Objective To investigate the application value of parallel and cross-to-overlap anastomosis method (PCOA) in three-dimensional (3D) laparoscopic radical resection of right hemicolon cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 138 patients who underwent 3D laparoscopic radical resection of right hemicolon cancer at Henan Provincial People′s Hospital between July 2016 and July 2019 were collected. There were 83 males and 55 females, aged from 30 to 76 years, with a median age of 64 years. All the 138 patients with right hemicolon tumors were diagnosed as malignant tumors by enteroscopy and pathological examination before operation. The lymph node dissection and radical resection of right hemicolon cancer were performed according to the 9th edition of Japanese General Rules for Cancer of Colon, Rectum and Anus of the Japanese Colorectal Cancer Association. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect survival of patients and tumor recurrence and metastasis up to September 2019. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were represented as percentages or absolute numbers. Results (1) Surgical situations: all the 138 patients underwent 3D laparoscopic radical resection of right hemicolon cancer using PCOA to reconstruct digestive tracts, without conversion to open surgery. The operation time, time for PCOA, and volume of intraoperative blood loss was (151.0±54.0)minutes, (20.1±2.0)minutes, and (60±21)mL. (2) Postoperative situations: the time to first flatus, time to semi-liquid food intake, length of auxiliary incision, and incidence rate of postoperative complications were (2.5±0.4)days, (4.0±1.3)days, (3.0±0.2)cm, and 3.62%(5/138), respectively. Of the 5 patients with postoperative complications, 1 patient with intestinal obstruction was cured after conservative treatment including gastrointestinal decompression and nutritional support, 1 patient with anastomotic leakage was cured after conservative treatment including gastrointestinal decompression, local patency drainage, infection control and nutritional support, 1 patient with ascites and abdominal infection was cured after computed tomography-guided percutaneous catheter drainage, 1 patient with incisional infection was cured by controlling infection, strengthening dressing changes, local irrigation and drainage, 1 patient with pulmonary infection was cured after anti-infective treatment.The number of lymph nodes dissected after surgery, duration of postoperative hospital stay, and hospital expenses were 19±8, (7.2±4.1)days, and (4.8±1.4)×104 yuan. All the 138 patients were confirmed as colonic adenocarcinoma by postoperative pathological examination, including 27 cases of poorly differentiated adenocarcinoma, 92 cases of moderately differentiated adenocarcinoma, 10 cases of highly differentiated adenocarcinoma, and 9 cases of mucinous adenocarcinoma. (3) Follow-up: 133 of 138 patients were followed up for 2-38 months, with a median follow-up time of 18 months. During the follow-up, 2 patients died, 1 of which was detected multiple liver metastases at postoperative 16 months and died at postoperative 21 months, and the other was detected multiple liver metastases at postoperative 20 months and died at postoperative 24 months. Eight patients had distant metastasis, including 5 cases of liver metastasis, 1 case of lung metastasis, and 2 cases of abdominal metastasis. The 10 patients with death and tumor metastasis were confirmed as stage Ⅲ by postoperative pathological examination, and the other 123 patients were generally in good condition. Conclusion PCOA is safe and effective for 3D laparoscopic radical resection of right hemicolon cancer. Key words: Colonic neoplasms; Digestive tract reconstruction; Parallel and cross-to-overlap anastomosis; Surgery for right hemicolon cancer; Three-dimensional; Laparoscopy

Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were collected. There were 289 males and 136 females, aged (53±11)years, with a range from 21 to 79 years. All the patients were allocated into 3 periods according to the operation time, including 100 patients of early period from February 2012 to March 2014, 156 patients of mature technology period from April 2014 to August 2016, and 169 patients of technology innovation period from september 2016 to December 2018. The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization, and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Patients were followed up by outpatient examination to detect the upper digestive rebleeding, gastric retention, and diarrhea up to March 2019. Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using ANOVA, and paired comparison was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test, and paired comparison was analyzed using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test and Fisher exact probability. Results (1) Surgical situations: the operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, cases with conversion to open surgery, and cases with emergency operation for bleeding were (187±46)minutes, 150 mL (range, 50-1 300 mL), 2, 2 , 1 for patients of early period, (164±22)minutes, 50 mL (range, 30-100 mL), 1, 1, 1 for patients of mature technology period, and (150±18)minutes, 50 mL (range, 10-300 mL), 0 , 0 , 0 for patients of technology innovation period, respectively. There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482, χ2=94.620, P 0.05). (2) Postoperative situations: 425 patients had oral aspirin enteric-coated tablets for prevention of thrombus, with no perioperative death. Duration of postoperative hospital stay, cases with portal vein thrombosis at postoperative 7 days, cases with pancreatic fistula, cases with pulmonary infection, and cases with abdominal infection were (11.0±2.9)days, 46, 2, 1, 0 for patients of early period, (9.9±1.7)days, 81, 3, 0, 0 for patients of mature technology period, and (8.8±1.3)days, 83, 2, 1, 1 for patients of technology innovation period, respectively. There was a significant difference in the duration of postoperative hospital stay between the three groups (F=39.836, P 0.05) and no significant difference in the cases with pancreatic fistula, cases with pulmonary infection, or cases with abdominal infection between the three groups (P>0.05). Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment. Patients with pancreatic fistula, pulmonary infection, and abdominal infection were cured and discharged after conservative treatment. (3) Follow-up: all the 425 patients were followed up for 1-72 months, with a median follow-up of 36 months. Of the 425 patients, 261 underwent postoperative sequential therapy of EVL, including 133 patients of mature technology period and 128 patients of technology innovation period. The incidence rate of upper digestive rebleeding was 3.83%(10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68%(29/164) of 164 patients without postoperative sequential therapy of EVL, showing a significant difference between them (χ2=23.185, P<0.05). The incidence rates of gastric retention and diarrhea were 96.24%(128/133) and 61.65%(82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period, and 1.56%(2/128) and 3.91%(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period, showing significant differences between them (χ2=233.876, 97.883, P<0.05). Conclusions It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension, and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications. Key words: Liver cirrhosis; Portal hypertension; Splenectomy; Pericardial devascularization; Vagus nerve; Laparoscopy

Objective To investigate the clinical application value of abdominal incisional hernia repair. Methods The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent abdominal incisional hernia repair in the Wuhan No.1 Hospital from January 2013 to December 2017 were collected. There were 38 males and 66 females, aged (58±4)years, with a range from 31 to 85 years. All patients underwent abdominal incisional hernia repair by patch implantation. Observation indicators: (1) intraoperative conditions; (2) complications; (3) follow-up. Follow-up by telephone questionnaires was performed to detect the postoperative recurrence up to June 2019. Measurement data with normal distribution were expressed as Mean±SD, measurement data with skewed distribution were expressed as M (P25, P75), and count data were expressed as absolute numbers. Results (1) Intraoperative conditions: all the 104 patients underwent the abdominal incisional hernia repair successfully. The operation time, duration of postoperative hospital stay were (111±18)minutes and (6.1±2.4)days. Among the 104 patients, 29 underwent open surgery, 38 underwent laparoscopic surgery, and 37 underwent hybrid surgery. Among the 29 patients undergoing open surgery, 25 had defect area in the subumbilical region (M4 type), 2 had defect area in the hypochondrial region (L2 type), and 2 had defect area in the ilium region (L3 type); all patients had patches placed in posterior muscle space. Among the 38 patients undergoing laparoscopic surgery, 9 had subxiphoid defects (M1 type), 23 had epigastric defects (M2 type), and 6 had subcostal defects (L1 type); all patients had patches placed in intraperitoneal cavity. Among the 37 patients undergoing hybrid surgery, 27 had umbilical defects (M3 type) and 10 had suprapubic defects (M5 type); all patients had patches placed in intraperitoneal cavity. (2) Complications: among the 29 patients undergoing open surgery, 7 had complications, including 4 of pain in the repaired area of abdominal wall, 1 of poor wound healing, and 2 of seroma in the repaired area. Among the 38 patients undergoing laparoscopic surgery, 2 were suffered from pain in the repaired area of abdominal wall. Among the 37 patients undergoing hybrid surgery, 6 had complications, including 2 of poor wound healing and 4 of seroma in the repair area. Among the 104 patients, 6 patients with pain in the repair area of abdominal wall after operation were improved by local closure and analgesic treatment; 3 patients of poor wound healing were healed well after local dressing change and secondary debridement and suture; 6 patients with seroma in the repaired area were cured by puncture, drainage and pressure bandage. No intestinal fistula, intestinal obstruction, abdominal compartment syndrome or death occurred. (3)Follow-up: 104 patients were followed up for 13 months (3 months, 24 months). Among the 104 patients, 1 recurred at 6 months, 13 months and 16 months after operation, respectively. All the 3 patients were recovered and discharged after re-repair. Conclusion Abdominal incisional hernia repair is safe and effective, which should be selected according to the specific conditions of the operation. Key words: Hernia; Abdominal incisional hernia; Repair surgery; Opening; Hybridization; Clinical application; Laparoscopy

