ObjectiveTo summarize the recent advancements in the researches on the pathogenesis of postoperative ileus and explain the clinical significances of postoperative ileus mechanisms for the diagnosis, treatment, and prevention. MethodsRelevant literatures about the postoperative ileus mechanism published recently were collected and reviewed. ResultsThe occurrence of postoperative ileus were related to postoperative nerve reflex inhibition, inflammatory response, effects of drugs, and other factors, it was a variety of mechanisms modulating each other. ConclusionThe gastrointestinal motility of postoperative ileus is mainly regulated by neural reflexes, inflammatory reactions, and drug interactions, three of which act differently but as a whole in different time segments while the inflammatory response play a key role of postoperative ileus persistence.
ObjectiveTo evaluate the functional outcomes and quality of life in patients with surgery for slow transit constipation (STC).MethodsFrom March 2013 to July 2017, 29 patients undergoing total or subtotal colectomy for STC in our department were analyzed prospectively. Their preoperative and postoperative 1-year follow-up details were analyzed. Evacuation function of all patients was assessed by bowel movements, abdominal pain, bloating, straining, laxative, enema use and the Wexner constipation scales. Quality of life was evaluated by the Gastrointestinal Quality of Life Index (GIQLI) and the short-form (SF)-36 survey.ResultsA high number of patients (93.1%, 27/29) in STC stated that surgery received benefits to their health. Compared with that before operation, the number of bowel movements per week during a 1-year follow-up increased significantly (31.6±19.9 vs. 1.21±0.6, P<0.05). Significant trends toward improvement of bloating, straining, laxative and enema use were noted 1-year following surgery (P<0.05). The Wexner constipation scales scores during a 1-year follow-up decreased significantly (5.69±3.4 vs. 20.34±0.6, P<0.05). The GIQLI scores during a 1-year follow-up increased significantly (120.7±20.4 vs. 78.6±17.3, P<0.05). Moreover, results of SF-36 showed significant improvements in 7 spheres (role physical, role emotional, physical pain, vitality, mental health, social function and general health) during a 1-year follow-up compared with those before operation (P<0.05).ConclusionTotal or subtotal colectomy for STC did not only alleviate constipation symptoms dramatically, but also received significant improvements in the patients’ quality of life.
ObjectiveTo standardize the techniques for laparoscopic radical rectal resection and discuss its application prospect. MethodsThe clinical data of 433 patients who underwent laparoscopic radical rectal resections from July 2003 to December 2010 in our hospital were reviewed retrospectively, and the different surgery procedures and the development prospect were explored. ResultsFive cases (1.2%) underwent handassistant laparoscopic procedures, 412 cases (95.2%) were done by laparoscopic-assisted operation, and the specimens were taken out with transanal pull-through technique in 16 cases (3.7%). In all of them, conversion to open procedures occurred in 11 patients (2.5%), and 290 (67.0%) patients were followed-up in 1 to 6 years, average in 2.7 years. Local recurrence occurred in 7 (2.4%) patients, while distant metastasis were diagnosed in 22 （7.6%） cases, and the overall mortality was 15.9% (46/290). There was no port-site metastasis occurred. ConclusionsFour-port laparoscopic rectal resection technique is also the clinical mainstream. Standardized laparoscopic procedure for rectal resections enhances the transformation of laparoscopic skills, and makes the operation predictable. Single incision procedure and natural orifice transluminal endoscopic surgery are future direction to explore.