BACKGROUND Gastrointestinal disorders (GIDs) frequently develop after abdominal surgery and impede postoperative recovery and quality-of-life improvement. AIM To determine whether acupuncture and moxibustion (Acu-Mox) can improve clinical outcomes in patients with postabdominal surgery GID. METHODS We selected 105 patients with GID following abdominal procedures between December 2022 and December 2024. Comparative analyses were conducted on 50 patients in the control group receiving conventional Western medical treatment and 55 cases in the research group who additionally received Acu-Mox, with endpoints including overall effectiveness, the Intake, Feeling Nauseated, Emesis, Physical Exam, and Duration of Symptoms (I-FEED) scale score and its normalization time, gastrointestinal function recovery (bowel sound recovery, exhaust/defecation time, first liquid diet intake time), serum inflammatory indicators (C-reactive protein, interleukin-6, tumor necrosis factor-α), and complications (ileus, constipation, bloating, abdominal pain). RESULTS The research group showed a markedly higher total effective treatment rate than the controls. This group also exhibited a notable reduction in posttreatment I-FEED scores, C-reactive protein, interleukin-6, and tumor necrosis factor-α that were statistically lower vs the control group, together with shorter time to I-FEED score normalization, bowel sound recovery, exhaust/defecation, and the first postoperative liquid diet, as well as an obviously lower overall complication rate. CONCLUSION Acu-Mox for post-abdominal surgery GID is more effective than traditional Western medicine, deserving promotion in clinical practice.

BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure; however, its short-term outcomes and comorbidity resolution remain underexplored. AIM To evaluate short-term weight loss outcomes and comorbidity improvements in patients with obesity within 12 months after LSG. METHODS A single-center retrospective analysis was conducted on 122 patients with obesity who underwent LSG between June 2019 and June 2024. Weight, body mass index, excess weight loss percentage, total weight loss percentage, and metabolic parameters were assessed preoperatively and 1 month, 3 months, 6 months, and 12 months postoperatively. RESULTS Significant reductions in weight (115.36 ± 18.72 kg to 90.65 ± 18.59 kg) and body mass index (38.73 ± 5.17 kg/m2 to 30.32 ± 5.01 kg/m2) were observed at 12 months (P < 0.05). Excess weight loss percentage reached 71.84% and total weight loss percentage showed a consistent upward trend. Marked improvements were also observed in type 2 diabetes, hypertension, dyslipidemia, hyperuricemia, and fatty liver disease (all P < 0.05). CONCLUSION LSG is effective for achieving significant short-term weight loss and ameliorating obesity-related metabolic comorbidities, highlighting its value as a therapeutic intervention for severe obesity.

BACKGROUND Several prior studies have reported a high incidence of gallstone disease post-bariatric surgery. However, its incidence and predictive factors in Asian populations have not been adequately studied. AIM To evaluate the incidence and predictive factors of gallstone disease post-bariatric surgery in a Thai population. METHODS We retrospectively evaluated patients who underwent laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass at a University Hospital in Thailand between July 2012 and December 2019. All patients underwent annual imaging studies for gallstones both before and after surgery. The predictive factors for postoperative gallstone disease were analyzed using univariate and multivariate analyses. RESULTS A total of 243 patients who underwent laparoscopic sleeve gastrectomy (70.8%) or laparoscopic Roux-en-Y gastric bypass (29.2%) were included in the analysis, with a mean age of 36.4 years. The incidence of postoperative gallstone disease was 19.3%, comprising 1.2% symptomatic and 18.1% asymptomatic cases, with a median follow-up of 24.6 (range: 6.1-98.4 months). Preoperative body mass index (BMI) was the only factor significantly associated with postoperative gallstone disease (P = 0.004). Patients with a BMI ≥ 50 kg/m2 were three times more likely to develop postoperative gallstone disease post-bariatric surgery compared to those with a BMI < 50 kg/m2 (P = 0.013). CONCLUSION The incidence of gallstone disease after bariatric surgery was relatively high. Preoperative BMI was the only predictive factor in this study. As only a few patients developed symptomatic gallstones post-bariatric surgery, the necessity of routine gallstone screening and prophylactic treatment in this population requires further evaluation.

