BACKGROUND Sphincter-preserving surgery is a common procedure for rectal cancer, but anterior resection syndrome (ARS) remains a frequent complication. AIM To evaluate the efficacy of combined magnetic-electrical biofeedback therapy in patients with ARS after sphincter-preserving surgery for low rectal cancer. METHODS Sixty patients with ARS following sphincter-preserving surgery for low rectal cancer admitted to our hospital between August 2024 to March 2026, were selected. Based on the chronological order of surgery, the patients were divided into control group and (n = 30) receiving conventional intervention or a study group (n = 30) receiving magnetic-electrical biofeedback therapy. Bowel function indicators, Low ARS (LARS) scores and Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC-BFI) scores were assessed before, 1 month after, and 3 months after intervention. Anal pressure indicators, including anal resting pressure and maximum squeeze pressure, were evaluated before and after the intervention. Anorectal function indicators, including first rectal sensation volume, maximum tolerated volume, and rectal compliance, were compared before and after the intervention. The clinical efficacy rates were also calculated for both groups. RESULTS Baseline bowel function indicators, LARS scores, and MSKCC-BFI scores (P > 0.05) did not differ significantly between groups. After treatment, the study group showed fewer daily bowel movements, lower fecal incontinence frequency scores, lower LARS scores, and higher MSKCC-BFI scores than the control group (all P < 0.05). No significant differences were observed in anal pressure or anorectal function indicators before the intervention (P > 0.05). Anal resting pressure, maximum squeeze pressure, as first rectal sensation volume, maximum tolerated volume, and rectal compliance were also significantly higher in the study group than the control group (P < 0.05). The total effective rate was 96.67% (29/30) significantly higher in the study group than 73.33% (22/30) in the control group [96.67% (29/30) vs 73.33% (22/30), P < 0.05]. CONCLUSION Combined intervention using magnetic-electrical biofeedback demonstrated significant efficacy in patients with ARS after sphincter-preserving surgery for low rectal cancer. It facilitates the synergistic recovery of rectal and anal canal functions, plays a positive role in improving patients’ bowel movements and anorectal function, and promotes enhanced clinical outcomes.
BACKGROUND Perineal small bowel fistula (PSF) is a highly debilitating complication of radical pelvic malignancy resections. It is typically driven by empty pelvis syndrome (EPS) and chronic adhesive disease. Current therapeutic guidelines lack standardization. AIM To evaluate an etiology-driven surgical algorithm, where procedures are chosen based on the underlying mechanism, aiming to improve closure rates. METHODS Retrospective cohort analysis was performed on 28 consecutive patients who underwent definitive repair for complex PSF. Patients were stratified into two surgical groups based on etiology: Group 1 (n = 15) underwent modified pelvic floor reconstruction for structural defects or EPS; group 2 (n = 13) underwent internal intestinal plication for extensive adhesions or tumor recurrence. Overall survival was calculated from the date of definitive surgery to the last follow-up or death. RESULTS The study cohort (mean age 56.6 years) included patients with rectal (35.7%), gynecological (35.7%), and various other pelvic malignancies. There were no significant baseline demographic differences between the groups. A significant correlation was observed between fistula etiology and surgical strategy (P = 0.02). While reconstruction was the exclusive surgical approach for patients with EPS (100%), plication was predominantly utilized for cases of tumor recurrence (66.7%). The overall fistula closure rate was 89.3% (25/28), showing no significant difference between group 1 (86.7%) and group 2 (92.3%; P = 1.0). However, group 2 experienced a significantly longer mean time to postoperative flatus (6.8 days vs 4.2 days; P = 0.002). The median follow-up time for the entire cohort was 34.5 months (range: 9.0-107.0 months). Overall survival was comparable across the two surgical groups (32.0 months vs 37.0 months; P = 0.66). CONCLUSION Managing complex PSFs requires a tailored approach. Employing an etiology-driven strategy, specifically pelvic floor reconstruction for structural voids (EPS) and internal intestinal plication for “frozen” adhesive conditions, achieves > 89% closure rates with acceptable morbidity.
