As the ideal window for surgical intervention in necrotizing enterocolitis （NEC） lies between the onset of intestinal gangrene and perforation, an accurate assessment of bowel injury severity and timely surgical intervention are critical for improving outcomes. Portal venous gas（PVG） is a significant marker of advanced NEC, particularly in extremely low birth weight（ELBW） infants, where its presence correlates with a markedly increased risk of extensive intestinal necrosis（> 75%-80% bowel involvement）. Pneumatosis intestinalis（PI） is commonly associated with NEC. Besides, linear PI may indicate a benign course, whereas cystic PI with fixed bowel loops raises suspicion for necrosis. Notably, the extent of PI does not directly correlate with bowel injury severity. Fixed bowel loops（FBL）,identified on serial radiographs, are associated with higher surgical and mortality rates, necessitating close clinical and imaging monitoring. Ascites, particularly complex ascites with debris on ultrasound, may be the sole sign of perforation. Most of scoring systems for assessing surgical indications for NEC have not been widely adopted. It is essential for further developing precise, dynamic risk assessment models, thus achieving the goal of transforming the experience-driven decision mode to data-driven mode.

Objective To further observe the exact morphology of the jejunal atresia and the development of ganglion cells within it, thus providing morphological reference for the involvement of vacuolar epithelial cells and mesenchymal cells in forming the diaphragm. Methods The segment of jejunal atresia was intraoperatively harvested from a child with type I jejunal atresia. Tissue sections were prepared along the longitudinal axis of the jejunal atresia for hematoxylin and eosin（H&E） and immunohistochemical staining. Images were captured by scanning tissue slices using the digital section system. Results Bilateral sides of the jejunal atresia were covered by intestinal mucosa,with complete epithelial layer, propria and muscularis mucosae. The mucosa derived from the distal and proximal intestinal mucosa of the diaphragm, where the submucosal tissue situated in the center and continued with the submucosal layer of the intestinal wall. The muscle layer of the intestinal wall traveled distally close to the diaphragm, without a further disclosure into the diaphragm. Immunohistochemical staining showed positive expressions of PGP9.5 and PHOX2B adjacent to the normal intestinal wall, between the medial ring and lateral longitudinal muscles, and in the septal membrane.Ganglion cells in the adjacent intestinal wall continued with each other. Conclusions The jejunal atresia is mainly composed of submucosal tissue and continues with the submucosal layer adjacent to the normal intestinal wall, where the bilateral sides are covered with mucosa. Ganglion cells develop in the diaphragm and continue with those adjacent to the submucosal layer of the normal intestinal wall. Vacuum epithelial cells and mesenchymal cells are involved in the formation of jejunal atresia.

Objective To analyze the clinical features of congenital intestinal malrotation （CIM） combined with Hirschsprung's disease （HD）, thus improving its clinical diagnosis and treatment. Methods Clinical data of neonates with CIM plus HD were collected, including birth weight, gestational age, initial symptoms, age at onset, meconium passage status, physical examination findings, imaging data, pathological diagnoses, and surgical approaches. A retrospective analysis was conducted to evaluate clinical characteristics and diagnostic/therapeutic outcomes. Results Eight neonates with combined CIM and HD were included,including 5 males and 3 females. The gestational age ranged from 34 to 40 weeks, and the birth weight was between 2 400 and 3 500 g. The age at disease onset was （13.9± 4.3） days （range：2-26 days）. Four cases were preoperatively diagnosed and underwent elective Ladd's procedure combined with stage-one radical surgery for HD （all short-segment type）. In the remaining four cases, three were diagnosed intraoperatively with transitional zones in the colon during exploratory surgery for CIM .Then, enterostomy and colonic biopsies confirmed HD, and they were treated with stage-two radical HD surgery（short-segment type）. One case showed no colonic dilation intraoperatively but developed recurrent postoperative abdominal distension, leading to a subsequent diagnosis of long-segment HD requiring subtotal colectomy.Among the seven cases with short-segment HD,abdominal upright X-rays revealed fixed dilated mid-abdominal bowel loops, while this sign was absent in the long-segment HD case. Conclusions In cases of CIM combined with HD, a miss diagnosis of HD is common. The presence of fixed dilated mid-abdominal bowel loops on preoperative abdominal upright X-rays differs from isolated CIM, which should raise suspicion for concurrent HD. Stage-one surgery for CIM combined with HD is safe and effective.

