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25 September 2020, Volume 25 Issue 05 Previous Issue    Next Issue

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Editorial

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Standardization and surgical innovation of bariatric and metabolic surgery HU Songhao, DONG Zhiyong, WANG Cunchuan 2020, 25 (05):  361-363.  DOI: 10.16139/j.1007-9610.2020.05.001 Abstract ( 236 )   HTML ( 3 )   PDF (430KB) ( 92 )   Figures and Tables | References | Related Articles | Metrics

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Bariatric and metabolic surgery in China: recent developments and future prospects CA Chaogiang, SUN Xulong, ZHU Shaihong 2020, 25 (05):  364-368.  DOI: 10.16139/j.1007-9610.2020.05.002 Abstract ( 152 )   HTML ( 1 )   PDF (543KB) ( 87 )   References | Related Articles | Metrics

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Robot-assisted surgery in bariatric and metabolic surgery: application and progress in China YING Xiayang, IIN Jiabin, SHEN Baiyong 2020, 25 (05):  369-372.  DOI: 10.16139/j.1007-9610.2020.05.003 Abstract ( 143 )   HTML ( 1 )   PDF (496KB) ( 95 )   References | Related Articles | Metrics

Experts forum

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Impact of bariatric and metabolic surgery on nonalcoholic fatty liver disease HUA Rong, YAO Qiyuan 2020, 25 (05):  373-377.  DOI: 10.16139/j.1007-9610.2020.05.004 Abstract ( 112 )   HTML ( 2 )   PDF (461KB) ( 92 )   References | Related Articles | Metrics

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Obese patients with ventral hernia: surgical treatment and strategy YANG Jianjun, SONG Zhicheng, YANG Dongchao, GU Yan 2020, 25 (05):  378-382.  DOI: 10.16139/j.1007-9610.2020.05.005 Abstract ( 112 )   HTML ( 0 )   PDF (508KB) ( 63 )   References | Related Articles | Metrics

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Strategy in treatment of weight loss failure after sleeve gastrectomy ZHU Jiangfan 2020, 25 (05):  383-385.  DOI: 10.16139/j.1007-9610.2020.05.006 Abstract ( 141 )   HTML ( 1 )   PDF (261KB) ( 91 )   References | Related Articles | Metrics

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Causes and prevention of weight regain after bariatric and metabolic surgery YAN Wenmao, BAI Rixing 2020, 25 (05):  386-390.  DOI: 10.16139/j.1007-9610.2020.05.007 Abstract ( 158 )   HTML ( 3 )   PDF (545KB) ( 124 )   References | Related Articles | Metrics

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New type of bariatric and metabolic procedure: sleeve gastrectomy with transit bipartition ZHU Xiaocheng, HOU Dongsheng 2020, 25 (05):  391-396.  DOI: 10.16139/j.1007-9610.2020.05.008 Abstract ( 216 )   HTML ( 1 )   PDF (777KB) ( 164 )   Figures and Tables | References | Related Articles | Metrics

Original article

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Comparative study on weight loss and remission of metabolic disorders after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy ZHANG Chenyang, ZHANG Hongwei, HAN Xiaodong, LIU Weijie, YU Haoyong, ZHANG Pin 2020, 25 (05):  397-401.  DOI: 10.16139/j.1007-9610.2020.05.009 Abstract ( 208 )   HTML ( 2 )   PDF (506KB) ( 86 )   Objective To compare the short-term effect of bariatric surgery on obesity patients with type 2 diabetes mellitus between laparoscopic Roux-en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Methods A retrospective study was performed from January 2011 to December 2018 for the obesity patients with type-2 diabetes who underwent LRYGB (n=38) and LSG (n=38) and matched in age, gender, body mass index, glycosylated hemoglobin A1c level, and diabetes duration to analyze the surgical effects. Results There was no any major complication and no any malnutrition during 24 months of follow-up. Both surgical procedures achieved weight loss and diabetes remission significantly. LRYGB reduced serum cholesterol levels [(4.31±0.94) mmol/L vs. (5.36±1.22) mmol/L, P<0.01] and low-density lipoprotein-c levels [(2.39±0.70) mmol/L vs. (3.22±0.94) mmol/L, P<0.01], as well as diabetes remission rate by glycosylated hemoglobin A1c (89.5% vs. 71.1%, P=0.044) significantly when compared with LSG. Conclusions Both LRYGB and LSG could get significant weight loss and disorders remission of glucose and lipid metabolism in short-term postoperatively. LRYGB may have a more favorable effect on reducing glycosylated hemoglobin A1c level and improving dyslipidemia compared with LSG. Figures and Tables | References | Related Articles | Metrics

