD after LSG is up to 35%. Laparoscopic sleeve gastrectomy with fundoplication (LSGFD) is a new procedure which is considered to be better for patients with morbid obesity and GERD, but there is a lack of objective evidence to support this statement. This study aimed to assess the effectiveness, safety, and results of LSG and LSGFD on patients who were morbidly obese with or without GERD over an average of 34 months follow-up. Methods: Fifty-six patients who were classified as obese underwent surgery from January 2018 to January 2020. Patients who were obese and did not have GERD underwent LSG and patients who were obese and did have GERD underwent LSFGD. The minimum follow-up time was 22 months and there were 11 cases lost during the follow-up period. We analyzed the short-term complications and medium-term results in terms of weight loss, incidence of de novo GERD/resolution of GERD, and remission of co-morbidities with follow-up. Results: A total of 45 patients completed the follow-up and a questionnaire-based evaluation (GERD-Q), of whom 23 patients underwent LSG and 22 patients underwent LSGFD. We had 1 case of leak after LSGFD.No medium or long- term complications. The patient's weight decreased from an average of 111.6 ± 11.8 Kg to 79.8 ± 12.2 Kg (P = 0.000) after LSG and from 104.3 ± 17.0 Kg to 73.7 ± 13.1 Kg (P = 0.000) after LSGFD. The GERD-Q scores increased from 6.70 ± 0.5 to 7.26 ± 1.7 (P = 0.016) after LSG and decreased from 8.86 ± 1.3 to 6.45 ± 0.8 (P = 0.0004) after LSGFD. The incidence of de novo GERD after LSG was 12 (52.2%) at the 12 month follow-up and 7 (30.4%) at the mean 34 (22-48) month follow-up. The remission of reflux symptoms, for patients who underwent LSGFD, was seen in 19 (86.4%) of 22 patients at 12 months and 20 (90.9%) of 22 patients at the mean 34 (22-48) month follow-up. The two groups did not have any significant difference in the effect of weight reduction and comorbidity resolution. Conclusion: The incidence of de novo GERD after LSG is high,LSG resulted in the same weight loss and comorbidity resolution as LSGFD, in patients who are morbidly obese and experience GERD, and LFDSG prevent the occurrence and development of GERD, combination of LSG with fundoplication (LSGFD) is a feasible and safe procedure with good postoperative results,which worthy of further clinical application.

SSH1 expression is associated with gastric cancer progression and predicts a poor prognosis.

BACKGROUND: Slingshot homolog-1 (SSH1) plays an important role in pathological processes, including in the occurrence and development of tumours. The purpose of this study was to determine whether SSH1 is a key biomarker with prognostic value for survival in patients with gastric cancer. METHODS: We performed immunohistochemistry (IHC) on tissue microarrays containing 100 gastric cancer specimens to evaluate SSH1 protein expression. The association of pathological characteristics with cumulative survival was determined by Kaplan-Meier analysis. A Cox proportional hazards model was generated in the multi-factorial survival analysis to identify univariate prognostic factors of GC. RESULTS: SSH1 expression level in gastric cancer tissues was significantly associated with lymph node metastasis (P = 0.032). Additionally, multivariate regression analysis clearly indicated that SSH1 expression was significantly correlated with poor clinical outcomes of patients with gastric cancer (P = 0.016). Multivariate analyses showed that SSH1 was the best predictor of poor prognosis in patients with gastric cancer (P = 0.030). CONCLUSIONS: SSH1 expression is associated with gastric cancer progression and predicts a poor prognosis. SSH1 may play an important role in the development of gastric cancer, and it is a promising target for prevention and/or treatment of gastric cancer.

Incidence and influence factors analysis of chronic postoperative inguinal pain after tension-free repair for inguinal hernia / 中华消化外科杂志

