Guangyong Zhang

Laparoscopic versus open proctocolectomy with ileal pouch‐anal anastomosis

In recent years laparoscopic proctocolectomy with ileal pouch‐anal anastomosis has been used as an alternative to conventional open techniques. Since many published series on proctectomy and ileal pouch‐anal anastomosis are based on open experience, in this paper we compare our laparoscopic experience on 21 patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) to 25 patients who had undergone open proctocolectomy with ileal pouch‐anal anastomosis. The median operative time in the laparoscopic group was significantly longer than that in the open group (325 min vs. 220 min). However, blood loss was less (115 ml vs.240 ml), bowel function returned earlier (2 days vs.4 days), and hospitalization time was shorter (9 days vs.11 days) in the laparoscopic group (all p<0.05). Early postoperative complications were encountered in five patients of the laparoscopic group and in seven patients of the open group. The median follow‐up time was 15 months (range 6–34) in both groups. Late postoperative complications were encountered in three patients of the laparoscopic group and in three patients of the open group. In conclusion, laparoscopic proctocolectomy with ileal pouch‐anal anastomosis is technically feasible. The technique described in this study provides the advantages of less blood loss, shorter hospitalization, quicker return of bowel function and more favorable cosmetic results when compared to the open technique.

Increased CD4+CD69+CD25‐ T cells in patients with hepatocellular carcinoma are associated with tumor progression

Background and Aim:  A new subset of Treg cells, CD4+CD69+CD25‐ T cells, has been identified in mice. Herein, we aimed to identify this subset of T cells and to evaluate its function in patients with hepatocellular carcinoma (HCC).

Influence of CXCR4/SDF-1 axis on E-cadherin/β-catenin complex expression in HT29 colon cancer cells.

AIM To study the influence of CXCR4/stromal cell-derived factor-1 (SDF-1) axis on E-cadherin/β-catenin complex expression in HT29 colon cancer cells and its underlying mechanisms. METHODS Effect of SDF-1 on E-cadherin/β-catenin expression was detected by immunocytochemistry. E-cadherin and β-catenin mRNA expression levels were measured by reverse transcriptase-polymerase chain reaction. SDF-1-induced phosphorylation of phosphatidylinositol 3-kinase (PI3K)/AKT and β-catenin was detected by Western blotting. RESULTS The E-cadherin and β-catenin mRNA expression levels in HT29 cells were lower 48 h after incubated with SDF-1 at the concentrations of 20 and 40 ng/mL (P<0.05). SDF-1-induced significant phosphorylation of PI3K/AKT and β-catenin. AMD3100 and LY294002 inhibited the phosphorylation of PI3K/AKT and β-catenin. CONCLUSION SDF-1 down-regulates the E-cadherin/β-catenin complex expression in HT29 cells by decreasing mRNA synthesis and increasing β-catenin phosphorylation.

Transumblical single port laparoscopic cholecystectomy with a simple technique: Initial experience of 33 cases

Abstract Transumbilical single port laparoscopic cholecystectomy is a novel laparoscopic surgical technique for cholecystectomy utilizing only a transumbilical incision, which eliminates any visible abdominal scars and improves cosmesis. As the true single port laparoscopic technique, we presented an easy and feasible method for transumbilical laparoscopic cholecystectomy. A total of 33 patients were presented for transumbilical single port laparoscopic cholecystectomy. A 1.5 cm incision was made at the umbilicus. We used one sterile glove and designed a simple method for this procedure. All the operations were completed successfully. The operative time of the first case was 189 min, the average time of the following two cases was 90 min, and the mean of the latest ten cases was 50 min. Operative blood loss was <30 ml for all patients. No drainage tube was placed and no postoperative complications such as bleeding or biliary leakage occurred after three to six months of follow-up. All the patients were discharged 24h after the operation. There were no visible scars on the abdominal wall at the second weekend. Transumbilical single port laparoscopic cholecystectomy by our designed methods was technically simple, feasible and safe. Furthermore, development of newer instruments, accumulation of experience and enhancement of operative technique may facilitate this new operative approach.

