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BACKGROUND Stoma reversal is associated with a high risk of wound infection. The gunsight and purse-string closure techniques are both effective alternatives for stoma reversal, but comparative studies are lacking. OBJECTIVE The purpose of this study was to compare the gunsight procedure with the purse-string closure technique when closing wounds after loop stoma reversal. DESIGN This was a nonblinded, multicenter prospective randomized study (clinicaltrials.gov No. NCT02053948). SETTINGS The study was conducted at a general surgery unit of 7 tertiary academic medical centers. PATIENTS A total of 143 patients undergoing loop stoma reversal were included in the study (72 in the gunsight group and 71 in the purse-string group) between November 2013 and December 2017. INTERVENTION Patients were randomly assigned to undergo either gunsight or purse-string closure procedure. MAIN OUTCOME MEASURES Primary outcome was wound healing time. Secondary outcomes were the incidence of surgical site infection, morbidity, and patient satisfaction. RESULTS No differences were found between the 2 groups in terms of surgical site infection, intraoperative blood loss, and postoperative hospital stay. The gunsight procedure had a shorter wound healing time compared with the purse-string procedure (17 vs 25 d; p < 0.001). A patient satisfaction questionnaire showed that the gunsight group had a higher score level of patient satisfaction with respect to wound healing time (p < 0.001) and total patient satisfaction score (p = 0.01) than the purse-string group. LIMITATIONS Treatment teams were not blinded, and there was operator dependence of techniques. CONCLUSIONS The gunsight and purse-string techniques are effective procedures for stoma reversal and both have a low incidence of surgical site infection. The gunsight technique is associated with shorter wound healing time, higher levels of patient satisfaction with regard to healing time, and overall final score and is recommended as the closure technique of choice. See Video Abstract at http://links.lww.com/DCR/B319. EL PROCEDIMIENTO DE GUNSIGHT VERSUS EL PROCEDIMIENTO DE JARETA, PARA EL CIERRE DE HERIDAS, DESPUeS DE REVERSIoN DE ESTOMA: UN ENSAYO, MULTICeNTRICO, PROSPECTIVO Y RANDOMIZADO: La reversion de estoma esta asociada con un alto riesgo de infeccion de la herida. Las tecnicas de gunsight y de jareta, son eficaces alternativas en la reversion de estoma, pero faltan estudios comparativos.Comparar el procedimiento de gunsight con la tecnica de jareta, despues de la reversion de estoma en asa.Estudio multicentrico, prospectivo y randomizado ciego (NCT02053948).Realizado en la unidad de cirugia general, de siete centros medicos academicos terciarios.Se incluyeron en el estudio, un total de 143 pacientes sometidos a reversion de estoma de asa (72 en el grupo de gunsight y 71 en el grupo de jareta) entre noviembre de 2013 y diciembre de 2017.Los pacientes fueron asignados aleatoriamente, para someterse a un procedimiento de cierre de gunsight o de jareta.El resultado primario fue el tiempo de cicatrizacion de la herida. Los resultados secundarios fueron la incidencia de infeccion del sitio quirurgico, morbilidad y satisfaccion del paciente.No se encontraron diferencias entre los dos grupos en terminos de infeccion del sitio quirurgico, perdida de sangre intraoperatoria o estadia hospitalaria postoperatoria. El procedimiento de gunsight tuvo un tiempo mas corto en la cicatrizacion de la herida, en comparacion con el procedimiento de jareta (17 dias frente a 25 dias, p

To investigate diagnosis and treatment of abdominal cocoon.Clinical data of patients received treatment for abdominal cocoon from January 2000 to January 2011 was retrospectively analyzed.A total of 67 patients underwent treatment in our hospital were analyzed, the preoperatively diagnosis rate was only 47.8% (32/67). Patients who received preoperatively nutrition support have a lower postoperative complication (8/27 vs.13/20, χ(2) = 5.815, P0.05) and patients with less extent of intestine involved had a lower early postoperative inflammatory ileus (EPII) rate (9/25 vs. 1/22, χ(2) = 6.912, P0.05) when compared with large extent.Appropriate perioperative management play an important role in the prognosis of abdominal cocoon. The main treatment is surgery while preoperatively nutrition support can reduce postoperative complications.

