The evolution of hernia and abdominal wall surgery is, in essence, a history of advancing anatomical cognition—progressing from macroscopic to microscopic perspectives and from vague impressions to precise understanding of abdominal wall structures. Traditional hernia repairs relied heavily on empirical techniques, which were often associated with high recurrence rates and significant complications. In contrast, the success of modern hernia surgery is firmly grounded in a profound comprehension of the fine anatomy of each abdominal wall layer, particularly the fasciae, muscles, nerves, vessels, and potential spaces. Individualized and precision-oriented surgical strategies based on the “anatomy-function-repair” philosophy are fundamental to reducing recurrence rates, minimizing postoperative chronic pain, and improving long-term quality of life. Looking ahead, with continued advancements in three-dimensional imaging reconstruction, artificial intelligence, and biomaterial science, research into the fine anatomy of the abdominal wall will continue to propel hernia and abdominal wall surgery toward higher levels of development.
Single incision laparoscopic transabdominal preperitoneal (TAPP) repair for inguinal hernia has become a focus in minimally invasive hernia surgery due to its scar-free cosmetic advantage. However, the inherent axial vision in single incision laparoscopy leads to operative difficulties such as the “chopstick effect” and visual compression, which constitute the bottleneck for the popularization of this technique. It is recommended to adopt a single-incision trocar placement via the transumbilical “hare-lip” incision combined with the umbilical fascia plane. By adopting the strategy of “replacing lateral distance with the anteroposterior movement of bilateral instruments” during the operation, combined with adjustments of the angle and position of the laparoscopic lens, the operational difficulties caused by the “chopstick effect” are resolved. The Cartesian coordinate system can be adopted to clarify the separated angular relationship between the lens and the instruments (i.e., the “unipolar operating view”). The core technique of one-handed peritoneal suturing is precise control of the needle, ensuring that it always remains engaged in the peritoneum without leaving the field of view, thereby allowing the coordinated actions of grasping and releasing to be performed smoothly for efficient suture closure.
Endoscopic totally extraperitoneal retromuscular repair represents an emerging minimally invasive approach for ventral and incisional hernia, adhering to the dual principles of plane-oriented dissection and minimally invasion. Enhanced-view totally extraperitoneal repair is currently the most widely accepted nomenclature. The core concept of this technique lies in achieving continuity of the retromuscular and extraperitoneal space under an optimized endoscopic enhanced-vision. A comprehensive understanding of surgical approaches and anatomical planes is fundamental to procedural success. Commonly adopted approaches include the midline, lateral, and ipsilateral approach, while the surgical planes could be categorized into the pre-sheath plane and the retro-sheath plane. The pre-sheath plane contains multiple tendinous intersections and aponeurotic partitions; therefore, meticulous anatomical dissection is required to balance adequate exposure, avoidance of excessive dissection, and restoration of anatomical structure, thereby preserving the biomechanical stability of the abdominal wall. In contrast, the retro-sheath plane lacks tendinous structures but encompasses areas of fascial convergence where tissue layers are thin and closely adherent, conferring a higher risk of peritoneal injury and directly influencing operative success rates.
In groin hernia surgery, the transversalis fascia and the extraperitoneal fascia should be regarded as two distinct membranous structures, yet their morphological description and terminology remain not fully unified. It is difficult to accurately understand their continuity and surgical significance by local anatomical observation alone. From the perspective of embryonic development, the membranous structures of the inguinal region can be divided into two parts: the “parietal membranous structures” attached to the abdominal wall and the “visceral membranous structures” enveloping organs or structures such as the urinary bladder and spermatic cord. The former mainly includes the transversalis fascia, extraperitoneal fascia, and parietal peritoneum, whereas the latter, depending on the region, mainly includes the umbilicovesical fascia and the urogenital fascia surrounding the spermatic cord. The naturally loose space formed between these two groups of membranous structures represents a relatively ideal operative plane for preperitoneal dissection and mesh placement. Understanding the membranous structures of the inguinal region according to developmental and anatomical characteristics may help standardize layer-by-layer dissection, reduce collateral injury, and improve surgical safety.