Objective To investigate the application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinical data of 60 patients who underwent radical gastrectomy for gastric cancer in Nanjing Medical University Affiliated Wuxi Second Hospital between January 2018 and December 2018 were collected. There were 37 males and 23 females, aged from 28 to 78 years, with an average age of 64 years. Thirty patients who received parenteral nutrition containing 100 mL of ω-3 fish oil fat emulsion after radical gastrectomy and 30 patients who received parenteral nutrition containing routine fat emulsion after radical gastrectomy were allocated into experimental group and control group, respectively. Observation indicators: (1) nutritional indicators in the perioperative period; (2) inflammatory indicators in the perioperative period; (3) immune indicators in the perioperative period; (4) postoperative complications. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated using the independent-sample t test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Repeated measurement data were analyzed by the repeated measures ANOVA. Results (1) Nutritional indicators in the perioperative period: the levels of total protein, albumin, prealbumin, and transferrin from preoperative day 1 to preoperative day 6 were respectively changed from (60.2±3.0)g/L to (57.2±3.1)g/L, from (35.3±3.1)g/L to (37.0±1.8)g/L, from (186±24)mg/L to (172±17)mg/L, from (3.0±0.7)g/L to (2.4±0.4)g/L in the experimental group and from (60.6±2.4)g/L to (55.7±4.2)g/L, from (35.0±3.8)g/L to (36.0±3.8)g/L, from (184±18)mg/L to (173±25)mg/L, from (3.1±0.6)g/L to (2.2±0.8)g/L in the control group, with no significant difference in the changing trends between the two groups (F=0.79, 2.14, 0.03, 0.36, P>0.05). (2) Inflammatory indicators in the perioperative period: the levels of white blood cells, C-reactive protein, interleukin 6, and tumor necrosis factor-α from preoperative day 1 to preoperative day 6 were respectively from (7.2±1.1)×109/L to (10.2±0.9)×109/L, from (7.2±2.3)mg/L to (25.5±6.3)mg/L, from (16±3)ng/L to (24±4)ng/L, from (17±4)ng/L to (22±5)ng/L in the experimental group and from (7.4±0.8)×109/L to (13.0±1.3)×109/L, from (6.9±2.4)mg/L to (41.6±18.9)mg/L, from (17±4)ng/L to (45±8)ng/L, from (16±4)ng/L to (43±7)ng/L in the control group, respectively, with significant differences in the changing trends between the two groups (F=63.05, 51.65, 127.82, 104.91, P 0.05). (4) Postoperative complications: 5 patients had postoperative complications, with a incidence rate of 16.7%(5/30), including 1 of abdominal infection, 1 of incisional infection, and 3 of pulmonary infection, and all the 5 patients were cured after symptomatic treatment. Nine patients had postoperative complications, with a incidence rate of 30.0%(9/30), including 2 of abdominal infection, 2 of incisional infection, and 5 of pulmonary infection, and all the 9 patients were cured after symptomatic treatment. There was no significant difference in the incidence of postoperative complications between the two groups (χ2=1.491, P>0.05). Conclusion For patients who receive gastric cancer surgery, ω-3 fish oil fat emulsion can reduce the inflammatory response, improve their immune function and not increase postoperative complications. Key words: Gastric neoplasms; Gastric cancer; ω-3 fish oil fat emulsion; Nutritional support; Perioperative period; Complications

Bariatric surgery is an effective method for the treatment of obesity and type 2 diabetes mellitus. Morbidly obese patients usually have metabolic syndromes, as such, surgeons need to choose the reasonable surgical methods for patients according to their individuality and particularity. Hiatal hernia is a very common disease prevalent in obese patients and could induce gastroesophageal reflux, which increases the difficulty of bariatric surgery and proposes higher demands on choice of surgical methods to surgeons. It is important to recognize the presence of the hiatal hernia preoperatively and choose a more effective procedure of bariatric surgery to decrease the incidence of postoperative complications. Key words: Obesity; Hiatal hernia; Gastroesophageal reflux; Bariatric surgery; Baria-tric and metabolic surgery

Bariatric surgery is an effective treatment for obesity and the related metabolic diseases. At present, although the jejunoileal bypass is widely used in various types of bariatric surgery, the effect of reconstructed anatomy after the jejunoileal bypass on normal physiological function of obese patients has not been clarified. This leaves some controversy about the recommended limb lengths in jejunoileal bypass. At the same time, there is no consensus on the optimal biliary limb length and alimentary limb length in the standard gastric bypass. Lack of accurate measurement of common limb length and total small bowel length inevitably results in unsatisfactory percentage of excess body weight loss caused by short limb length, or malabsorption and malnutrition caused by long limb length. The authors discussed the effects of different length of biliary limb, alimentary limb and common limb on weight loss, and introduced the preliminary application and prospects of the jejunoileal bypass including measurement of total small bowel length in bariatric surgery. Key words: Obesity; Bariatric surgery; Bariatric and metabolic surgery; Jejunoileal bypass; Total small bowel length