Cunchuan Wang

The value of routine gastroscopy before laparoscopic Roux-en-Y gastric bypass surgery in Chinese patients

BACKGROUND Obesity is closely related to upper gastrointestinal diseases. China has a high incidence of gastropathy. Postoperative examination of the distal stomach becomes extremely difficult after laparoscopic Roux-en-Y gastric bypass surgery (LRYGB). Whether preoperative routine gastroscopy should be performed at all remains controversial. The objective of this study was to explore the value of routine gastroscopy before performing LRYGB in Chinese patients. METHODS The preoperative gastroscopy reports of 180 patients who had undergone LRYGB for morbid obesity and/or metabolic syndrome in the Department of Gastrointestinal Surgery of our hospital from January 2009 to August 2013 were retrospectively analyzed. RESULTS Gastroscopy showed chronic superficial gastritis (n = 159, 88.3%), reflux esophagitis (n = 19, 10.6%), erosion (n = 69, 38.3%), hiatal hernia (n = 5, 2.8%), gastric ulcer (n = 3, 1.7%), duodenal ulcer (n = 32, 17.8%), and gastric polyps (n = 10, 5.6%). CONCLUSION It is useful to perform gastroscopy before LRYGB. The findings of this investigation can help physicians to develop tailored therapies and procedures and thus improve the prognosis considerably. Gastroscopy should be routinely performed in Chinese patients who are planning to undergo bariatric surgery.

Precise Laparoscopic Roux-en-Y Gastric Bypass: A New Concept in Bariatric and Metabolic Surgery.

Purpose: Bariatric surgery is technically complex. It is important to refine existing methods and explore new techniques to improve the outcomes of patients. We discuss the characteristics and applications of the precise laparoscopic Roux-en-Y gastric bypass (PLRYGB) in clinical practice. Materials and Methods: We retrospectively analyzed the clinical records of obese patients who underwent laparoscopic Roux-en-Y gastric bypass between 2009 and 2012, and compared surgical data, postoperative recovery, weight loss, and complications of patients who underwent PLRYGB with those who underwent conventional laparoscopic Roux-en-Y gastric bypass (CLRYGB) surgery. Results: Of 211 patients, 89 underwent CLRYGB and 122 PLRYGB. Although the operating time for PLRYGB was significantly longer than CLRYGB (149±23 min vs. 138±23 min, P<0.05), length of hospital stay was shorter in those undergoing the precise technique (4.2±1.1 d for PLRYGB and 7.7±1.5 d for CLRYGB, P<0.05), and the percentage of excess weight lost 18 months after surgery was greater (78.4±8.2% for PLRYGB and 64.5±8.4% for CLRYGB, P=0.000). Five patients (5.6%) who underwent conventional surgery experienced postoperative complications, including 1 anastomotic leak and 1 internal hernia; 1 patient required redo surgery, and 2 corrective surgery. There were no postoperative complications in the PLRYGB group. Conclusions: PLRYGB is safe and feasible. The precise approach did not substantially increase operating time but decreased duration of hospital stay and the incidence of postoperative complications, whereas weight loss outcomes were significantly better.

Effect of Bariatric Surgery on Thyroid Function in Obese Patients: a Systematic Review and Meta-Analysis

We aimed to make a meta-analysis regarding the effect of bariatric surgery on thyroid function in obese patients. PubMed, EMBASE, CENTRAL, and four Chinese databases were searched for clinical studies. Data were pooled using Review Manager 5.3, and subgroup and sensitivity analyses were performed if necessary and feasible. As a result, 24 articles were included into meta-analysis. Bariatric surgery was associated with significant decrease in TSH, FT3, and T3 levels. However, FT4, T4, and rT3 levels were not significantly changed postoperatively. In addition, bariatric surgery had a favorable effect on overt and subclinical hypothyroid, with reduction of thyroid hormone requirements postoperatively. In conclusion, TSH, FT3, and T3 decrease are expected following bariatric surgery, as well as non-significant change of T4, FT4, and rT3 levels.