The component separation CS is a core approach for repairing large and complex abdominal wall defects. Its surgical manipulation inevitably involves interference with key anatomical structures of the abdominal wall, and effective protection of these structures directly impacts postoperative complications and long-term functional recovery. A thorough understanding and mastery of the critical anatomical layers, as well as the course and distribution of blood vessels and nerves in the abdominal wall, are prerequisites for the safe implementation of CS. Protecting the abdominal wall vascular system, neural innervation, and the integrity of the myofascial structures is essential to avoiding the anatomical risks associated with CS. The anterior approach CS that preserves perforating vessels, the posterior approach CS that retains intact neurovascular bundles, and endoscopic or robot-assisted minimally invasive techniques all provide significant support for implementing individualized CS that balances efficacy and safety, while also enhancing the safety and long-term outcomes of abdominal wall reconstruction. Greater refinement, minimally invasive application, intelligence, and functional restoration represent the future direction of CS.
With the introduction of the concept of “abdominal core health”, various kinds of complex abdominal wall hernias require individualized functional abdominal wall reconstruction using different surgical techniques. Precise abdominal wall reconstruction requires a deep understanding of the blood vessels, nerves, and biomechanics of the abdominal wall fascia. The external oblique muscle flap is a novel type of abdominal wall reconstruction technique, which is preformed near the defect, preserves relatively complete muscle flap nerve innervation and vascular supply, and is suitable for special types (such as absence of rectus abdominis complex), special sites (large or giant semilunar line incisional hernia), specific conditions (lateral ventral hernia with loss of domain, traumatic ventral hernia with contamination) of functional reconstruction of abdominal wall defects. This technique requires no vascular or nerve anastomosis, features convenient operation, is easy to master, and possesses good clinical applicability
The development of fundoplication has been driven by two intertwined forces: the continuous deepening of anatomical understanding and the iterative advancement of surgical techniques. The introduction of membrane anatomy theory has further provided theoretical support for the standardization of this procedure. Key factors ensuring surgical efficacy and reducing postoperative complications such as dysphagia include precise dissection of the distal esophagus and gastric fundus, meticulous management of the short gastric vessels, and selection of the surgical approach based on the patient’s individual esophageal function. Furthermore, the robotic surgical system, with its unique advantages of clear three-dimensional vision and flexible, precise manipulation, has significantly improved the performance of crural closure and mesh fixation during hiatal hernia repair. Meanwhile, various modified fundoplication techniques, through innovative fixation strategies, not only reinforce the anti-reflux barrier but also open promising avenues for reducing the risk of postoperative hernia recurrence.
For patients with hiatal hernia who present with significant symptoms, show poor response to medication, or have complications, surgery is the primary treatment. During the procedure, particular attention must be paid to the meticulous dissection and preservation of the anterior and posterior vagal trunks, the left and right inferior phrenic arteries, the branches of the left gastric artery, and the periesophageal vascular network, in order to avoid postoperative complications such as swallowing dysfunction, delayed gastric emptying, or bleeding. In each surgical step, the principles of meticulous dissection, direct visualization, avoidance of blind electrocoagulation, and excessively deep suturing should be adhered to. Intraoperative techniques guided by the concept of precise anatomy not only improve the quality of anatomical reduction in hernia repair but also significantly enhance patients' postoperative quality of life and long-term outcomes.
From March 4 to 6，2026，the 98th Annual Meeting of the Japanese Gastric Cancer Association (JGCA) was held in Okinawa, Japan, where the 16th edition of the Japanese Classification of Gastric Carcinoma (hereinafter referred to as the Classification) was also released. This edition has undergone significant modifications, maintaining consistency and continuity with the 15th edition of the “Classification of Gastric Carcinoma” and the 12th edition of the “Classification of Esophageal cancer”, aligning with the TNM classification of the UICC/AJCC, and incorporating new provisions. The 16th edition of the “Classification of Gastric Carcinoma” primarily revises the methods for recording the cancer at the gastroesophageal junction, the staging of gastric cancer progression, the state of the cancer, and the evaluation methods for treatment outcomes.