BACKGROUND Gastric perforation is a life-threatening surgical emergency that frequently leads to sepsis with significant postoperative mortality. Appropriate analgesia management is critical as it influences inflammatory response and clinical outcomes. While fentanyl is widely used, it has limitations including immunosuppression and respiratory depression. The oxycodone-dexmedetomidine combination offers potential advantages with anti-inflammatory and organ-protective properties, but comparative studies in septic patients after gastric perforation surgery are lacking. AIM To compare the clinical efficacy and safety of oxycodone combined with dexmedetomidine vs conventional fentanyl analgesia on clinical outcomes in patients with sepsis following gastric perforation surgery. METHODS Clinical data from 98 patients with sepsis following gastric perforation surgery at our hospital between March 2019 and October 2024 were retrospectively analyzed. Patients were divided into two groups based on postoperative analgesic protocols: Control group (n = 49, receiving conventional fentanyl analgesia) and intervention group (n = 49, receiving oxycodone combined with dexmedetomidine). Inflammatory markers [procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6)], hemodynamic parameters, sedation and pain scores, organ function indicators, intensive care unit (ICU) stay duration, mechanical ventilation duration, and adverse event rates were compared between the two groups. RESULTS Baseline characteristics were comparable between the two groups (P > 0.05). Compared with the control group, the intervention group demonstrated significantly lower levels of PCT, CRP, and IL-6 on postoperative days 3 and 5 (all P < 0.05). Hemodynamic stability was superior in the intervention group, with smaller fluctuations in heart rate and mean arterial pressure (all P < 0.05). Richmond Agitation-Sedation Scale scores indicated better sedation quality in the intervention group, with lower Critical Care Pain Observation Tool scores at all time points (all P < 0.05). The intervention group showed significantly shorter ICU stay duration and mechanical ventilation duration (all P < 0.01). The incidence of delirium was significantly lower in the intervention group compared with the control group (8.2% vs 24.5%, P = 0.031). No significant difference was observed in the incidence of respiratory depression between the two groups (P > 0.05). CONCLUSION Oxycodone combined with dexmedetomidine provides superior analgesia and sedation effects compared with conventional fentanyl in patients with sepsis following gastric perforation surgery, effectively reducing inflammatory response, maintaining hemodynamic stability, shortening ICU stay duration, and decreasing the incidence of delirium, demonstrating favorable clinical application value.
Correction to: Bai Y, Zhang ZL, Qiao L, Shi LL, Wang J, Nian H, Du QC, Tian ZH, Yao ZL, Wu YB. "Liuzijue" Qigong training enhances early pulmonary function recovery after esophageal cancer surgery. World J Gastrointest Surg 2025; 17(12): 113408 [PMID: 41479713 DOI: 10.4240/wjgs.v17.i12.113408]. In this article, we have identified an error in Tables 3 and 4: The columns labeled “Control group” and “Experimental group” were inadvertently transposed during a post-publication review.
BACKGROUND Intestinal tuberculosis is the most common form of abdominal tuberculosis, and surgical intervention is required when complications arise or conservative treatment fails. Postoperative gastrointestinal function recovery in these patients is often delayed, increasing complication rates and hospital stays. Early mobilization based on enhanced recovery after surgery (ERAS) principles has shown benefits in various gastrointestinal surgeries, yet its application in intestinal tuberculosis surgery remains insufficiently studied. AIM To evaluate the clinical effectiveness of an early mobilization protocol based on ERAS principles on postoperative gastrointestinal function recovery in patients undergoing intestinal tuberculosis surgery. METHODS Clinical data from 102 patients who underwent intestinal tuberculosis surgery at our hospital between July 2018 and February 2025 were retrospectively analyzed. Patients were divided into two groups based on postoperative rehabilitation protocols: Control group (n = 51, receiving traditional postoperative rehabilitation protocol) and intervention group (n = 51, receiving early mobilization protocol based on ERAS principles). Gastrointestinal function recovery indicators (time to first flatus, time to first defecation, time to bowel sound recovery, etc. ), postoperative mobilization-related indicators, quality of life and functional status assessment, pain management-related indicators, and complication rates were compared between the two groups. RESULTS Baseline characteristics were comparable between the two groups (P > 0.05). Compared with the control group, the intervention group demonstrated significantly shorter time to first flatus, time to first defecation, time to bowel sound recovery, and time to first ambulation (all P < 0.01). The modified Barthel Index and Karnofsky Performance Status scores on postoperative days 3 and 7 were higher in the intervention group than in the control group (all P < 0.05). Visual Analog Scale pain scores at all time points were lower in the intervention group compared with the control group, with reduced analgesic medication consumption (all P < 0.05). The overall complication rate showed no statistical difference between the two groups (P > 0.05). CONCLUSION The early mobilization protocol based on ERAS principles can safely and effectively promote postoperative gastrointestinal function recovery in patients undergoing intestinal tuberculosis surgery, improve patient mobilization tolerance and quality of life, optimize pain management, without increasing postoperative complication rates.