Cell Apoptosis and Fas Gene Expression in Liver and Renal Tissues After Ischemia-Reperfusion Injury in Liver Transplantation

Ischemia-reperfusion (I/R) injury is an important factor in a nonfunctioning liver graft and acute renal failure. Apoptosis is a cell death mechanism in early stages of I/R injury. In the present study, orthotopic liver transplantation (oLT) using a modified double-cuff method was performed in Wistar rats, with sham-operated rats serving as the control group. Rats in the treatment and control groups were sacrificed at 1, 3, 6, 12, and 24 hours after oLT to obtain liver and kidney tissues. Fas protein expression in apoptotic cells at various times was detected at immunohistochemical staining and flow cytometry, and Fas gene expression was detected using the reverse transcriptase polymerase chain reaction. Apoptosis began in liver and renal cells at 1 hour after oLT, peaking at 12 hours. The reverse transcriptase polymerase chain reaction demonstrated Fas gene expression in liver and renal tissues at 1 hour post-oLT, peaking at 12 hours. Changes in the treatment group were significantly greater than in the control group (P < .05). We conclude that renal cells, like liver cells, undergo apoptosis due to I/R injury after oLT.

Endoscopic thyroidectomy: the development in a Chinese center.

BACKGROUND Endoscopic thyroidectomy (ET) precludes the long cervical incision of the open procedure. Although endoscopy is an essential tool taught to almost every surgeon, its effective use with regard to thyroidectomy requires understanding its limitations pertaining to trauma and cancer, as well as an understanding of the advantages and disadvantages of the different endoscopic approaches. The development of an ET center in China is discussed here. METHODS Overall, 235 patients who had undergone attempted ET in Qilu Hospital of Shandong University in China from August 2001 to September 2010 were evaluated. RESULTS Of the 11 men and 224 women on whom the procedure had been attempted, all but seven successfully underwent ET, 145 (63.6%) via a modified anterior chest approach, and 83 (36.4%) via a breast approach. Age ranged from 17 to 52 years, with a mean of 34.5 years. Surgery was limited, in the case of masses, to lesions smaller than 6 cm ultrasonographically. All patients were followed for at least 3 months. The 24 and 48 hours Visual Analog Scale postoperative measurements were low. Complications included four cases of cutaneous emphysema, five seromas, four episodes of anterior chest discomfort, three transient laryngeal nerve palsies, and four episodes of hypocalcemia. The seven procedures that had been converted to an open procedure comprised two patients discovered at frozen section to have poorly differentiated thyroid carcinoma, two with tumors larger than 5 cm, and three with thyroiditis. CONCLUSIONS ET is readily learned, provided the surgeon is competent at both laparoscopic technique and open thyroidectomy. Procedural advantages of an endoscopic approach include superior cosmesis and decreased invasiveness.

Endoscopic thyroidectomy by a modified anterior chest approach: A single institution`s 5-year experience

Endoscopic thyroidectomy embodies the features of both minimally invasive surgery and aesthetic surgery. However, none of the established approaches is minimally invasive and meanwhile maximally cosmetic. Here we applied a modified anterior chest approach to achieve excellent cosmesis with reduced physical invasion. Fifty-six patients with benign thyroid diseases accepted this procedure. A 10mm longitudinal incision was made about one-fourth of the distance from the xiphoid to the sternal notch. Bilateral transversal incisions (5mm and 10mm) were performed about one-third of the distance from the nipple to the sternoclavicular joint. The subfascial space was maintained with CO2 insufflation. Endoscopic lobectomy or subtotal thyroidectomy was performed according to the diseases. Fifty-four of the 56 procedures were successfully performed endoscopically, including 41 unilateral lobectomies and 13 subtotal thyroidectomies. The mean operative time for uni- and bilateral procedures was 117.2 min and 184.5 min, respectively. Conversion occurred in two cases due to bleeding and malignant frozen section analysis, respectively. Postoperative complications included one temporary recurrent nerve palsy, one transient hypocalcemia, and one subcutaneous emphysema. 96.2%(50/52) of the patients were extremely satisfied or satisfied with the cosmetic effect. This procedure is more likely to be accepted by patients older than 30 years. Endoscopic thyroidectomy by the modified anterior chest approach is an effective procedure with both excellent aesthetic benefits and reduced physical injury.

A novel therapeutic approach to non-parasitic splenic cysts: laparoscopic fenestration and endothelium obliteration.