Objective To investigate the clinical efficacy of totally laparoscopic surgery in the treatment of neonates with type I high jejunal atresia. Methods A total of 46 neonates with type I high jejunal atresia （within 10 cm of the ligament of Treitz） admitted to the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2024 were retrospectively analyzed. According to whether laparoscopic surgery was used or not, they were divided into laparoscopic procedure（LP） group （n=16） and open procedure （OP） group （n=30）.The general data, perioperative inflammation,operation time, intraoperative bleeding, the first defecation time,the first postoperative oral feeding time, postoperative full oral feeding time, postoperative abdominal drain removal time, postoperative complications, unexpected second operations,the length of hospital stay, and mortality were compared between the two groups. Continuous variables that followed or approximately followed a normal distribution were expressed as x±s, and compared by the t-test.Continuous variables that did not conform to a normal distribution were expressed as the median（Q1,Q3）.Count data were compared by the chi-square test. Results The operation was successfully completed in both groups. There were no significant differences in the gender,gestational age,weight,preterm birth rate,and abnormal prenatal diagnosis between groups（all P> 0.05）. Compared to the OP group, the LP group had significantly less intraoperative bleeding （2.00 [1.00,2.38] mL vs. 2.00 [2.00,5.25] mL）, shorter time to first defecation （2.25± 1.24 d vs. 3.20± 1.37 d）, shorter time to first postoperative oral feeding （7.19± 2.07 d vs. 9.00± 3.18 d）, shorter time to postoperative full oral feeding （15.56± 6.77 d vs. 23.43± 14.94 d）, shorter time to abdominal drain removal（10.43± 3.67 d vs.13.47± 4.98 d）, and shorter length of hospital stay （21.50± 7.30 d vs. 29.50± 14.21 d） （all P< 0.05）.There were no significant differences between the two groups in C-reactive protein（CRP）,operation time, postoperative complications, unexpected second operations, and mortality（all P> 0.05）. Conclusion Totally laparoscopy is safe and feasible in the treatment of neonatal type Ⅰ high jejunal atresia, and offering significant advantages in reducing bleeding, restoring gastrointestinal function as soon as possible, and shortening hospital stay.

Objective To summarize the experience of laparoscopic management for choledochoenterostomy anastomotic stricture after choledochal cyst excision in children. Methods Clinical data of 8 pediatric patients who were re-examined by surgery for choledochoenterostomy anastomotic stricture after laparoscopic treatment for choledochal cysts at the Pediatric Surgery Department of Fujian Medical University Union Hospital from July 2016 to June 2024 were retrospectively analyzed. underwent laparoscopic biliary-enteric anastomotic reconstruction for postoperative biliary-enteric anastomotic stenosis. The operation time, intraoperative blood loss, time to first flatus, postoperative hospital stay, and complications were collected. Results All 8 children successfully underwent complete laparoscopic biliary-enteric anastomotic reconstruction. The operation time ranged from 120 minutes to 270 minutes,with an average of 188.5± 47.5 minutes. Blood loss ranged from 15 mL to 185 mL, with an average of 99.1± 62.1 mL. The postoperative hospital stay ranged from 7 days to 14 days, with an average of 9.2± 1.8 days. There were no cases of postoperative intra-abdominal bleeding, intra-abdominal infection, need for reoperation, or mortality. The follow-up period ranged from 6 months to 60 months, with an average of 30.2± 16.1 months. None of the followed-up children experienced recurrent biliary-enteric anastomotic stenosis. One child developed postoperative cholangitis, which was successfully treated with conservative management including anti-inflammatory and gallbladder-soothing medications, as well as traditional Chinese medicine. Conclusion Laparoscopic reconstruction of the choledochoenterostomy anastomotic stricture following choledochal cyst excision is safe and effective.

