Novel surgery for refractory mixed constipation: analysis of the technical notes and outcome to Jinling procedure / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss a new surgical strategy: Jinling procedure (subtotal colectomy combined with modified Duhamel procedure), of which the indications, technical notes and outcomes were analyzed.</p><p><b>METHODS</b>The 590 patients with refractory slow-transit constipation associated with outlet obstruction was strictly included between February 2000 and December 2011. The patients included 103 males and 487 females. Their age were 14-75 years (average 42 ± 13). The 412 patients received laparoscopic-assistant Jinling procedure, and 178 patients with open Jinling procedure. The pre- and post-operation data were collected. The follow up rate were 100%, 98.1%, 95.8% and 92.7% at 3, 6, 12 and 24 months.</p><p><b>RESULTS</b>There was no surgery-related death. Mean hospital day was (12 ± 9) days. Most complications were managed conservatively without significant events. The common complications after surgery were adhesive intestinal obstruction (9.2%), anastomosis bleeding (8.1%) and anastomosis leakage (2.9%). The gastrointestinal quality of life index score was 72 ± 9 preoperatively and increased to 68 ± 11, 99 ± 6, 105 ± 9, 106 ± 9 at 3, 6, 12 and 24 month follow-up, respectively (t = 62.1, -25.1, -126.5, -143.2, P < 0.01). The Wexner constipation scale was 21.9 ± 4.5 preoperatively and decreased to 9.6 ± 2.4, 5.9 ± 2.1, 4.6 ± 1.9, 4.5 ± 1.8 at 3, 6, 12 and 24 month follow-up, respectively (t = 48.6, 61.8, 58.2, 45.9, P < 0.01). The satisfactory rate was 77.5%, 92.1%, 93.0% and 94.1% at 3, 6, 12, and 24 month follow-up.</p><p><b>CONCLUSIONS</b>Jinling procedure provides a good surgical option for refractory slow-transit constipation associated with outlet obstruction.</p>

Surgical innovation for refractory constipation (Jinling procedure): a long-term follow-up of its safety and efficacy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To propose a novel surgical procedure for refractory constipation, namely Jinling procedure, and to explore its safety and efficacy through long-term follow-up.</p><p><b>METHODS</b>A total of 614 patients with refractory constipation were admitted to the Department of General Surgery between February 2000 and June 2011. Five hundred and fifty-four patients received Jinling procedure and were included in this study. The general clinical data, complications after Jinling procedure, gastrointestinal quality of life index (GIQLI), Wexner constipation scale and satisfaction rate during follow-up were collected.</p><p><b>RESULTS</b>No operation-associated death occurred. Increased bowel movement frequency was observed during the perioperative period. Temporary difficulty in urination occurred in 24.5% of the patients. Other complications included small bowel obstruction (9.6%), anastomotic bleeding (8.1%), anastomotic leakage (3.1%), sexual dysfunction (3.1%), and wound infection (3.1%). Most postoperative complications were managed conservatively. The most recent follow-up was on August 2011, and the follow-up rate was 100%, 88.8%, 75.1%, 56.3% at 3, 6, 12, and 24 months after surgery. GIQLI temporarily increased from 78.1±9.4 preoperatively to 92.0±9.5 at 3 months follow-up, but continued to decrease during the follow-up at the 6 months (48.4±14.1), 12 months (21.0±4.3), and 24 months (20.0±3.4). Wexner constipation scale decreased from 19.9±4.3 preoperatively to 8.4±2.1 at 3 months follow-up (P<0.01). The low Wexner scale sustained until 24 months after operation. The satisfaction rate at the 3, 6,12 and 24 months follow-up was 78.1%, 91.1%, 94.2% and 94.6%, respectively.</p><p><b>CONCLUSION</b>Jinling procedure provides refractory constipation patients with a novel, safe and effective surgical option.</p>

Reduction of plasma obestatin levels in patients with impaired glucose regulation and type 2 diabetes / 中华内分泌代谢杂志

Plasma obestatin level was determined in patients with impaired glucose regulation and type 2 diabetes mellitus.The plasma obestatin levels in patients of both groups were significantly decreased as compared with that in controls.Plasma obestatin level was negatively correlated with body mass index,HbA_(1C),waist-to-hip ratio,plasma insulin and HOMA-IR.Obestatin level seems to be related with metabolic disorder.