BACKGROUND Laparoscopic hiatal hernia repair (LHHR) is the surgical intervention of choice for symptomatic hiatal hernias; however, a major complication such as postoperative sepsis presents a serious challenge, particularly in elderly and comorbid patients. Acute kidney injury (AKI) occurring in patients with sepsis is termed sepsis-associated AKI. This complication has been reported to affect 40%–50% of intensive care unit patients with sepsis and is an independent risk factor for increased mortality and prolonged hospital stay. A large proportion of patients who develop sepsis after LHHR may subsequently develop AKI, but the incidence, predictors, and prognosis of AKI remain mostly unknown in this setting despite the clinical importance of this complication. The objective of this study was to identify independent prognostic factors and examine the AKI-mortality association in a surgical cohort. AIM To evaluate the prognostic factors associated with postoperative sepsis following LHHR, with particular emphasis on the incidence, risk factors, and clinical impact of AKI in this patient population. The primary objectives were to determine perioperative predictors of sepsis severity, assess AKI as an independent prognostic determinant, and establish evidence-based recommendations for postoperative monitoring and management strategies. METHODS We conducted a retrospective analysis of 214 patients who underwent LHHR at the Department of Gastrointestinal Surgery between January 2019 and December 2024. Patients who developed sepsis within 30 days of surgery were identified and compared with non-sepsis controls. Sepsis was defined according to the Sepsis-3 consensus criteria. AKI was diagnosed and staged using the Kidney Disease: Improving Global Outcomes criteria. Logistic regression analysis identified independent predictors of sepsis, AKI, and in-hospital mortality. Receiver operating characteristic curve analysis evaluated the discriminative capacity of identified predictors, and Kaplan–Meier curves compared survival outcomes between the AKI and non-AKI subgroups among patients with sepsis. RESULTS Of 214 patients, 42 (19.6%) developed postoperative sepsis. Among patients with sepsis, 18 (42.9%) were diagnosed with AKI: 7 (38.9%) with Kidney Disease: Improving Global Outcomes stage 1, 6 (33.3%) with stage 2, and 5 (27.8%) with stage 3. The overall in-hospital mortality rate among patients with sepsis was 16.7% (7/42); mortality was significantly higher in the AKI subgroup (38.9%, 7/18) than in the non-AKI subgroup (0.0%, P < 0.001). Independent predictors of sepsis included American Society of Anesthesiologists class ≥ III [odds ratio (OR) 3.42, 95% confidence interval (CI): 1.68–6.97, P = 0.001], operative time > 180 minutes (OR 2.85, 95%CI: 1.41–5.77, P = 0.003), and preoperative hypoalbuminemia (OR 2.61, 95%CI: 1.27–5.35, P = 0.009). Independent predictors of AKI among patients with sepsis included Sequential Organ Failure Assessment score ≥ 8 at sepsis onset (OR 4.73, 95%CI: 1.52–14.72, P = 0.007), vasopressor requirement (OR 3.86, 95%CI: 1.24–12.04, P = 0.020), and preoperative creatinine elevation (OR 3.14, 95%CI: 1.03–9.61, P = 0.044). AKI-stage progression was associated with incremental mortality (stage 1: 14.3%; stage 2: 33.3%; stage 3: 80.0%, P < 0.001). CONCLUSION Postoperative sepsis following LHHR carries significant morbidity, with AKI representing a critical determinant of prognosis. AKI stage correlates strongly with in-hospital mortality, and its early identification should guide intensified organ support and renal-protective strategies. Preoperative optimization of nutritional status and renal function, combined with vigilant postoperative sepsis monitoring, may mitigate these risks. Prospective multicenter studies are required to validate predictive scoring systems and evaluate targeted interventions for this high-risk cohort.