To investigate the effect of preoperative nutritional support in the management of patients with chronic radiation enteritis (CRE) with intestinal obstruction undergoing resectional surgery.Clinical data of 158 CRE patients undergoing diseased bowel resection from 2001 to 2011 were analyzed retrospectively. A total of 130 patients received preoperative nutritional support, including 28 patients with enteral nutrition support, 60 patients with total parenteral nutrition support, and 42 patients with combined nutritional support. The nutritional parameters, procedures, operation-related complications, and postoperative hospital stay were recorded.After aggressive nutritional support in 130 patients, patients nutritional index, such as serum prealbumin, transferrin, serum albumin improved significantly preoperatively, while the change of body mass index and hemoglobin was not significant. Compared to those without preoperative nutritional support, those who received preoperative nutritional support had lower stoma rate (31.5% vs. 53.6%, P=0.027), less postoperative infection rate (13.8% vs. 32.1%, P=0.019), shorter postoperative hospital stay [(14.1±7.3) d vs. (18.8±15.8) d, P=0.013). Enteral nutrition group had less postoperative infection rate (7.1% vs. 21.7%, P=0.017), lower stoma rate (28.6% vs. 48.3%, P=0.02), and shorter postoperative hospital stay [(15.5±9.6) d vs. (21.7±19.0) d, P=0.025) as compared to total parenteral nutrition group.Preoperative nutritional support can decrease the stoma rate, postoperative infection rate, and shorten hospital stay in CRE patients complicated with intestinal obstruction. If tolerated, enteral nutrition support should be chosen.

To determine whether the perioperative disease activity is associated with recurrence and complications after bowel resection for Crohn's disease (CD).Clinical data of patients underwent bowel resection for CD at the Nanjing General Hospital of Nanjing Military Command from January 2002 to January 2011 was retrospectively analyzed. Postoperative recurrence and complications in patients with active disease were compared with those in patients with remission.A total of 90 patients underwent bowel resection for CD, active disease were seen in 43 patients at the time of surgery, while the rest 47 patients were in remission. The postoperative cumulative endoscopic recurrence rate was 8.5% at 1 year, 27.7% at 2 years and 44.7% at 3 years in the patients with remission, and was 27.9% at 1 year, 37.2% at 2 years and 53.5% at 3 years in patients with active disease. Data indicated the endoscopic recurrence were statistically significant in the first year after surgery (χ² = 4.605, P = 0.032). Additional, the postoperative complication rates in patients with remission (14.9%) was significantly lower than that in patients with active disease (51.2%) (χ² = 6.979, P0.001).Patients with active disease at the time of surgery were encountered with early postoperative recurrence and increased complications after intestinal resection for CD.

To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge, while 104 consecutive patients underwent conventional care after resection of colorectal cancer. Their gastrointestinal functions, postoperative complications and hospital stay time were recorded.The restoration time of gastrointestinal functions in the patients was significantly faster after fast-track rehabilitation program than after conventional care (2.1 d vs 3.2 d, P0.01). The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (13.2% vs 26.9%, P0.05). Also, the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (6.6% vs 15.4%, P0.05). The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care (5 d vs 7 d, P0.01). No significant difference was observed in the re-admission rate 30 d after fast-track rehabilitation program and conventional care (3.8% vs 8.7%).The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

To investigate the potential role of enteral nutrition (EN) combined with Tripterygium Wilfordii Poly-glycoside (TWP) for remission induction of active adult Crohn's disease (CD).Clinical data of 62 adult patients with active CD treated with EN and TWP in combination (n = 42) or TWP alone (n = 20) from March 2001 to September 2008 were retrospectively analyzed. All the patients had a Crohn's Disease Activity Index (CDAI)150 and450. In TWP group, subjects received TWP tablets (1.0 - 1.5 mg x kg(-1) x d(-1)) with uncontrolled diets; while in the group of combination therapy, the patients were given total enteral nutrition (TEN) through tube feeding in addition to TWP tablets. Clinical response was defined by a decrease of at least 70 points in the CDAI from baseline after treatment, and clinical remission was defined as the absolute value of CDAI (less than 150). Patients' nutritional and disease activity index, such as CDAI score, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were determined at 0, 4, and 12 weeks after treatment.The ratio of clinical response (78.6% vs. 40.0%, P = 0.003) and clinical remission (69.1% vs. 30.0%, P = 0.004) were both significantly higher in the combined treatment group than in those the TWP group at week 4. At week 12, the clinical response ratio was significantly higher in the combined treatment group (90.5% vs. 65.0%, P = 0.014); the remission ratio was also higher in the combined treatment group (76.2% vs. 55.0%, P = 0.091). The nutritional parameters improved from baseline at week 4 and 12 in the combined treatment group but not in TWP group. At week 4, blood albumin, prealbumin, and transferrin levels was higher in the combined treatment group than those in TWP group (P0.05); at week 12, patients in combined treatment group also had significantly higher body mass index (BMI), blood albumin, prealbumin, transferrin and hemoglobin levels (P0.05).Treatment with enteral nutrition and TWP in combination are superior to TWP alone for induction of clinical response and remission in adult Crohn's Disease. This strategy also improves patient's nutritional status and avoids the adverse effects of traditional therapy.