Splenic cyst is a relatively rare disease; true splenic cysts are classified as parasitic and non‐parasitic cysts. Although most cysts are asymptomatic, large cyst cases show clinical symptoms, consisting mainly of dyspepsia and fullness in the upper left abdomen. Surgical intervention is recommended primarily for large cysts to prevent complications such as rupture, hemorrhage, and infection. This paper presents our experience of eleven laparoscopic procedures for non‐parasitic splenic cysts. Laparoscopic fenestration was performed in all cases, and the cyst endothelium was destroyed . All operations were accomplished successfully. The mean operative time was 56 minutes (range 40‐90 minutes). Intraoperative bleeding was 15ml (range 5‐30 ml), oral food intake was started on the first postoperative day. The median duration of postoperative hospitalization was 2.8 days (range 1–7days). There were no postoperative complications. All cases were followed up for a period of 21 months to 5.5 years, and no recurrence occurred. Laparoscopic fenestration and endothelium obliteration is an advantageous approach to large non‐parasitic splenic cysts with little postoperative pain, fast recovery, splenic tissue and splenism preservation, low complication rates, and a short hospital stay; it is easily accepted by patients. It yields favorable medium‐term results. Our study confirms that good results can be achieved with an approach of laparoscopic fenestration and endothelium obliteration for simple non‐parasitic splenic cysts.

Economical Strategies of Laparoscopic Splenectomy: A Chinese Single-Center Experience

Background: The proposed benefits of laparoscopic splenectomy (LS) such as decreased postoperative pain and hospitalization have to be balanced against the proposed deficits of increased costs, especially in developing countries such as China. Herein we propose economical strategies of LS based on our single-center experience. Patients and Methods: We have reviewed our data of patients undergoing LS or open splenectomy (OS) between August 1998 and August 2006 at Qilu Hospital of Shandong University in China to evaluate factors reducing operative time, blood loss, complication rate, postoperative hospitalization, presence of accessory spleens, platelet consumption, hospital costs, and total costs. Results: The blood loss, complication rate and presence of accessory spleen were comparable in both groups (p > 0.05). Although it was associated with significantly longer operative time (161.25 vs. 71.07 min, p < 0.01), LS carried lower postoperative hospitalization (5.6 vs. 10.5 days) and platelet transfusion (2.46 vs. 11.03 IU). The mean charges of blood products in the LS group and in the OS group were calculated as USD 33.26 and USD 136.86, respectively (p < 0.01). Those for the ward amounted to USD 250.00 and USD 433.33 in the LS group and in the OS group, respectively (p < 0.05). The mean charges of operating room were USD 588.00 for LS and USD 235.33 for OS (p < 0.01), but the total charges for patients with LS were comparable to those of OS patients (USD 871.20 vs. USD 783.20, p > 0.05). Conclusions: We have decreased the total charges of LS so that they were comparable to those of OS by the use of reusable ultrasonic shear, suture silk, titanium clips and sterile wrapping of disposable surgical items instead of Endo-stapler and commercial retriever bag. The patients obtained the minimal invasive benefits at no significant additional costs which might contribute to an increased propagation of laparoscopic techniques in developing countries such as China.

Laparoscopic primary choledochorrhaphy over endonasobiliary drainage tubes

BackgroundThe T-tube is widely used in laparoscopic choledochotomy to decompress the biliary tree. However, there are high morbidity rates related to the T-tube. This study reviewed the results of laparoscopic primary choledochorrhaphy over endonasobiliary drainage (ENBD) tubes to find an effective alternative to the T-tube for the performance of laparoscopic choledochotomy.MethodsFrom March 2003 to September 2005, 23 patients (9 men and 14 women) with choledocholithiasis underwent laparoscopic choledochotomy over ENBD tubes. The mean age of these patients was 47 years (range, 32–73 years). At admission, six patients had cholangitis. All the patients had ENBD tubes placed preoperatively after the failure of endoscopic sphincterotomy.ResultsThere was no conversion to open surgery. The mean operative time was 90 min (range, 70–150 min). There were no biliary complications such as bile leaks, biliary peritonitis, or pancreatitis. No residual stones were found by postoperative cholangiograms. The ENBD tubes were removed between postoperative days 7 and 9. The hospital stay ranged from 8 to 14 days, with 16 patients (70%) discharged on postoperative day 8. The complications were limited to one umbilical infection and one case of pneumonia. The median follow-up period was 24 months (range, 8–36 months), and none of the patients were readmitted with biliary symptoms.ConclusionLaparoscopic choledochotomy over ENBD tubes proved to be technically feasible and safe. The ENBD tube decompresses the biliary tree and allows for cholangiography after surgery. Its removal does not need to wait for tract maturation, which allows an earlier removal of the tube and a shorter postoperative hospital stay. Laparoscopic choledochotomy over ENBD tubes is an effective alternative to the T-tube in laparoscopic choledochotomy.