BACKGROUND Obstructed defecation syndrome (ODS) frequently results from an internal rectal prolapse, which disrupts the rectal axis and impairs evacuation. Resectional transanal operations can remove redundant tissue, but fail to restore structural support, whereas abdominal mesh rectopexy involves prosthetic materials and has a higher operative burden. The sutured rectal lift (SuReL) was developed as a reconstructive, non-resective, and mesh-free transanal technique to restore rectal suspension while preserving continence in patients with ODS secondary to internal prolapse. AIM To describe the rationale, indications, and step-by-step operative technique of SuReL for Oxford grade II-III internal rectal prolapse causing obstructed defecation. METHODS SuReL was performed using the Sylarum® transanal access device. The rectal wall was addressed sequentially in six circumferential sectors (11, 1, 9, 3, 7, and 5 o’clock). In each sector, a triphasic suture sequence with a barbed 0/0 monofilament (Filbloc®) was placed: (1) A mucosa-submucosa pass; (2) A deeper pass including the muscularis layer at the same level; and (3) A third pass 3 mm caudally, forming a semiloop for suspension. Cranial plications advanced distally to the upper limit of the prolapse. A deep circumferential reinforcement layer with a 2/0 Assuplus® monofilament consolidated the lift. RESULTS The procedure standardizes the reconstructive phase through sector-based rotation, allowing symmetric traction and full-thickness suspension without resection. Operative pearls consist of maintaining uniform exposure, ensuring precise semiloop depth for tension control, and verifying lumen patency with saline irrigation. Key technical advantages include the absence of stapling devices or prosthetic materials, minimal bleeding, a short operative time, and preservation of mucosal sensitivity. Postoperative recovery is typically rapid with early mobilization and minimal discomfort. CONCLUSION SuReL represents a technically reproducible and standardized approach for the treatment of internal rectal prolapse. This preclinical study demonstrated feasibility and mechanical consistency using anatomical simulators, while the clinical efficacy and physiological benefits remain to be validated in prospective trials.

BACKGROUND Postoperative recovery in hepatectomy patients is often prolonged; early mobilization may improve outcomes, but relevant protocols need development. AIM To develop an early postoperative activity program for patients undergoing hepatectomy and to investigate its effect on rehabilitation quality. METHODS Two hundred patients undergoing hepatectomy, between January 2022 and January 2023, were enrolled. They were divided into intervention and control groups (100 patients each) using randomized number tables. The control group received routine perioperative care for hepatectomy; the intervention group received the early postoperative activity program developed in this study, in addition to routine care. Differences in postoperative recovery indicators, complications, pain levels, inflammation and stress response indicators, functional recovery and quality of life levels, and nursing satisfaction were compared. RESULTS Patients in the intervention group achieved their first postoperative ambulation, passed flatus, completed hospitalization, and had drainage tubes removed earlier than those in the control group. Their International Classification of Functioning, Disability and Health - 20-item Functioning Scale fatigue scores on postoperative day 5 were lower than those of the control group, and their 6-minute walk test distances at discharge were longer. They demonstrated higher 36-Item Short Form Health Survey scores at discharge and 1 month postoperatively (P < 0.05). The 30-day postoperative complication rate (15.00%) was lower than that in the control group (31.00%), while overall nursing satisfaction (96.00%) exceeded that of the control group (82.00%), with all differences being statistically significant (P < 0.05). Patients in the intervention group exhibited lower Visual Analogue Scale pain scores and reduced C-reactive protein and interleukin-6 levels on postoperative days 3 and 5 compared to those in the control group, with a statistically significant interaction effect between the time and group (P < 0.05). CONCLUSION The early postoperative mobilization program is scientifically sound and effective. It significantly improves rehabilitation outcomes in hepatectomy patients, shortens the recovery time, reduces complication rates, alleviates pain, diminishes inflammatory and stress responses, enhances functional recovery and quality of life, and increases nursing satisfaction. This program demonstrates considerable value for clinical implementation.