This article provides a systematic interpretation of the “SAGES-AHPBA 2025 surgical management guidelines for bile duct injury after cholecystectomy”, jointly issued by the Society of American Gastrointestinal and Endoscopic Surgeons and the American Hepato-Pancreato-Biliary Association. The guidelines focus on definitive repair strategies for bile duct injuries following cholecystectomy. Utilizing the GRADE methodological framework, the guidelines address four key clinical questions, including timing of repair, treatment modality, surgical approach and anastomotic technique. All recommendations are “conditional”, supported by evidence of “low” or “very low” quality, reflecting the current lack of high-quality randomized controlled trials in this field. The guidelines emphasize multidisciplinary collaboration, individualized treatment, patient-centered care, and consideration of resource disparities and health equity. Overall, this guideline offers a structured, flexible, and practical decision-making framework based on the best available evidence and expert consensus.
Surgical treatment is the most effective therapeutic approach for intrahepatic cholangiocarcinoma. Establishing surgical classification and treatment strategies based on key adverse biological mechanisms of the disease is crucial for increasing the rate of curative resection and improving prognosis. Under the crosstalk effects between cancer-associated fibroblasts and tumor-associated macrophages in the tumor microenvironment and Schwann cells of the nerve myelin sheath，intrahepatic cholangiocarcinoma readily invades nerves and metastasizes via lymphatic routes. The anatomical characteristics of Glisson’s capsule enveloping the large hepatic pedicle in the liver hilar region exacerbate these adverse biological behaviors of the tumor. Cholangiocarcinoma originating from secondary branches of the intrahepatic bile duct system and originating from small intrahepatic bile duct branches but invading the large hepatic pedicle Glisson’s capsule in the liver hilar region share similar tumor anatomical and biological characteristics. Defining these two types as central-type intrahepatic cholangiocarcinoma，to distinguish them from peripheral-type intrahepatic cholangiocarcinoma，which lacks the aforementioned pathological and anatomical characteristics. This classification facilitates the conduct of homogeneous clinical studies and the establishment of a more effective surgical treatment system.
Objective To compare outcomes of open and laparoscopic repair for recurrent inguinal hernia and identify risk factors of postoperative complications. Methods A retrospective analysis was conducted on the clinical data of 94 patients with recurrent inguinal hernia who underwent tension-free repair at The First Affiliated Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou Central Hospital, Xuchang Central Hospital and Luoyang Central Hospital between January and December 2023. Hernia defect diameter, hernia position, hernia type, repair method, operation time, urinary retention, wound infection, hematoma, seroma and hospital stay were recorded. Follow-up included hernia recurrence, chronic pain, foreign body sensation and quality of life. Results Twenty-one patients underwent open repair, and 73 patients underwent laparoscopic surgery. Postoperatively, urinary retention occurred in 10 patients, surgical site infection occurred in 4, hematoma occurred in 5, and seroma occurred in 6. Follow-up was completed on 89 patients, among whom 4 experienced recurrence, 8 had chronic pain, and 14 reported foreign body sensation. The 36-item short-form general survey questionnaire (SF-36) score was 24 (21, 26). Sixty-five patients had undergone open surgery previously, of whom 59 received laparoscopic repair in the current operation. Twenty-four patients had undergone laparoscopic surgery previously, of whom 14 underwent open surgery in the current operation. Six patients underwent open surgery twice, and 10 patients underwent laparoscopic surgery twice. The SF-36 score was significantly higher in patients who underwent laparoscopic surgery twice than in those who underwent open surgery twice (P=0.042). There were statistically significant differences between the laparoscopic and open surgery groups in the proportion of American Society of Anesthesiologists (ASA) physical status classification, hernia ring diameter and length of hospital stay（P<0.001、<0.001、=0.002）. Univariate analysis revealed that for patients with recurrent inguinal hernia, the presence of coronary heart disease, BPH and advanced age were risk factors for postoperative recurrence (P=0.012, 0.021, 0.043). Bilateral hernia was a risk factor for chronic postoperative pain (P=0.021), while lower ASA classification and the occurrence of seroma during the perioperative period were risk factors for postoperative foreign body sensation (P=0.021, <0.001). Multivariate analysis showed that seroma was an independent risk factor for postoperative foreign body sensation (OR=35.482, 95%CI 3.491-360.585, P=0.003). Conclusion The efficacy of laparoscopic surgery and open surgery in treating recurrent inguinal hernia is comparable. For elderly patients with comorbid coronary heart disease and BPH, thorough evaluation and management are required to reduce recurrence risk; bilateral hernia patients may benefit from multimodal analgesia postoperatively; measures should be taken to prevent seroma formation and minimize foreign body sensation.