Surgical results of laparoscopic Roux-en-Y gastric bypass in super obese patients with BMI≥60 in China.

Purpose: Bariatric surgery in mainland China is still in its initial stages. The aim of this study was to investigate the feasibility and efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) for Chinese super obese patients with body mass index (BMI) ≥60 kg/m2. Methods: Twenty-six super obese patients underwent LRYGB, performed by a single surgeon, at the First Affiliated Hospital of Jinan University between June 2004 and September 2012. Surgical outcomes were analyzed retrospectively. Results: All 26 LRYGB procedures were performed successfully, with no conversion to open surgery. Preoperative mean body weight and BMI were 192.3 kg and 65.8 kg/m2, respectively. Mean percentage of excess weight loss in the 12 months after surgery was 55.3±7.6%. Obesity-related comorbidities improved significantly. Two patients experienced perioperative complications, 1 with respiratory failure and 1 with umbilical wound infection. Six patients developed long-term complications, but all were cured by conservative treatment. Conclusions: Chinese obese population is unique in diet, lifestyle, sex, age, and geographical differences. LRYGB is feasible for Chinese super obese patients, with significant short-term results. Further observations are required to assess long-term outcomes.

Characterization of cardiovascular depression effect for propofol during anesthesia induction period on morbidly obese patients

This study aims to determine the pharmacodynamics (PD) effect (measured by cardiovascular depression) of propofol during anesthesia induction period on morbidly obese (MO) patients. Four hemodynamics indexes [i.e., three indexes about blood pressure and cardiac output (CO)] representing cardiovascular function were measured. Pharmacokinetic/pharmacodynamic (PK/PD) modeling was performed by population analysis to obtain PD parameters. Two propofol dosing scalars, namely, dosing based on total body weight (TBW) or lean body weight (LBW), were used for MO subjects. The PD data were well described by a PK/PD model. Blood pressure and CO were rapidly decreased within one minute after intravenous injection of propofol (2 mg/kg). TBW group showed significantly lower blood pressure and CO values at and 1 min after propofol administration compared with the control group, whereas the control and LBW groups had similar PD profiles. In addition, the propofol EC50 value was significantly decreased in MO patients, whereas all other PD parameters were similar between control and MO subjects. This change indicated that propofol potency and/or sensitivity was increased in MO subjects. For MO patients, dosing of propofol based on LBW rather than TBW would be a safer choice due to a less cardiovascular depression effect.

Insights into the Therapeutic Potential of Heparinized Collagen Scaffolds Loading Human Umbilical Cord Mesenchymal Stem Cells and Nerve Growth Factor for the Repair of Recurrent Laryngeal Nerve Injury

Recurrent laryngeal nerve (RLN) injury can result in unilateral or bilateral vocal cords paralysis, thereby causing a series of complications, such as hoarseness and dyspnea. However, the repair of RLN remains a great challenge in current medicine. This study aimed to develop human umbilical mesenchymal stem cells (HuMSCs) and nerve growth factor (NGF)-loaded heparinized collagen scaffolds (HuMSCs/NGF HC-scaffolds) and evaluate their potential in the repair of RLN injury. HuMSCs/NGF HC-scaffolds were prepared through incorporating HuMSCs and NGF into heparinized collagen scaffolds that were prefabricated by freeze-drying in a template. The resulting scaffolds were characterized by FTIR, SEM, porosity, degradation in vitro, NGF release in vitro and bioactivity. A rabbit RLN injury model was constructed to appraise the performance of HuMSCs/NGF HC-scaffolds for nerve injury repair. Electrophysiology, histomorphology and diagnostic proteins expression for treated nerves were checked after application of various scaffolds. The results showed that the composite scaffolds with HuMSCs and NGF were rather helpful for the repair of broken RLN. The RLN treated with HuMSCs/NGF HC-scaffolds for 8 weeks produced a relatively normal electromyogram, and the levels of calcium-binding protein S100, neurofilament and AchE pertinent to nerve were found to be close to the normal ones but higher than those resulted from other scaffolds. Taken together, HuMSCs/NGF HC-scaffolds exhibited a high score on the nerve injury repair and may be valuable for the remedy of RLN injury.