Objective To investigate the incidence and influence factors of chronic postoperative inguinal pain (CPIP) after tension-free repair for inguinal hernia.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 188 patients who underwent tension-free repair for inguinal hernia in the People's Hospital of Xinjiang Uygur Autonomous Region between January 2011 and August 2017 were collected.Observation indicators:(1) surgical and postoperative situations;(2) follow-up;(3) influence factors analysis of CPIP.Follow-up using outpatient examination and telephone interview was performed to detect inguinal pain and complications at 1,3,6 months and 1 year postoperatively up to August 2018.Measurement data with normal distribution were represented as x ±s.Measurement data with skewed distrubution were described as M (range).The univariate and multivariate analysis were done using the chi-square test and Logistic regression model.Results (1) Surgical and postoperative situations:1 188 patients underwent successful tension-free repair for inguinal hernia.Eighty-five patients (7.155％,85/1 188) had CPIP,including 76 (8.370％,76/908) undergoing open surgery and 9 (3.214％,9/280) undergoing laparoscopic surgery.(2) Follow-up:1 188 patients were followed up for 12-36 months,with a median time of 19 months.Incidence rates of CPIP with visual analogue score ＞ 3were 11.785％(140/1 188),7.155％(85/1 188),5.808％(69/1 188),3.199％(38/1 188) at 1,3,6 months and 1 year postoperatively.Patients were given individualized and reasonable treatment according to their own conditions and CPIP was relieved after conservative treatment including drug treatment,physiotherapy such as acupuncture,nerve block and psychotherapy.Of 5 patients with CPIP after tension-free repair for inguinal hernia undergoing surgeries,1 was relieved nerve ligation by surgery,3 with mesh related pain were removed meshes,1 was taken the fixed stiches out.They were relieved CPIP after above treatments.During the follow-up,161 patients with incisional seroma,75 with incisional infection and 5 with disruption of wound were cured by symptomatic treatments including reinforced incision management,dressing change and physiotherapy.Seven patients with mesh infection were removed meshes.Of 68 patients with hernia recurrence,53 had reoperation,18 complicated with diseases induced severe increased intra-abdominal pressure were suggested to undergo surgeries after treatment of complications.(3) Influence factors analysis of CPIP:① results of univariate analysis showed that sex,age,bodymass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were related factors affecting CPIP after tension-free repair for inguinal hernia (x2 =21.002,6.715,6.012,8.563,11.887,49.447,10.025,P＜0.05).② Results of multivariate analysis showed that sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection were independent related factors affecting CPIP after tension-free repair for inguinal hernia (odds ratio =1.267,2.986,1.661,3.208,2.034,1.871,95％ confidence interval:1.042-1.392,1.372-4.901,0.998-2.758,1.933-6.013,1.556-3.118,1.095-3.534,P＜0.05).Conclusions Sex,body mass index,surgical method,degree of preoperative pain,intraoperative nerve stretching or injury and incisional infection are independent related factors affecting CPIP after tension-free repair for inguinal hernia.Preoperative pain management and psychological counseling,intraoperative refine performance,inguinal nerve protection and postoperative incisional management should be reinforced to prevent and reduce incidence of CPIP.

Application value of the preoperative multi-slice spiral computed tomography for the repair of huge abdominal incisional hernia / 中华消化外科杂志

Objective To explore the application value of the preoperative multi-slice spiral computed tomography (MSCT) for the repair of huge abdominal incisional hernia.Methods The retrospective crosssectional study was conducted.The clinical data of 61 patients with huge abdominal incisional hernia who were admitted to the Xinjiang Uygur Autonomous Region People's Hospital from January 2012 to February 2016 were collected.All patients underwent preoperative MSCT and three-dimensional reconstruction to measure the percentage of volumes of the hernia sac and abdominal cavity and then selected the individualized surgical methods according to the percentage,and length of small intestine resected was calculated in patients undergoing initiative volume reduction combined with onlay repair.Observation indicators:(1) pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity,duration of preoperative hospital stay,surgical procedure,length of small intestine resected in patients undergoing initiative volume reduction combined with onlay repair,operation time and volume of intraoperative blood loss;(2) postoperative recovery situation:intraabdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function,removal time of postoperative abdominal drainage-tube,postoperative complications and duration of postoperative hospital stay;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative hernia recurrence and long-term complications up to March 2017.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (range).Results (1) Pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity in 61 patients was 19％ ± 4％,and duration of preoperative hospital stay was (7 ± 5) days.All the 61 patients underwent successful operation,including 48 receiving onlay repair and 13 receiving initiative volume reduction combined with onlay repair,without conversion to other surgery.Length of small intestine resected in 13 patients undergoing initiative volume reduction combined with onlay repair was (48±8)cm.Operation time and volume of intraoperative blood loss in 61 patients were (2.6 ± 0.8) hours and (82± 50) mL.(2) Postoperative recovery situation:intra-abdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function and removal time of postoperative abdominal drainage-tube in 61 patients were (9.6 ± 2.9) mmHg (1 mmHg=0.133kPa),(2.1 ± 0.9) days and (3.5 ± 1.1) days,respectively.Twelve patients had postoperative complications,and grade Ⅰ intra-abdominal hypertension,grade Ⅱ intra-abdominal hypertension,incisional effusion,incisional infection,incisional sinus,mesh infection and urinary retention were respectively detected in 4,2,4,2,1,1,1 in patients undergoing the onlay repair and 2,1,1,0,0,0,0 in patients undergoing initiative volume reduction combined with onlay repair.Some patients had 2 or more of complications.There was no occurrence of abdominal compartment syndrome and perioperative death.Patients with complications were cured or improved by symptomatic treatment.Duration of postoperative hospital stay in 61 patients was (8±4)days.(3) Follow-up:all the patients were followed up for 6-36 months,with a median time of 19 months.During follow-up,2 patients with recurrence of huge abdominal incisional hernia received tentative follow-up,and were suggested to treat risk factors of recurrence firstly and then undergo reoperations.Other patients didn't have long-term complications.Conclusion MSCT can provide the accurate data of percentage of volumes of the hernia sac and abdominal cavity before repair of huge abdominal incisional hernia,it also has the important clinical value of choosing the individualized surgical method,preserving the maximum out of normal organs in initiative volume reduction combined with onlay repair and increasing surgical outcomes.