Objective To explore the learning curve characteristics and clinical efficacy of laparoscopic paraesophageal hernia repair based on key anatomical principles. Methods A retrospective analysis was conducted on the clinical data of 83 patients who underwent laparoscopic mesh repair of paraesophageal hernia combined with fundoplication at the Department of Hernia and Obesity Surgery, The First Affiliated Hospital of University of Science and Technology of China, between January 2021 and December 2025. The observed outcomes included postoperative recurrence rate, GERD remission rate, and incidence of postoperative complications. The cumulative sum (CUSUM) analysis method was used to plot the learning curve of paraesophageal hernia repair, and comparisons were made across different learning phases in terms of operative time, recurrence rate, complication rate, and improvement in postoperative GERD-Q scores. Results Follow-up was 22 (1-60) months, with no imaging-confirmed recurrence. The GERD-Q score decreased from 12 (6-18) preoperatively to 6 (3-14) postoperatively (Z=-10.158, P<0.001). The GERD remission rate was 94.0% (78/83), and the rate of proton pump inhibitor discontinuation was 97.6% (81/83). All 83 patients successfully underwent the surgery, with an intraoperative complication rate of 6.0% (5/83), all of which were right-sided pleural tears. The intraoperative complication rate was significantly lower in the group with identification of the infracardiac bursa compared to the group without identification (0 vs. 29.4%, P<0.001). Regarding postoperative complications, one patient (1.2%) underwent reoperation due to excessive tightness of the Nissen fundoplication. The incidence of postoperative dysphagia was 10.8% (9/83), with no statistically significant difference between the Nissen group (13.6%) and the Dor group (4.2%). The incidence of postoperative reflux was 4.8% (4/83), also showing no statistically significant difference between the two groups (both P>0.05). The CUSUM learning curve analysis identified an inflection point in 31 cases, based on which patients were divided into the learning phase (31 cases) and the proficiency phase (52 cases). The intraoperative complication rate was significantly lower in the proficiency phase than in the learning phase (1.9% vs. 16.1%, P=0.025), while there were no statistically significant differences between the two phases in terms of postoperative GERD-Q scores, dysphagia, or reflux incidence (P>0.05). Conclusion During the learning curve of laparoscopic paraesophageal hernia repair, a deeper understanding of the surgical anatomy and function of the gastroesophageal junction is required, which can achieve advantages such as a low recurrence rate, a high remission rate of GERD symptoms, and few complications.