Objective To investigate the clinical characteristics， diagnostic methods， and treatment strategies for liver abscess complicating laparoscopic appendectomy in children. Methods A rare case of a boy at 6 years and 11 months with liver abscess following laparoscopic appendectomy for acute appendicitis was reported. The child was admitted to the Affiliated Children's Hospital of Xi'an Jiaotong University on August 6， 2024， presenting with fever for 4 days， and 26 days after laparoscopic appendectomy for acute appendicitis. Initial blood tests revealed a leukocyte count of 15.07×10⁹/L.Color Doppler ultrasound and CT confirmed a right hepatic lobe abscess. A literature review was conducted by searching key words of "acute appendicitis" "appendectomy" "liver/hepatic abscess" and "children" in both Chinese and English languages in the PubMed， Medline， Springer Link， The Cochrane Library， Wanfang， and CNKI databases. Articles published up to December 2024 were included for analysis， and the related cases were analyzed and summarized. Results The patient underwent ultrasound-guided percutaneous catheter drainage， anti-infective therapy， and oral traditional Chinese medicine.The liver abscess significantly resolved， and the child was discharged after 16 days of hospitalization， without a recurrence during a 3-month follow-up. Including this case， 8 pediatric cases were reviewed. In details，comprising 4 males and 4 females aged 5 to 14 years.Seven patients underwent laparoscopic appendectomy while one had open appendectomy；three cases involved gangrenous appendicitis and five involved perforated suppurative appendicitis. Diagnosis occurred between 1 week and 4 months post-appendectomy， with the primary clinical manifestations being fever and abdominal pain emerging 1 to 4 weeks after surgery， confirmed by color Doppler ultrasound or abdominal CT. In terms of treatment，4 received ultrasound-guided percutaneous drainage combined with antibiotics，2 received antibiotics alone，1 underwent anti-infective therapy + abscess drainage + exploratory laparotomy， and 1 underwent laparoscopic stone removal + drainage + antibiotics. Length of hospital stay ranged from 8-49 days， with all cases achieving a full recovery. Conclusion Postoperative liver abscess is a rare complication of acute appendicitis in children. Early ultrasound-guided percutaneous drainage combined with antibiotic therapy yields favorable outcomes.

Hepatoblastomas（HB） are usually found in a large size. Due to the immature, vulnerable tissues in children, a precise anatomy is particularly important that increases the surgical challenges. In recent years, artificial intelligence （AI） has played an important role in preoperative planning and intraoperative navigation of HB surgery. This article reviewed the development status of intelligent planning and surgical navigation of HB surgery, mainly including the following aspects： （1）AI-guidedsurgical planning： three-dimensional reconstruction and virtual simulation of medical images, and optimization of AI-driven resection path; （2）Surgery planning： Augmented reality （AR） navigation, intraoperative multimodal real-time navigation fusion and intelligent navigation of robotic surgery; （3）AI-guidedsurgical planning and navigation of HB in special sites： HB in the second hepatic portal and in the caudate lobe of the liver were mainly discussed.

Laparoscopic sleeve gastrectomy （LSG） is currently the most common bariatric surgery procedure. However, gastroesophageal reflux disease （GERD） caused by post-operative intrathoracic sleeve migration（ITSM） is the most concerned long-term complication. This article discussed the morbidity and possible mechanisms, clinical manifestation and diagnosis, prevention and treatment of ITSM. It is crucial to take feasible measures during the initial LSG to prevent ITSM. The possible approaches include avoiding damage to the phrenoesophageal ligament and fixing the left crus to the upper part of stomach. For patients with preoperative GERD symptoms, grade B or C esophagitis on endoscopy, or Hill grade Ⅲ or Ⅳ, simultaneous hiatal exploration, repair, and proper fixation should be considered. Regardless of the surgical approach, the fundamental measure for treating ITSM is to return the distal esophagus from the mediastinum to the abdominal cavity. Comprehensive hiatal repair and proper fixation around the gastro-esophageal junction are essential measures to ensure efficacy and prevent recurrences. Adding a gastroileal anastomosis can decrease the pressure in the sleeve which is favoring to GERD symptom, and simultaneously improve constipation and weight regain caused by ITSM.

Pancreatic cancer is a highly aggressive malignancy of the digestive system. Over 80% of patients are diagnosed at an advanced stage. The majority of pancreatic cancer patients progresses to cancer cachexia, characterized by uncontrolled weight loss, muscle wasting, and a systemic inflammatory response. To date, effective therapeutic strategies for managing cancer cachexia are scant.This article aims to provide an in-depth review of the latest research advancements both domestically and internationally, systematically elucidate the pathophysiological mechanisms and etiology of pancreatic cancer-associated cachexia.