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Application of bariatric and metabolic analysis and reporting outcome system LIAN Dongbo, LIU Chen, YAN Wei, DU Dexiao, GONG Ke, ZHANG Nengwei 2020, 25 (05):  402-407.  DOI: 10.16139/j.1007-9610.2020.05.010 Abstract ( 167 )   HTML ( 3 )   PDF (812KB) ( 67 )   Objective To use the Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire and to evaluate the effect of bariatric and metabolic surgery (BMS) on obese patients. Methods A total of 105 patients with BMS were enrolled and stratified into 4 groups according to postoperative duration: 3-12 months (n=40), 13-36 months (n=38), 37-60 months (n=16) and >61 months (n=11). The Chinese version of BAROS was used to evaluate the results of operation including percentage of excess weight loss (%EWL), improvement of co-morbidities associated with obesity, quality of life (QOL), postoperative complications and reoperation. Results All patients completed BAROS questionnaire and were followed-up with duration of (26.26±25.51) (3-114) months. Postoperative body mass index decreased significantly compared with those preoperative in all groups (P<0.001). %EWL of patients in group 3-12 months was 57.3%±17.6%, and 83.5%±11.4% in group 13-36 months, 84.9%±8.2% in group 37-60 months and 88.2%±8.9% in group >61 months (P<0.001). The co-morbidities with obese improved significantly and remission rate was 69.77% in cases with type 2 diabetes, 98.15% in cases with hyperlipidemia. Mean score of QOL was (1.59±0.49). QOL was evaluated good and very good in 86.70% cases without any case evaluated as poor or very poor. Difference in QOL(%) among all groups was not statistically significant( χ2=7.506, P=0.277). There were 18 cases with complications and one case had reoperation. Evaluation of operative results using BAROS score showed 89.6% cases as excellent and good and no case as failure of operation. There was no statistically significant difference among groups ( χ2=6.682, P=0.670). Conclusions BAROS can be used to analyze the effect of BMS and the results of short-term and middle/long term in this study were encouraged. Figures and Tables | References | Related Articles | Metrics

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Pregnancy outcomes and perinatal complications after three types of bariatric and metabolic surgery LIU Ruiping, YANG Ningli, LIN Shibo, GUAN Wei, Liang Hui 2020, 25 (05):  408-412.  DOI: 10.16139/j.1007-9610.2020.05.011 Abstract ( 186 )   HTML ( 0 )   PDF (444KB) ( 60 )   Objective To compare the pregnant outcomes of three types of bariatric and metabolic surgery (BMS) and explore the management measures during the perinatal period after BMS. Methods A retrospective analysis was conducted for the fertility in the patients underwent BMS in our hospital from January 2014 to December 2019. The weight loss and nutritional status of women with pregnancy, results of both pregnancy and perinatal maternal and infant were analysed after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or SG plus jejunojejunal bypass (SG+JJB) including maternal body mass index (BMI), newborn weight, neonatal complications and nutritional status of both pre-pregnancy and pregnant women before delivery. Results A total of 46 patients who underwent BMS including 16 cases in RYGB, 16 cases in SG, and 14 cases in SG+JJB delivered 48 newborns. Both twins and two babies delivered in one patient each. Mean BMI and mean weight preoperative were 40.92±6.93 and (111.29±18.10) kg in 46 patients, respectively. Thirty-six patients (78.26%) had polycystic ovary syndrome preoperatively. Mean weight was (74.19±12.62) kg before pregnancy and (83.61±11.89) kg before childbirth, and (76.56±11.39) kg after child birth one month later. Mean weight of newborns was (3.12±0.54) kg. There were 6 pregnancy case with anemia and 3 newborn with low birth weight in RYGB group. One newborn with anemia and one newborn with low birth weight were detected in SG+JJB group. Conclusions Pregnancy would be safe after the three types of BMS. Attentions should be paid on the nutritional status with perinatal guidance after surgery of malabsorption, especially RYGB. References | Related Articles | Metrics