Objective To evaluate the clinical effectiveness of the lateral single-incision laparoscopic totally visceral sac separation technique (L-SILTVS) in the repair of umbilical hernia. Methods A retrospective analysis was conducted on 28 patients with umbilical hernia who underwent L-SILTVS between June 2023 and December 2025 at the First Affiliated Hospital of Ningbo University, Ningbo Beilun Traditional Chinese Medicine Hospital. Intraoperative peritoneal quality, operation time and postoperative pain, complications were observed and recorded. Results Among the 28 patients, the procedure was successfully completed in 27 cases, with 1 case requiring a modification in the operative approach; no conversion to open surgery occurred. The mean age was (54.3±15.9) years, and the mean body mass index was 29.4±4.4. The median operative time was 64 (54, 93) minutes, and the median blood loss was (3.6±2.7) mL. Three distinct peritoneal types were identified: intact(17 cases), attenuated(10 cases), and friable(1 cases). Intraoperative peritoneal rupture occurred in 20 cases（71.4%）, and no rupture in 8 cases（28.6%）.Postoperative visual analog scale pain scores at 6, 24, and 48 hours were (3.0±0.6), (2.0±0.6), and (1.0±0.4)points, respectively. The mean postoperative hospital stay was (2.9±0.6) days. Patients were followed up for 7 (1-30) months postoperatively, and no surgery-related complications were observed. Conclusion L-SILTVS demonstrates favorable short-term outcomes in specific umbilical hernia patients with appropriate indications. However, the procedure is technically demanding, highlighting the importance of meticulous surgical details, peritoneal status evaluation, and cautious implementation.
Objective To explore the application of ultrasonic volume auto-scan (UVAS) in the classification, diagnosis, and treatment of abdominal incisional hernia. Methods Using a prospective, randomized, and single-blind study design, The study subjects were 46 elderly patients with abdominal wall incisional hernia recruited from the Department of Hernia and Abdominal Wall Surgery, Huadong Hospital Affiliated to Fudan University, from August 2023 to December 2024. totally 56 abdominal wall defects (hernia rings), were recruited based on inclusion criteria. UVAS was employed to measure the width, area, and hernia sac volume (HSV) of the hernia rings. The consistency between these measurements and the HSV determined by CT was evaluated. Additionally, the ultrasound-based classification diagnosis of incisional hernia was compared with the surgical diagnosis. Results The average ratio of UVAS and CT measurements for HSV values was 1.007, which was close to 1. Only 1.79% (1/56) of the points fall outside the 95% consistency bounds 0.997-1.026, which showed good consistency between the two methods in measuring HSV. Based on the location and width of the abdominal wall defect, UVAS preoperative classification diagnosis showed a good accuracy rate (94.6%, 98.2%), achieving good consistency with postoperative diagnosis (K=0.86, 95%CI 0.718-0.996; K=0.95, 95%CI 0.887-0.999). In large and giant incisional hernias, the mesh size is 2 to 9 times the area of the abdominal wall defect measured by UVAS. Conclusion UVAS could accurately diagnose and measure the width, area, and HSV of abdominal incisional hernia, perform preoperative classification and localization, have the advantages of no radiation hazard and instant report provision and provide detailed and reliable data and imaging information for comprehensive preoperative evaluation of elderly patients with incisional hernia.