Objective To observe the efficiency of ultrasound-guided percutaneous transhepatic gallbladder drainage（PTGBD） and laparoscopic cholecystectomy（LC） in patients with moderate-level acute moderate cholecystitis. Methods Clinical data of patients with moderate-level acute cholecystitis in the Qingdao Municipal Hospital from March 2021 to December 2023 were retrospectively analyzed. According to the different treatment methods, they were divided into the LC group（LC treatment） and PTGBD+LC group （LC treatment after PTGBD）.The propensity score matching （PSM） at 1∶ 1 matching was performed with a caliper of 0.01,and 65 cases were included in each group. The surgical indicators, incidence rates of complications, liver function indicators （alkaline phosphatase [ALP], indirect bilirubin [IBIL], direct bilirubin [DBIL]）, serum inflammatory factors（tumor necrosis factor-α[TNF-α],C-reactive protein [CRP], interleukin-6[IL-6]） and 30-day mortality before and after treatment were compared between groups. Results In comparison to LC group,the intraoperative blood loss （31.13± 7.95 mL vs.44.86± 9.63 mL）,surgical time（62.47± 11.13 min vs.81.32± 10.52 min）,rate of intraoperative drainage （80.00% [52/65] vs.98.46%[64/65]）,and rate of LC conversion to laparotomy（0 vs.9.23% [6/65]） were significantly lower in the PTGBD+LC group （all P< 0.05）.The incidence of surgical complications in the PTGBD+LC group was significantly lower than that of the LC group （4.62%[3/65] vs.15.38%[10/65],P< 0.05）.Compared with preoperative values,ALP,IBIL,DBIL,CRP,and IL-6 at 72 h postoperatively were significantly reduced in both groups （all P< 0.05）. The above liver function indexes and serum inflammatory factors in the PTGBD+LC group at 72 h postoperatively were significantly lower than those of the LC group （all P< 0.05）. There was no significant difference in the 30-day mortality rate between the two groups（P> 0.05）.No cholecystitis recurred during the follow-up period. No significant difference in the 36-Item Short Form Health Survey （SF-36） score was found between groups （P> 0.05）. Conclusion PTGBD combined with LC can reduce intraoperative bleeding and shorten operation time, promote the postoperative recovery of AC patients, quickly relieve the inflammatory state, and improve the liver function. It has few surgical related complications, good therapeutic effect and important clinical application value.

Objective To explore the clinical characteristics,treatment,and prognosis of Petersen hernia after radical gastrectomy for gastric cancer, thus enhancing the understanding of clinical physicians about this disease. Methods A summary analysis was conducted on 6 cases of Petersen hernia after radical gastrectomy treated by Union Hospital,Tongji Medical College,Huazhong University of Science and Technology and Xishui People's Hospital from January 2018 to October 2023, as well as 75 cases of Petersen hernia reported in domestic literatures from January 2013 to June 2023. Results Among the 81 patients, there were 77 males and 4 females, aged 35-90 years（median age 56 years）. Among them, 32 underwent total gastrectomy, 46 underwent distal gastrectomy, and 3 underwent proximal gastrectomy. The interval between Petersen hernia and previous gastric surgery ranged from 7 days to 30 years, with a median interval of 10 months.A total of 79 cases were accompanied by abdominal pain,66 cases were accompanied by abdominal distension, 43 cases were accompanied by nausea and vomiting, and 31 cases were accompanied by anal cessation of exhaust and defecation. Among the preoperative abdominal CT scans, 79 patients showed signs of intestinal obstruction, and 2 patients were not complicated with intestinal obstruction.During the second surgery,2 patients underwent robotic surgery,19 patients underwent laparoscopic surgery, and 60 patients underwent open surgery. Totally, 56 cases did not undergo intestinal resection surgery, while 25 cases underwent internal hernia reduction after removing the small intestine.Among the 81 cases, one patient died during the perioperative period, while the others were discharged after a success treatment. The postoperative hospitalization time ranged from 5days to 21 days. Conclusion Petersen hernia is a relatively rare complication after radical gastrectomy for gastric cancer. Patients with intestinal obstruction after radical gastrectomy for gastric cancer should be vigilant about the occurrence of intra-abdominal hernia, and active surgical exploration should be performed after CT diagnosis to improve the prognosis.