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Effect of bariatric and metabolic surgery on anemia related parameters: a retrospective study TIAN Peirong, LIU Yang, BIAN Shibo, LI Mengyi, ZHANG Meng, LIU Jia, JIN Lan, ZHANG Zhongtao, ZHANG Peng 2020, 25 (05):  413-416.  DOI: 10.16139/j.1007-9610.2020.05.012 Abstract ( 156 )   HTML ( 2 )   PDF (416KB) ( 60 )   Objective To compare the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on body weight, glycemic regulation, and especially on anemia associated parameters. Methods A total of 107 obese patients who underwent metabolic and bariatric surgery in our hospital between December 2017 and July 2019 were studied retrospectively including SG(n=56) and RYGB(n=51). All patients took multi-vitamin and multi-mineral supplements postoperatively at a dose of 200% of daily suggested amount and vitamin B complex was additionally supplemented. Weight loss, diabetes remission and anemia related parameters were compared before and 3, 6 months after surgery. Results Age, sex, weight, and body mass index were comparative between two groups preoperatively. RYGB group had significantly more diabetes patients than SG group (88.2% vs. 25.0%, P<0.01). There was no significant difference in body weight loss between two groups. Percentages of total weight loss in SG and RYGB group were 26.92% and 22.20% (P>0.05), respectively. RYGB group had significant drop in glycosylated hemoglobin A1c than SG group at 6 months after surgery (2.31% vs. 0.69%, P<0.001), which indicated RYGB was effective in type-2 diabetes remission. No difference in anemia related parameters including hemoglobin, serum ferrum, ferritin, and folic acid after surgery was present between two groups. However, vitamin B12 of the patients in RYGB group was 327.46 ng/L at 6 months after surgery indicating a strong dropping from 421.42 ng/L preoperatively. Conclusions RYGB was used much more for obese patients with 2 type diabetes when both SG and RYGB had robust effects on weight loss and beneficial outcomes in glycemic regulation. Anemia can be effectively prevented by supplementing vitamin and minerals and RYGB patients need even more supplement of vitamin B12 and folic acid. Figures and Tables | References | Related Articles | Metrics

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Fresh frozen cadavers for clinical teaching of laparoscopic bariatric and metabolic surgery LIU Yanyang, HUA Rong, XU Bo, SHEN Qiwei, HUANG Xianjue, YAO Qiyuan 2020, 25 (05):  417-421.  DOI: 10.16139/j.1007-9610.2020.05.013 Abstract ( 174 )   HTML ( 2 )   PDF (848KB) ( 61 )   Objective To explore the effect of fresh frozen cadavers on training of laparoscopic metabolic and bariatric surgery (LMBS). Methods From December 2018 to December 2019, three training courses of LMBS were conducted using fresh frozen cadavers. Participants were given questionnaires to test the knowledge before and after the trai-ning courses and to evaluate the courses. Results Thirteen participants in the third training course provided feedback of questionnaires and showed the scores (6.15±1.51) points before training course and (8.08±1.20) points after training course with significant difference (P<0.05). The feedback of questionnaire was obtained from 22 participants who attended first or second training course, of whom 16 (72.7%) believed that training courses on fresh frozen cadavers was positive for their understanding of intraoperative anatomy, 19 (86.4%) valued the course in carrying out of LMBS, and 13 (59.1%) proposed to carry out LMBS after training. Conclusions The training courses of LMBS on fresh frozen cadavers are feasible and of value in improvement of participants knowledge and development of LMBS. Figures and Tables | References | Related Articles | Metrics

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Laparoscopic sleeve gastrectomy with four ports and posterior gastric wall dissection first: a report of 122 cases WU Lisheng, YU Jianwei, LI Yu, DAI Congcong 2020, 25 (05):  422-425.  DOI: 10.16139/j.1007-9610.2020.05.014 Abstract ( 221 )   HTML ( 1 )   PDF (694KB) ( 46 )   Objective To investigate the feasibility and safety of four ports laparoscopic sleeve gastrectomy (LSG) with preferential dissection of the left cardia and posterior gastric wall. Methods The clinical data of 122 patients including cases with obesity and cases with diabetes mellitus related to obesity who underwent surgery were retrospectively analyzed in our hospital from January 2017 to May 2020. LSG with four ports was performed for all patients. During operation, left cardia and posterior gastric wall were dissected preferentially to incise gastropancreatic ligament and part gastrophrenic ligament. Then short gastric vessels were dissected and cut off carefully. LSG was performed using cutting and closing instruments and the greater curvature of stomach was reinforced with absorbable sutures. Results All the patients completed the operation successfully. Median operative time was 76(62-117) min, and the intraoperative bleeding was about 20 mL. Patients were safely discharged all 4-5 days postoperative and were followed up with the period of duration 1-42 months. There was no postoperative bleeding or gastric leakage complications. Conclusions LSG with four ports in which the left cardia and posterior gastric wall are preferentially dissected and short gastric vessels are cut then have clinical value for easy to dissociate the fundus of stomach and lower technique need of assistant. Figures and Tables | References | Related Articles | Metrics