Objective To validate the applicability of the AJCC 8th edition staging system in predicting prognosis for gallbladder neuroendocrine carcinoma (GB-NEC) and to evaluate the comparative efficacy of different surgical and chemotherapy regimens using data from the Chinese Research Group of Gallbladder Cancer (CRGGC) specialized cohort. Methods Clinicopathological data of 81 patients diagnosed with GB-NEC between 2010 and 2017 across 49 hospitals nationwide were retrospectively analyzed from the CRGGC database. Patient demographics, pathological characteristics, surgical procedures, and chemotherapy regimens were examined. Survival analysis was conducted using the Kaplan-Meier method and Cox proportional hazards regression models. Results The cohort exhibited a male-to-female ratio of 1:1.89. Immunohistochemically, the neuroendocrine markers synaptophysin (Syn), chromogranin A (CgA), and CD56 demonstrated positive rates of 89.2%, 73.8%, and 85.7%, respectively, with Ki67 strong positivity (>50%) observed in 79.7% of cases. Radical resection was achieved in 76.3% of patients. Median overall survival (mOS) was 11.0 (7, 27) months, median progression-free survival (mPFS) was 7.0 (3, 20) months, and the 5-year survival rate was only 13.2%. Univariate analysis revealed that higher AJCC stage correlated with significantly worse prognosis (P<0.001). In patients with TNM stage Ⅲ disease, those undergoing radical surgery had a significantly longer mOS than those receiving non-radical surgery (21.0 months vs. 9.0 months, P=0.041). For patients with advanced disease (stage Ⅲ and Ⅳ), treatment with etoposide plus cisplatin (EP) or irinotecan plus cisplatin (IP) resulted in a significantly superior mOS compared to non-EP/IP regimens (27.0 months vs. 8.0 months, P=0.001). Multivariate analysis identified surgical approach (non-radical vs. radical, HR=2.710, P=0.001), nodal status (N1+N2 vs. N0, HR=2.054, P=0.007), and chemotherapy regimen (non-EP/IP vs. EP/IP, HR=3.576, P=0.001) as independent prognostic factors for GB-NEC. Conclusion The 8th edition AJCC TNM staging system for gallbladder cancer closely correlates with the prognosis of GB-NEC and offers a preliminary reference for clinical prognostic assessment. Radical resection significantly prolongs overall survival in patients with TNM stage Ⅲ disease and should be considered the preferred treatment modality. The EP/IP regimen substantially improves patient survival and represents a potentially optimal chemotherapy strategy. Absence of lymph node metastasis, radical surgical resection, and administration of EP/IP chemotherapy constitute independent predictors of prognosis in GB-NEC.
Objective To investigate the prognostic factors infecting pancreatic necrosis (IPN) secondary to hypertriglyceridemic acute pancreatitis (HTG-AP) and to establish the multiple visualized model of IPN in HTG-AP patients. Methods The clinical data of 119 HTG-AP patients who received treatment at the Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, between September 2019 and December 2024, was retrospectively analyzed. These patients were categorized into IPN group (38 cases) and non-IPN group (81 cases) based on whether IPN occurred. Univariate analysis was initially conducted to identify potential prognostic factors, followed by multivariate logistic regression analysis to determine independent predictors of IPN in HTG-AP. Nomogram model for IPN in HTG-AP patients were established based on independent prognostic factors. Receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used to test the effectiveness of the nomogram model. Results The differences in albumin, calcium, blood urea nitrogen (BUN), procalcitonin (PCT), prothrombin time activity (PTA), high density lipoprotein cholesterol (HDL-C), D-dimer, persistent organ failure (POF) within 72 hours, mean arterial pressure and pleural effusion between the IPN group and non-IPN group were statistically significant (P<0.05). Multivariate logistic regression analysis showed that diagnosed POF within 72 hours of admission (OR=4.110, 95%CI 1.128-14.971, P=0.032), elevation of PCT(OR=1.120, 95%CI 1.005-1.248, P=0.041), declining of PTA (OR=0.946, 95%CI 0.897-0.997, P=0.039) and elevation of D-Dimer (OR=1.148, 95%CI 1.046-1.260, P=0.004), were independent risk factors of IPN in HTG-AP patients. The AUC of this nomogram model was 0.895 (95%CI 0.834-0.957) which demonstrated good calibration and discrimination. Conclusion The nomogram incorporating PCT, PTA, D-Dimer, and POF within 72 hours can early and reliably predict IPN in HTG-AP patients, which could assist surgeons in early identification of high-risk patients.
