A Simple Predictive Index of the Abdominal Shape for Postoperative Complications After Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Background: The purpose of this study was to explore the effect of abdominal shape on the short-term surgical outcomes.Methods: This was a retrospective study that included 425 patients undergoing laparoscopic distal gastrectomy plus D2 lymph node dissection (LADG) from January 2013 to January 2021. The abdominal parameters, including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of the subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and the left-right diameters (LRD) at the navel level, the distance from the xiphoid process to the navel (XND) and the distance from the xiphoid process to the pubis (XBD), were calculated by preoperative abdominal computed tomography (CT) imaging. The parameters and short-term surgical outcomes were analyzed.Results: In males, the number of retrieved lymph nodes was significantly higher in patients with a lower APD group (p = 0.031). The operation time was significantly shorter in the lower body mass index (BMI) (p = 0.007), lower LSA (p = 0.035), lower PAAD (p = 0.000), lower SFT (p = 0.004), lower APD (p = 0.000) and lower LRD (p = 0.014) groups. The estimated blood loss was significantly less in the lower BMI (p = 0.035), lower LSA (p = 0.001), lower PAAD (p = 0.012), lower SFT (p = 0.003), lower APD (p = 0.000) and lower LRD (p = 0.005) groups. The complications were fewer in the lower LSA (p = 0.012), lower APD (p = 0.043) and lower LRD (p = 0.023) groups. In females, the postoperative hospital stay was shorter in the lower PAAD (p = 0.027) and lower SFT (p = 0.004) groups, and the lower SFT group had fewer complications (p = 0.020). Furthermore, in multivariate analysis, higher PAAD (p = 0.037, odds ratio = 1.030, 95% CI = 1.002–1.059) was an independent factor for predicting postoperative complications in males.Conclusion: Various abdominal shapes can affect the difficulty of LADG. Higher PAAD is a simple independent index for predicting postoperative complications in males.

A Simple Predictive Index of the Abdominal Shape for Postoperative Complications After Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Purpose The purpose of this study was to explore the effect of abdominal shape on the short-term surgical outcomes of laparoscopic distal gastrectomy + D2 lymph node dissection (LADG). Methods This was a retrospective study that included 425 patients undergoing LADG from January 2013 to January 2021 at a single clinical center. The abdominal parameters, including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of the subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and the left-right diameters (LRD) at the navel level, the distance from the xiphoid process to the navel (XND) and the distance from the xiphoid process to the pubis (XBD), were calculated by preoperative abdominal computed tomography (CT) imaging. The abdominal parameters and short-term surgical outcomes were analyzed. Results In males, the number of retrieved lymph nodes was significantly higher in patients with a lower APD group (p=0.031). The operation time was significantly shorter in the lower body mass index (BMI) (p=0.007), lower LSA (p=0.035), lower PAAD (p=0.000), lower SFT (p=0.004), lower APD (p=0.000) and lower LRD (p=0.014) groups. The estimated blood loss was significantly less in the lower BMI (p=0.035), lower LSA (p=0.001), lower PAAD (p=0.012), lower SFT (p=0.003), lower APD (p=0.000) and lower LRD (p=0.005) groups. The complications were fewer in the lower LSA (p=0.012), lower APD (p=0.043) and lower LRD (p=0.023) groups. In females, the postoperative hospital stay was shorter in the lower PAAD (p=0.027) and lower SFT (p=0.004) groups, and the lower SFT group had fewer complications (p=0.020). Furthermore, in multivariate analysis, higher PAAD (p=0.029, odds ratio=1.030, 95% CI=1.003-1.058) was an independent factor for predicting postoperative complications in males. Conclusion Various abdominal shapes can affect the difficulty of LADG. Higher PAAD is a simple independent index for predicting postoperative complications in males.

Abdominal Wall Reconstruction

The closure of the abdominal wall defects is a fascinating field within surgery. The combined strength of sutures and scar after simple approximation of tissues in many cases does not suffice to contain the abdominal viscera and an incisional hernia results. Surgical failure can be seen immediately in the dramatic form of a dehiscence or can emerge slowly over time with a change in the abdominal shape and contour. This chapter delves into the theory and practicum of how a surgeon can approximate two halves of an abdominal wall together to resist the inherent tensile forces that exist and create a durable closure. This review contains 19 figures and 35 references Key Words: bioprosthetic, bridging, component release, force distribution, foreign body reaction, gap formation, hernia, laparotomy, mesh, perforator preservation, rectus diastasis, suture pull-through, TAR release

The Simulation Design of Umbrella Gasless Laparoscopic Device with Variable Cross-Section Spokes

A kind of umbrella gasless laparoscopic device with variable cross-section spokes is designed for the common problems of gasless laparoscopic devices. Under working conditions, the device can better simulate the abdominal shape of gas laparoscopic surgery, provide good surgical views, improve the stress conditions of the spokes and the abdominal wall and avoid the secondary injure to patients.The spoke, the key part of the device, is simulated by applying the analysis software ANSYS to obtain the ideal design size of its variable cross-section. Furthermore, physical prototype tests are done on the device, whose results show that the device can be opened as spherical and meet the design requirements.