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Revisonal surgery after breast reconstruction in breast cancer in China: a cross-sectional study WU Ke, XIU Bingqiu, GUO Rong, ZHANG Qi, LI Lun, YANG Benlong, WANG Jia, SU Yonghui, JI Weiru, SHAO Dingyi, SHAO Zhimin, WU Jiong 2020, 25 (05):  426-431.  DOI: 10.16139/j.1007-9610.2020.05.015 Abstract ( 184 )   HTML ( 1 )   PDF (565KB) ( 90 )   Objective To investigate the application and influence factors of revisional surgery after breast reconstruction in breast cancer patients in China. Methods It is a cross-section national study by distributing questionnaires to 110 hospitals with more than 200 annual breast cancer surgeries each. The questionnaire included questions concerning the application, operative programme, influence factors and complications of revisional surgery including nipple reconstruction, fat grafting and symmetric surgery. Results A total of 96 (87.3%) in 110 hospitals had breast reconstruction and 87 (79.1%) hospitals with revisonal surgery. There was nipple reconstruction in 55 (50.0%) hospitals, fat grafting in 41 (37.3%) hospitals and symmetric surgery in 64 (58.2%) hospitals. Two types of revisonal surgery were performed in 31 (28.2%) hospitals and three types in 21 (19.1%) hospitals. The application of revisonal surgery did not have relationship significantly with local economy. There were more cases with nipple reconstruction (P=0.01) and symmetric surgery (P<0.01), as well as 2 or more than 2 types of revisonal surgery (P≤0.01) performed in hospitals which had more cases with breast cancer surgery. Conclusions Revisional surgery after breast reconstruction in breast cancer has been paid more attention in China and might be affected by the amount of breast cancer surgery in hospital, professional training and patient education. Figures and Tables | References | Related Articles | Metrics

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Safety of normal saline isolation zone: An experimental study on laser, radiofrequency and microwave thyroid thermal ablation ZHAO Yanna, LIU Jun, HUANG Li, XU Wenjuan, NIE Zihuai, FEI Jian, GU Jianhua 2020, 25 (05):  432-436.  DOI: 10.16139/j.1007-9610.2020.05.016 Abstract ( 225 )   HTML ( 3 )   PDF (639KB) ( 97 )   Objective To investigate the safety of normal saline isolation zone in laser, radiofrequency and microwave thyroid ablation. Methods Fifteen pigs were divided into laser, radiofrequency and microwave three groups. Ten mL sterile normal saline were injected postanesthesialy to separate thyroid from surrounding tissues and form a liquid isolation zone with the width >5 mm. Two of 3 temperature measurement needles were placed in the tissues beneath 5 mm, 10 mm from ablation needle, and one needle in normal saline isolation zone 5 mm from ablation needle other side. Porcine thyroid was ablated using ultrasound-guided laser, radiofrequency or microwave respectively and a thermal ablated lesion in thyroid was formed with inner diameter about 10 mm. Two-dimensional ablation process was observed and recorded by ultrasound in real time and the change in temperature of ablation was carefully observed and recorded by temperature measurement needle. Results There were no significant differences statistically in the volume of ablation lesion and the volume of defect measured by perfusion after thermal ablation among laser, radiofrequency or microwave (P>0.05). Ablation process was proved effective by laser, radiofrequency or microwave ablation with the temperature at 5 mm from center point. The temperature in normal saline isolation zone of three pigs with microwave ablation exceeded 60.0 ℃, and up to 80.7 ℃ in one pig. Conclusions Normal saline may provide safe isolation zone in thyroid thermal ablation for laser or radiofrequency ablation, but not appropriate for microwave ablation. We recommended to use non-polar substances with great difference in dielectric properties from surrounding biological tissues as isolation zone, which can improve safety for microwave thermal ablation. Figures and Tables | References | Related Articles | Metrics

Clinical research

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Enhanced recovery after laparoscopic cholecystectomy in perioperative management ZHANG Yong, SUI Meili, CUI Weidong, ZHAO Su, LI Xiaoyong, CHEN Yanjun 2020, 25 (05):  437-439.  DOI: 10.16139/j.1007-9610.2020.05.017 Abstract ( 98 )   HTML ( 4 )   PDF (335KB) ( 52 )   Figures and Tables | References | Related Articles | Metrics

Case report

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Bariatric and metabolic surgery in patient with obesity and respiratory failure: a report of one case CHEN Fu, LI Zhen, ZHOU Yong, WANG Yong 2020, 25 (05):  440-441.  DOI: 10.16139/j.1007-9610.2020.05.018 Abstract ( 140 )   HTML ( 0 )   PDF (281KB) ( 43 )   References | Related Articles | Metrics

Review

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Research progress on comprehensive treatment of locally advanced pancreatic cancer QIAN Lihan, SHN Baiyong 2020, 25 (05):  442-446.  DOI: 10.16139/j.1007-9610.2020.05.019 Abstract ( 169 )   HTML ( 3 )   PDF (523KB) ( 99 )   References | Related Articles | Metrics

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Non-coding RNA within extracellular vesicle in pathogenesis of hepatocellular carcinoma CHEN Peng, LI Tao 2020, 25 (05):  447-451.  DOI: 10.16139/j.1007-9610.2020.05.020 Abstract ( 118 )   HTML ( 2 )   PDF (469KB) ( 43 )   Figures and Tables | References | Related Articles | Metrics