Objective To investigate the impact of early postoperative stress hyperglycemia (SHG) on postoperative complications in gastric cancer patients without a history of type 2 diabetes mellitus, and to analyze the associations of peak blood glucose level and SHG duration with prognosis. Methods A retrospective analysis was conducted on the clinical data of 455 gastric cancer patients without a history of type 2 diabetes mellitus who underwent laparoscopic radical gastrectomy at the Department of Gastrointestinal Surgery, Northern Jiangsu People’s Hospital, between January 2022 and March 2024. According to whether SHG occurred after surgery, the patients were divided into a SHG group (n=113) and a non-SHG group (n=342). The incidence and severity of postoperative complications were compared between the two groups, and multivariate logistic regression analysis was used to identify independent risk factors. In addition, SHG patients were stratified according to peak blood glucose level and duration of SHG for further analysis. Results The incidence of postoperative complications was significantly higher in the SHG group than in the non-SHG group (46.9% vs. 23.1%, P<0.001). Multivariate analysis showed that age (OR=2.262, P=0.002), operation time (OR=1.876, P=0.005), and SHG (OR=2.355, P=0.004) were independent risk factors for postoperative complications. The incidences of incision infection, pulmonary infection, intestinal obstruction, and anastomotic leakage were significantly higher in the SHG group (P<0.05). Further analysis showed that patients with peak blood glucose ≥14.0 mmol/L had a higher risk of postoperative complications (χ²=8.246, P=0.004) and a higher incidence of grade III complications (χ²=5.262, P=0.022). Among patients with SHG, the incidence of postoperative complications differed significantly among groups with different SHG durations (χ²=25.862, P<0.001). Conclusion Early postoperative SHG is an independent risk factor for postoperative complications in gastric cancer patients without a history of type 2 diabetes mellitus. Severe hyperglycemia and prolonged SHG duration are associated with an increased risk of complications. Therefore, perioperative blood glucose management should focus on both glucose level and duration.
The main anatomical and pathological changes of hiatal hernia are as follows: enlargement of the esophageal hiatus, loosening of the phrenoesophageal ligament, weakness of the diaphragmatic crura, and obturation of the angle of His. In response to the above changes, laparoscopic hiatal hernia repair and antireflux surgery require sufficient mobilization of the esophagus to restore the length of the intra-abdominal esophagus, reliable suture repair of the diaphragmatic crura, and mesh reinforcement when necessary. The Nissen, Toupet, or Dor procedure should be selected according to esophageal motility to reconstruct the antireflux barrier, and a stable antireflux structure should be formed through fixation techniques.
Recently, liquid biopsy and artificial intelligence (AI) technology offer promising early HCC detection opportunities. Liquid biopsy can provide non-invasive early molecular events from circulating tumour DNA mutations, methylation alterations and fragmentomic features, circulating tumour cells or extracellular vesicles. AI technologies such as machine learning and deep learning algorithm can overcome technical issues such as low-abundance signals and background noises for improved diagnostic performance. Building multimodal analytic models using liquid biopsies and clinical protein biomarkers, radiomics and pathomics features can improve model performance, which has substantial potential for clinical application. However, several barriers still impede clinical translation including poor technical standardization, low-interpretability of algorithms, poor external validation, and high implementation costs.
Whether cholecystectomy increases the risk of colorectal cancer (CRC) has long been a topic of interest in the field of digestive surgery. Post-cholecystectomy alterations in bile acid metabolism lead to increased secondary bile acid production and gut microbiota dysbiosis, while abnormalities in gut motility and immune regulation create favorable conditions for CRC development to some extent. The right half of the colon, particularly the proximal colon, is considered the primary risk site, with more pronounced effects in specific populations. However, current research in this area still faces limitations such as small sample sizes, confounding surgical indications, insufficient disease understanding, and failure to account for population heterogeneity. Therefore, existing evidence is insufficient to support the classification of cholecystectomy as an independent risk factor for CRC. Future studies should focus on conducting more rigorously designed, long-term prospective cohort studies and meta-analyses to eliminate confounding factors, further exploring the causal relationship between cholecystectomy and CRC at a systemic level. This will aim to provide more reliable evidence-based guidance for clinical decision-making, improving surgical outcomes and overall quality of life for patients.