Objective This study aims to develop and validate a novel platelet index score （PIS）-based nomogram to predict the prognosis of hepatocellular carcinoma （HCC）. Methods A retrospective analysis was conducted on the medical records of 692 patients with HCC who underwent surgical resection at the Department of Hepatopancreatobiliary Surgery, Zhengzhou University People’s Hospital, between January 2017 and June 2022. Preoperative laboratory testing, clinicopathological characteristics, and surgery-related data were collected. Postoperative follow-up was performed according to standard protocols, with recurrence-free survival （RFS） as the primary outcome to assess early recurrence and metastasis after HCC resection. Platelet parameters were analyzed using Kaplan-Meier curves in the training cohort to establish the platelet index score. Independent risk factors for postoperative recurrence were identified using univariate and multivariate Cox proportional hazards regression models, and a nomogram was constructed. The predictive performance of the model was evaluated using receiver operating characteristic （ROC） curves and calibration curves in both the training and validation cohorts, aiming to assess the consistency with actual RFS outcomes. Results Kaplan-Meier analysis revealed that lower platelet counts （PLT≤ 157.5× 109/L, P=0.001）, higher mean platelet volume （MPV≥ 11.35 fL, P< 0.001）, and higher platelet distribution width （PDW≥ 13.85 fL, P< 0.001） were associated with shorter RFS in HCC patients. These three platelet indices were integrated into a novel scoring system, namely PIS, which demonstrated a good predictive performance. Based on the PIS, HCC patients were stratified into high- and low-risk groups. The 1-, 2-, and 3-year RFS in the low-risk group was 13.32% （51/383）, 28.20% （108/383）, and 38.90% （149/383）, respectively, which was 23.53% （24/102）, 49.02% （50/102）, and 67.65% （69/102） in the high-risk group, respectively. Multivariate Cox regression analysis identified the American Joint Committee on Cancer （AJCC） staging （HR=2.921, 95%CI： 1.83-4.67, P< 0.001）, microvascular invasion （HR=1.906, 95%CI： 1.28-2.83, P=0.001）, portal vein tumor thrombus （HR=1.408, 95%CI： 1.03-1.92, P=0.031）, tumor satellite lesions （HR=1.388, 95%CI： 1.03-1.88, P=0.033）, Ki-67 expression （HR=1.997, 95%CI： 1.45-2.75, P< 0.001）, alpha-fetoprotein （HR=1.723, 95%CI： 1.29-2.30, P< 0.001）, and PIS （HR=1.442, 95%CI： 1.08-1.92, P=0.013） were independent risk factors for postoperative recurrence. The nomogram was plotted based on independent risk factors. The results showed that the AUC of the nomogram model in the training queue for 1-,2-, and 3-years was 0.826 （95%CI：0.773-0.876）, 0.850 （95% CI： 0.800-0.876）,and 0.909 （95% CI： 0.882-0.934） respectively,and the AUC in the validation queue was 0.826（95% CI： 0.752-0.890）,0.807（95%CI： 0.741-0.863）, and 0.804 （95%CI： 0.737-0.862） respectively.The higher the total score of the nomogram, the better the efficacy of the model in predicting the RFS of patients. Calibration curves showed a good consistency between the predicted and actual RFS in both cohorts. Conclusion The PIS-based nomogram model, incorporating multiple platelet indices, accurately predicts 1-, 2-, and 3-year recurrence status after HCC resection and provides effective postoperative risk stratification for patients with HCC.

Hepatocellular carcinoma（HCC） is a prevalent tumor of digestive system. Surgical removal has been a primary treatment. However, HCC patients have a high postoperative risk of recurrence, particularly within 2 years. Therefore elucidating the signaling pathways for early recurrence after HCC surgery aids in formulating early and effective intervention measures.Counter-measures help to prevent or delay early recurrences of HCC,thereby enhancing patient survival.This review focused upon primary signaling pathways for early recurrence after HCC surgery, aiming to enhance understanding and refine precise prevention and intervention strategies for early recurrence of HCC.