Objective To investigate the effect of refined management on the reducing of the rate of delayed connection of thoracoscopic lung nodule surgery in day surgery. Methods Patients scheduled for thoracoscopic lung nodule surgery admitted to Daytime Medical Center of Deyang People’s Hospital from January to December 2022 and September 2023 to August 2024 were retrospectively selected. Patients admitted between January and December 2022 were divided into the pre-fine management group, while those admitted between September 2023 and August 2024 were divided into the post fine management group. The incidence of delayed connection of thoracoscopic lung nodule surgery in day surgery was compared between the two groups. Results A total of 888 patients were included. Among them, there were 419 cases in the pre-refined management group and 469 cases in the post refined management group. There was no statistically significant difference in the basic information between the two groups (P>0.05). In the pre-refined management group, 28 cases were delayed, the rate of delay was 6.68%. In the pre-refined management group, 7 cases were delayed, the rate of delay was 1.49%. There was a statistically significant difference in the occurrence of delayed reception between the two groups (χ2=15.744, P<0.001). Before refined management, the incidence of delayed reception caused by the patient’s own reasons and medical factors accounted for 28.57% (8/28) and 71.43% (20/28), respectively. Among them, the proportion of four factors was relatively high: preoperative examination imperfect and unqualified, anesthesia assessment not completed on time, surgical scheduling changed at will, and patients did not prepare for surgery according to the requirements. After refined management, the incidence of delayed reception caused by the patient’s own reasons and medical factors accounted for 71.43% (5/7) and 28.57% (2/7), respectively. Conclusion Refined management of daytime surgery is an effective measure to reduce the rate of delayed of thoracoscopic lung nodule surgery in daytime surgery.
ObjectiveTo evaluate the impact of preserving versus resecting the angle of His fat pad at the gastroesophageal junction (abbreviated as “fat pad”) during laparoscopic sleeve gastrectomy (LSG) on the incidence of postoperative gastroesophageal reflux disease (GERD) and weight loss outcomes. MethodsConsecutive obese patients who underwent LSG at the Third People’s Hospital of Chengdu from January 2018 to February 2023 were enrolled. Based on whether the fat pad was resected during surgery, the patients were divided into a group with preservation of the fat pad (preservation group) and group with resection of fat pad (resection group). The primary outcome was the incidence of GERD at 1 year postoperatively. Secondary outcomes were weight loss effects, evaluated by the percentage of excess weight loss (EWL%) and the percentage of total weight loss (TWL%). Furthermore, a subgroup analysis was conducted within the preservation group based on the distance of the stapler from the fat pad (0.5 cm, 1.0 cm, 2.0 cm). After adjusting for confounding factors using multivariate logistic regression and linear regression models, the association between fat pad resection and the incidence of postoperative GERD, as well as EWL% and TWL%, was analyzed. ResultsA total of 560 obese patients were enrolled in this study, with 395 in the preservation group and 165 in the resection group. The incidence of postoperative GERD was significantly lower in the preservation group than in the resection group [25.32% (100/395) vs. 41.82% (69/165), P<0.001]. After adjusting for confounding factors (age, sex, body mass index, cholesterol, fasting blood glucose, and hemoglobin A1c), preservation of the fat pad might be an independent protective factor against postoperative GERD [OR (95%CI)=0.41 (0.25, 0.67), P<0.001]. Regarding weight loss outcomes, preservation of the fat pad had no significant effect on EWL% [β (95%CI)=–4.79 (–16.25, 6.66), P=0.41], but had a significant effect on TWL% [β (95%CI) =–3.27 (–5.45, –1.10), P=0.003]. Within the preservation group, subgroup comparisons (0.5 cm, 1.0 cm, and 2.0 cm) showed no statistically significant differences in the incidence of postoperative GERD (P=0.71), EWL% (P=0.93), or TWL% (P=0.15). ConclusionsFor LSG, resection of the fat pad may increase the risk of postoperative GERD but could be associated with better TWL%. Under the premise of preserving the fat pad, the distance of the stapler from the fat pad (0.5–2.0 cm) has no significant impact on the incidence of postoperative GERD or weight loss outcomes.
ObjectiveTo compare the safety of the incision along the upper umbilical margin (referred to as the “upper incision”) versus the transverse umbilical incision (referred to as the “transverse incision”) for single-port bariatric surgery, and to assess their effects on postoperative scar appearance and patient’s psychological adaptation. MethodsThis study was designed as a multi-center retrospective analysis. The patients who underwent bariatric surgery via the upper incision and transverse incision at the Third People’s Hospital of Chengdu, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, and the First Affiliated Hospital of Jinan University from December 2024 to April 2025. The incidence of postoperative complications and the pionts of scar appearance (evaluated using the POSAS 3.0 scale) and psychological adaptation (measured with the BODY-Q scale) between the two incision methods were compared. Furthermore, multiple linear regression model was employed to evaluate the impact of different incision methods on points of scar appearance and psychological adaptation. ResultsA total of 194 patients who underwent single-port bariatric surgery were included, with 134 in the transverse incision group and 60 in the upper incision group. There was no statistically significant difference in the total incidence of incision complications between the transverse and upper incision groups [11.9% (16/134) vs. 18.3% (11/60), χ2=0.930, P=0.335]. The transverse incision group showed significantly better outcomes than the upper incision group in the overall points of BODY-Q scale [(39.86±1.02) points vs. (37.63±4.70) points, t=–6.090, P<0.001] and POSAS scale [(17.60±2.35) points vs. (21.25±6.00) points, t=5.239, P<0.001]. After adjusting for potential confounding factors such as history of diabetes mellitus, education level, smoking status, alcohol consumption status, keloid tendency, and use of scar improvement products in the multiple linear regression model, the advantage of the transverse incision remained significant [β(95%CI)=–1.81 (–2.84, –0.78), P<0.001]. Conclusions This study demonstrates that the transverse incision significantly improves the overall appearance of the postoperative scar and enhances patient’s psychological adaptation compared to the upper incision in single-port bariatric surgery. This advantage persists independently after adjusting for multiple confounding factors. Therefore, the transverse incision could be considered a more favorable approach in terms of cosmetic outcomes and patient’s psychological adaptation.