BACKGROUND The S-1+oxaliplatin (SOX) regimen shows limited efficacy in postoperative recurrent/metastatic gastric cancer (RMGC) treatment, requiring adjuvant therapy optimization to enhance effectiveness. AIM To clarify how adjuvant irinotecan-apatinib therapy works in postsurgical RMGC management using real-world data. METHODS We enrolled 124 postoperative RMGC cases (April 2021 to April 2024) and allocated them to the control (n = 60, sole irinotecan) and research (n = 64, irinotecan + apatinib) groups. All participants received intravenous S-1 infusion and oral oxaliplatin administration. Between-group comparisons were made regarding effectiveness, inflammation-associated parameters [vascular endothelial growth factor, matrix metalloproteinase (MMP)-2, MMP-9], serum tumor biomarkers [carbohydrate antigen (CA) 242, CA199, carcinoembryonic antigen], and treatment-emergent adverse events (thrombocytopenia, hemoglobin reduction, nausea/vomiting, myelosuppression). Assessments were further extended to survival and life quality outcomes Generic Quality of Life Inventory-74 (GQOLI-74). RESULTS The between-group comparison revealed similar effectiveness, overall complications, and survival outcomes. The research group demonstrated greater post-treatment reductions in inflammatory markers and serum tumor biomarkers and achieved higher scores across all GQOLI-74 dimensions. CONCLUSION In real-world postoperative RMGC management, irinotecan-apatinib therapy achieves non-inferior antitumor efficacy, tolerability, and survival relative to irinotecan and more effectively attenuates inflammation, reduces serum tumor biomarkers, and improves quality of life.

BACKGROUND Traumatic liver rupture has high mortality (10%-15%) but current prognostic tools show limited accuracy. This study develops an integrated model combining serum biomarkers and imaging scores for improved risk stratification. AIM To investigate the predictive value of serum biochemical indicators combined with imaging scores for the prognosis of patients with traumatic liver rupture, establish a comprehensive prediction model, and provide scientific evidence for early clinical identification of high-risk patients. METHODS A single-center retrospective cohort study was conducted, including 186 patients with traumatic liver rupture treated from June 2020 to June 2024. Patient baseline data, serum biochemical indicators within 2 hours of admission (including liver function indicators, coagulation function, inflammatory indicators), and imaging scores were collected. The primary outcome was adverse prognosis within 30 days, including death, need for emergency surgical intervention, severe complications, or need for Intensive care unit treatment. Univariate and multivariate logistic regression analyses were used to screen independent predictive factors, establish a prediction model, and evaluate its predictive efficacy. RESULTS Among 186 patients, 142 cases (76.3%) had good prognosis and 44 cases (23.7%) had poor prognosis. Age, liver function indicators, coagulation function indicators, inflammatory indicators, and imaging scores in the poor prognosis group were significantly higher than those in the good prognosis group (all P < 0.001). Multivariate logistic regression analysis showed that aspartate aminotransferase, international normalized ratio, C-reactive protein, Glasgow Coma Scale score, and long-term services and supports (LTSS) total score were independent predictive factors for prognosis (all P < 0.05). The combined prediction model based on these 5 indicators had a receiver operating characteristic area under the curve (AUC) of 0.923 (95%confidence interval: 0.881-0.965), with sensitivity of 86.4%, specificity of 91.5%, and Youden index of 0.779, significantly superior to using serum biochemical indicators alone (AUC = 0.887) or long-term services and supports score alone (AUC = 0.845) (all P < 0.05). Decision curve analysis showed that the model had good clinical net benefit. CONCLUSION The comprehensive prediction model established by combining serum biochemical indicators with imaging scores can effectively predict the prognosis of patients with traumatic liver rupture, providing important scientific evidence for early clinical identification of high-risk patients.

BACKGROUND A nomogram model predictive of pancreatic ductal adenocarcinoma (PDAC) outcomes based on the systemic immune inflammation index (SII) and prognostic nutritional index (PNI) does not exist. AIM To determine the prognostic value of a nomogram model combining the SII and PNI in patients with PDAC after radical surgery. METHODS One hundred sixty-four patients who underwent radical surgery for PDAC between 2017 and 2023 were retrospectively enrolled. A nomogram prediction model for the survival rate after PDAC surgery was established based on the multivariable Cox regression results of the training cohort (n = 129). The model was validated in the external validation cohort (n = 35). The time-dependent receiver operating characteristic (ROC) curve, C-index, calibration curve, and decision curve were used to evaluate model efficacy, and an online prediction tool was developed. RESULTS An SII > 335.82, a PNI ≤ 44.45, poorly differentiated PDAC, no postoperative adjuvant chemotherapy, and a carbohydrate antigen 19-9 level > 37 U/mL were independent risk factors for poor prognosis of patients with PDAC after radical surgery. These five factors were included in the nomogram model. The internal validation C-index of the nomogram model was 0.691 (95% confidence interval: 0.626-0.755). The area under the ROC curve values for the 1-year, 2-year, and 3-year postoperative survival rates in the training cohort were 0.684, 0.762, and 0.822, respectively; the area under the ROC curve values for the external validation cohort were 0.772, 0.755, and 0.796, respectively. CONCLUSION The nomogram model based on the SII and PNI accurately predicted the survival risk and prognosis in patients with PDAC after surgery, providing a quantitative tool for individualized treatment decisions.