Metabolism dysfunction-associated fatty liver disease (MAFLD) has emerged as a frequent complication for liver transplant (LT) recipients. In view of the high incidence of MAFLD after LT, research on MAFLD is of considerable clinical significance. Key research areas include the mechanisms responsible for the development of MAFLD following LT, therapeutic strategies, and the optimization of immunosuppressive regimens to achieve a balance between graft protection and metabolic protection. Most existing studies relating to MAFLD following LT are clinical observational studies, and the majority of investigations into pharmacological aspects are based on non-transplantation populations, thus highlighting significant gaps in research. In this review, we propose that the development of MAFLD after LT is primarily driven by the use of immunosuppressive agents and comprehensively synthesize the existing evidence regarding pathogenesis, immunosuppressive optimization strategies, and therapeutic approaches. Specifically, we focus on mechanistic analyses centered on insulin resistance pathways to elucidate immunosuppression-related mechanisms underlying the development and progression of MAFLD following LT. Based on the evaluation of current immunosuppressive optimization strategies and therapeutic agents, we propose several important directions for future research: Optimizing immunosuppressive regimens, conducting transplant recipient-specific pharmacological studies, and exploring strategies to balance metabolic protection with graft preservation.
BACKGROUND Obesity is associated with increased risk of otitis media with effusion (OME), potentially due to peritubal fat accumulation and chronic inflammation. Laparoscopic sleeve gastrectomy (LSG) effectively reduces weight but achieves slow early middle ear effusion resolution. Montelukast, a leukotriene receptor antagonist, possesses anti-inflammatory properties that may promote OME recovery. However, rapid weight loss may paradoxically induce patulous eustachian tube, complicating outcome interpretation. We hypothesized that combining LSG with montelukast would accelerate middle ear effusion clearance and improve eustachian tube function without compromising weight loss efficacy. AIM To evaluate LSG combined with montelukast for obese patients with OME regarding recovery, eustachian tube function, and weight loss. METHODS This retrospective cohort study enrolled 112 obese OME patients treated at a tertiary hospital between January 2020 and March 2025. Groups: Control (n = 48, LSG alone) and observation (n = 64, LSG plus oral montelukast 10 mg/day for one month). Outcomes included total weight loss, excess weight loss, middle ear effusion resolution time, air-bone gap, Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) score, 36-Item Short Form Health Survey (SF-36), and adverse events. Assessors were blinded. Inter-group comparisons used t tests and chi(2) tests. RESULTS Baseline characteristics were comparable between groups (P > 0.05). Weight loss outcomes at 1 months and 6 months showed no significant inter-group differences (P > 0.05). Middle ear effusion clearance was significantly faster in the observation group compared to controls (28.39 +/- 6.51 days vs 42.10 +/- 8.32 days, P < 0.001). At one month postoperatively, the observation group demonstrated superior air-bone gap reduction (18.92 +/- 4.65 dB vs 22.04 +/- 4.57 dB, P = 0.001) and lower ETDQ-7 scores (2.63 +/- 0.97 vs 3.75 +/- 1.16, P < 0.001). SF-36 scores favored the observation group at 1 month and 3 months (P < 0.01). Adverse event rates were comparable between groups (7.81% vs 4.17%, P > 0.05). CONCLUSION LSG combined with montelukast significantly accelerates middle ear effusion resolution, improves auditory function and quality of life in obese OME patients, with maintained weight loss and favorable short-term safety.
Gastrointestinal (GI) dysfunction following surgery for GI tumors is a common complication that significantly impacts patient recovery, prolongs hospital stays, and increases healthcare burdens. This review of recent research systematically examines the risk factors, predictive model development, and clinical prognostic value associated with this postoperative condition. We delve into key risk determinants including patient age, tumor stage, operation duration, and nutritional indices. We focus on the clinical significance of translating complex regression models into simplified, practical risk indices for bedside application. The review also addresses current limitations in the field, particularly concerning study follow-up duration and the need for robust external validation of existing models. Finally, we provide a forward-looking perspective on future research directions, emphasizing the necessity for model refinement, deeper exploration of underlying pathophysiological mechanisms, and the integration of predictive tools into comprehensive prevention and management strategies.