Effect of Sleeve Gastrectomy on Thyroid Function in Chinese Euthyroid Obese Patients

Background: Changes in thyroid function following bariatric surgery in euthyroid obese patients have yielded inconsistent results. Nevertheless, no data exist on changes in thyroid function after bariatric surgery in Chinese obese subjects. Objectives: The objective of this study is to evaluate the influence of weight reduction on thyroid function following laparoscopic sleeve gastrectomy (LSG) in patients with normal thyroid function. Patients and Methods: Serum free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) levels were retrospectively analyzed before and 12 months after LSG in euthyroid patients with morbid obesity. Correlation between weight loss after LSG and changes in thyroid function were investigated. Results: In total, 16 patients who underwent LSG were included in the study. Mean BMI change from 35.78 to 23.66 kg/m2 (P<0.000) after LSG was associated with a mean reduction in the TSH from 2.31 to 1.54 mU/L (P=0.022), whereas FT4 (15.19±0.33 pmol/L at baseline and 14.85±0.58 pmol/L at 12 mo after LSG; P=0.583) and FT3 (4.98±0.15 pmol/L at baseline and 4.77±0.60 pmol/L at 12 mo after surgery; P=0.406) levels remained steady. Decrease in TSH was significantly correlated with decrease in BMI at 12 months after surgery but did not correlate with excess weight loss and total weight loss. Conclusions: Weight loss after LSG is accompanied by significant decrease in serum TSH level but no change in serum FT4 and FT3 levels. However, further work is required to elucidate the mechanism.

Prognostic value of preoperative prognostic nutritional index in stage III gastric cancer after curative resection: a retrospective cohort study

BACKGROUND AND OBJECTIVES Nutrition and inflammation play a crucial role in the development of cancer. The prognostic value of the prognostic nutritional index (PNI) has been confirmed in some types of human cancers. This study analyzed the prognostic significance of the preoperative PNI in patients with stage III gastric cancer after curative surgery. METHODS AND STUDY DESIGN In this retrospective study, we enrolled 274 patients who underwent curative operation for stage III gastric cancer. The correlation between the preoperative PNI and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analyses. RESULTS The patients with a high PNI had a significantly higher median OS than did those with a low PNI (46.8 months vs 24.1 months, p=0.01). In the subgroup analysis, the survival benefit of the PNI was limited to the patients with poorly differentiated gastric cancer (high PNI, 46.8 months; low PNI, 21.8 months, p=0.004) and was not observed in those with well and moderately differentiated cancer (high PNI, 30.3 months; low PNI, 26.7 months, p=0.30). In the multivariate analysis, the PNI was an independent prognostic factor for OS. CONCLUSIONS The PNI can be used as an independent prognostic biomarker for operable advanced gastric cancer.

Letter to the Editor: Minimizing the Access Trauma of Laparoscopic Sleeve Gastrectomy: the Transoral Specimen Extraction Technique (vol 26, pg 619, 2016)

access trauma of LSG in certain extent [1, 2]. But we have concerns in several aspects. By using the NOSE technique the authors used, there is a risk that tearing of the esophagus by the staples in the resected stomach may happen. There is also possibility to damage of the blood vessels of the esophagus and cause bleeding. This risk can be even elevated when the size of the resected stomach is large. Besides, there is friction when extracting the stomach via the esophagus, there may have rupture of the esophagus and that may cause infection. All these result a contraindication of the NOSE that patients with large stomach size may not be suitable to use this technique.