BACKGROUNDPercutaneous cholecystostomy (PCT) is widely used for high-risk acute cholecystitis as an alternative to emergent cholecystectomy. Despite its effectiveness, the optimal timing, catheter management, and long-term outcomes remain to be elucidated.AIMTo characterize timing, catheter management, survival, and follow-up outcomes after PCT in a high-risk cohort.METHODSThis single center retrospective cohort study included consecutive adult patients undergoing PCT placement for acute cholecystitis at a community hospital setting in New York between January 2012 and December 2024. The study population was grouped according to type of acute cholecystitis (calculous vs acalculous), according to the timing of PCT placement since diagnosis [early (≤ 4 days) vs late (> 4 days)], and according to level of care [intensive care unit (ICU) vs non-ICU patients]. Cox proportional hazards models were used to examine effects of PCT placement interval on mortality rates, after accounting for potential confounding factors (age, Charlson Comorbidity Index, cholecystitis type, ICU status, bile culture and blood culture data).RESULTSThe population consisted of 174 patients who underwent PCT placement for acute cholecystitis between 2012 and 2024 at a community hospital in New York. Median time to PCT was 2 days (interquartile range 1-4). Overall, mortality was 21% (36/174) and was higher with delayed PCT (> 4 days) vs early PCT [35% (17/49) vs 15% (19/125), P = 0.001]. Catheter removal occurred in 13% (23/174), 55% (96/174) remained catheter-dependent, and 32% (56/174) had interval cholecystectomy. ICU admission was associated with prolonged catheter duration but was not associated with mortality. Kaplan-Meier analysis demonstrated a significantly higher survival rate in the early group compared with the late group (log-rank P = 0.006). In both unadjusted models and models adjusted for selected covariates, patients who had catheters placed late (> 4 days) had 2.5-fold higher risk of death than patients with early placement.CONCLUSIONEarly PCT was associated with higher survival in high-risk acute cholecystitis. High rates of catheter dependency highlight the need for standardized protocols and reassessment for definitive surgery.

BACKGROUNDAcute intestinal obstruction is a common surgical emergency with high mortality, requiring efficient multidisciplinary collaboration to improve outcomes.AIMTo explore the optimization of nursing pathways for patients with acute intestinal obstruction using the multidisciplinary team (MDT) model.METHODSA total of 176 patients with acute intestinal obstruction admitted to the Emergency Department of our hospital between December 2023 and February 2025 were randomly divided into a control group (n = 88) and an intervention group (n = 88) using a random number table. The control group received routine emergency nursing interventions, whereas the intervention group received emergency nursing pathway interventions under the MDT model. The groups were compared in terms of emergency treatment efficiency, improvement of clinical symptoms, 36-Item Short Form Health Survey (SF-36) scores, nursing satisfaction, and early (within 72 hours) intestinal obstruction–related complications-specifically, electrolyte disturbance, strangulated obstruction, and intestinal necrosis/perforation.RESULTSThe intervention group had significantly shorter triage, condition assessment, and emergency treatment times (all P < 0.001), faster relief of abdominal pain and vomiting, and earlier return of bowel function (all P < 0.001). The rate of early complications was lower in the intervention group (2.27% vs 10.23%, P = 0.029). Nursing satisfaction was higher (96.59% vs 81.82%, P = 0.002), and post-intervention SF-36 scores were significantly higher (P < 0.05).CONCLUSIONThe MDT-based emergency nursing pathway improves emergency efficiency, relieves clinical symptoms, enhances quality of life and satisfaction, and reduces early intestinal obstruction–related complications in patients with acute intestinal obstruction.