The objective of this study is to evaluate the long-term clinical significance of enteral nutrition (EN) in weaning adult short bowel patients off parenteral nutrition (PN) undergoing intestinal rehabilitation therapy (IRT). Sixty-one adult patients with small bowel length 47.95+/-19.37 cm were retrospectively analyzed. After a 3-week IRT program, including recombinant human growth hormone (rhGH, 0.05 mg/kg/d), glutamine (30 g/d), and combined EN and PN support, patients were maintained on EN or plus a high-carbohydrate, low fat (HCLF) diet. Continuous tube feeding was used when EN was started. Patients were followed up for 50.34+/-24.38 months and had an overall survival rate 95.08% (58/61). On last evaluation, 85.24% (52/61) of the patients were free of PN. For 77.42% patients (24/31) with small bowel length35 cm in jejunoileocolic anastomosis (type III) and60 cm in jejunocolic anastomosis (type II), weaning off PN was achieved. EN comprised of 52.56+/-13.47% of patients' daily calorie requirements on follow-up. Five patients were maintained on home PN (HPN) plus EN. Nutritional and anthropometric parameters, urine 5-hr D-xylose excretion and serum citrulline levels all increased significantly after IRT and on follow-up compared with baseline. In conclusion, with proper EN management during and after IRT, a significant number of SBS patients could be weaned from PN, especially for those who were considered as permanent intestinal failure; continuous tube feeding is recommended for enteral access, and long-term EN support could meet the daily nutritional requirement in majority of SBS patients.

To observe the efficacy of perioperative combined nutritional support in patients with Crohn disease.From January 2000 to June 2008, 165 patients with Crohn disease receiving perioperative nutritional support were included in this retrospective analysis. The patients were divided into three groups according to the ways of nutritional support: total enteral nutrition group, total parenteral nutrition group and combined nutrition group; there were 55 patients in each group. Each group had the same treatment except for nutritional support. The efficacy of different approaches of nutritional support was analyzed and compared among the groups.Compared with total enteral and total parenteral nutrition, combined nutrition supplied more sufficient energy, the nutritional status improved more significant in short time; pre-albumin, transferrin, lymphocytes and platelet count increased significantly. The disease remission rate in combined nutrition group was 80.0%, better than 76.4% in total enteral nutrition group and 74.5% in total parenteral nutrition group. The morbidity rate was 10.9% in combined nutrition group, and it was lower than that in total enteral nutrition group and total parenteral nutrition group (25.4% and 18.2%, respectively). The length of hospital stay was shorter and the treatment was more cost-effective in combined nutrition group.For patients with Crohn disease, perioperative combined nutritional support is more efficient than total enteral or parental nutrition support.

To investigate the significance, effects and precautions of enteral nutritional support in patients with short bowel syndrome (SBS).Clinical data of 40 SBS patients who were maintained on enteral nutrition (EN) for more than 2 years were retrospectively summarized. The cost of EN and parenteral nutrition (PN), the PN-free duration, and the current nutritional status of these patients were analyzed.The mean length of the remnant small bowel was (50.8 +/- 29.4) cm. All the patients currently lived on high-carbohydrate low-fat diet supplemented with EN (3284.0 +/- 1408.8) kJ/d, the cost was significantly lower than that of PN (P0.01). Mean PN-free duration was (29.1 +/- 9.2) months for these patients. The current defecation frequency and volume were (3.4 +/- 1.7) times/d and (720.2 +/- 350.3) ml/d, respectively. As for the patients' nutritional index, mean BMI, blood hemoglobin and serum albumin level were (17.8 +/- 3.2) kg/m(2), (113.3 +/- 14.8) g/L and (35.0 +/- 4.1) g/L, respectively.Enteral nutrition is a cost-effective method for maintaining the nutritional status in patients with short bowel syndrome, but proper management in clinical practice to avoid diarrhea or other complications should be ensured.

To investigate the potential role of serum citrulline level in evaluating the intestinal absorptive area and capacity in patients with short bowel syndrome (SBS).Serum citrulline concentration was determined using high performance liquid chromatography (HPLC) in SBS patients (n=22) and healthy controls (n=33). In SBS patients, the remnant small bowel lengths and diameters were measured by radiography, and their 5- hour urine D- xylose excretion and intestinal protein absorption were also determined. The correlationship of serum citrulline level with remnant small bowel length, surface area, protein and D- xylose absorption was analyzed. The 6 patients receiving intestinal rehabilitative therapy, serum citrulline level, protein and D- xylose absorption after therapy were also measured.Serum citrulline level of SBS patients was significantly lower than that of healthy controls [(5.94+/- 2.65) vs [(16.87 +/- 5.97) micromol/L, P0.01]. In SBS patients, serum citrulline was positively correlated with remnant small bowel length and surface area (r=0.82 and r=0.86 respectively). There was also a significant correlationship of serum citrulline level with 5- hour D- xylose excretion (r=0.56) and intestinal protein absorption (r=0.48). Serum citrulline, 5- hour D- xylose excretion and intestinal protein absorption were all significantly raised in patients after rehabilitative therapy, although no correlation of increasing percentage was found among above three parameters.Serum citrulline concentration is positively correlated with intestinal absorptive area and capacity in SBS patients. It is a potential marker for evaluating the severity of intestinal failure and the efficacy of rehabilitative therapy in short bowel patients.