Gastrointestinal functions after laparoscopic right colectomy with intracorporeal anastomosis: a pilot randomized clinical trial on effects of abdominal drain, prolonged antibiotic prophylaxis, and D3 lymphadenectomy with complete mesocolic excision.

PURPOSE: Routine use of abdominal drain or prolonged antibiotic prophylaxis is no longer part of current clinical practice in colorectal surgery. Nevertheless, in patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (ICA), it may reduce perioperative abdominal contamination. Furthermore, in cancer patients, prolonged surgery with extensive dissection such as central vascular ligation and complete mesocolon excision with D3 lymphadenectomy (altogether radical right colectomy RRC) is called responsible for affecting postoperative ileus. The aim was to evaluate postoperative resumption of gastrointestinal functions in patients undergoing right hemicolectomy for cancer with ICA and standard D2 dissection or RRC, with or without abdominal drain and prolonged antibiotic prophylaxis. METHODS: Monocentric factorial parallel arm randomized pilot trial including all consecutive patients undergoing laparoscopic right hemicolectomy and ICA for cancer, in 20 months. Patients were randomized on a 1:1:1 ratio to receive abdominal drain, prolonged antibiotic prophylaxis or neither (I level), and 1:1 to receive RRC or D2 colectomy (II level). Patients were not blinded. The primary aim was the resumption of gastrointestinal functions (time to first gas and stool, time to tolerated fluids and food). Secondary aims were length of stay and complications' rate. CLINICALTRIALS: gov no. NCT04977882. RESULTS: Fifty-seven patients were screened; according to sample size, 36 were randomized, 12 for each arm for postoperative management, and 18 for each arm according to surgical techniques. A difference in time to solid diet favored the group without drain or antibiotic independently from standard or RRC. Furthermore, when patients were divided with respect to surgical technique and into matched cohorts, no differences were seen for primary and secondary outcomes. CONCLUSION: Abdominal drainage and prolonged antibiotic prophylaxis in patients undergoing right hemicolectomy for cancer with ICA seem to negatively affect the resumption of a solid diet after laparoscopic right hemicolectomy with ICA for cancer. RRC does not seem to influence gastrointestinal function recovery.

Effect of tissue tension on magnetic compression anastomosis of digestive tract.

With the increasing application of magnetic compression anastomosis (MCA) in gastrointestinal anastomosis, we identified an interesting phenomenon that an anastomosis is more prone to stenosis after endoscopic gastrointestinal MCA. We hypothesized that the increase in tissue tension during endoscopic procedures is the cause of anastomotic stenosis. In this study, we investigated the effect of tissue tension on gastroduodenal bypass MCA in Sprague-Dawley (SD) rats. Twenty SD rats were divided into the study group (high-tension group, n = 10) and control group (no tension group, n = 10), wherein the rats underwent complete gastroduodenal bypass magnetic anastomosis under high tension and no tension of the digestive tract, respectively. Anastomotic specimens were obtained 4 weeks after the operation, and anastomotic diameters of the two groups were observed and measured. The histological difference was observed by hematoxylin & eosin and Masson staining. The operation was successfully completed in all rats, and all survived until 4 weeks postoperatively. Anastomotic measurements revealed that the anastomosis diameter was significantly smaller in the study group than in the control group, and there were three cases of severe anastomotic stenosis. Histological observation showed that the amount of collagen fibers in the anastomosis was greater in the study group than in the control group. The results suggest that the high-tension state of the digestive tract is an important factor leading to anastomotic stenosis, and thus, we put forward the Yan-Zhang's Tissue Tension Theory of MCA to explain this phenomenon.

Bioresorbable shape-adaptive structures for ultrasonic monitoring of deep-tissue homeostasis.

Monitoring homeostasis is an essential aspect of obtaining pathophysiological insights for treating patients. Accurate, timely assessments of homeostatic dysregulation in deep tissues typically require expensive imaging techniques or invasive biopsies. We introduce a bioresorbable shape-adaptive materials structure that enables real-time monitoring of deep-tissue homeostasis using conventional ultrasound instruments. Collections of small bioresorbable metal disks distributed within thin, pH-responsive hydrogels, deployed by surgical implantation or syringe injection, allow ultrasound-based measurements of spatiotemporal changes in pH for early assessments of anastomotic leaks after gastrointestinal surgeries, and their bioresorption after a recovery period eliminates the need for surgical extraction. Demonstrations in small and large animal models illustrate capabilities in monitoring leakage from the small intestine, the stomach, and the pancreas.

Accidental ingestion of multiple magnetic beads by children and their impact on the gastrointestinal tract: a single-center study.

OBJECTIVE: In this study, we aimed to enhance the treatment protocols and help understand the harm caused by the accidental ingestion of magnetic beads by children. METHODS: Data were collected from 72 children with multiple gastrointestinal perforations or gastrointestinal obstructions. The 72 pediatric patients were divided into a perforation and a non-perforation group. The data collected for the analysis included the gender, age, medical history, place of residence (rural or urban), and symptoms along with the educational background of the caregiver, the location and quantity of any foreign bodies discovered during the procedure, whether perforation was confirmed during the procedure, and the number of times magnetic beads had been accidentally ingested. RESULTS: The accuracy rate of preoperative gastrointestinal perforation diagnosis via ultrasound was 71%, while that of the upright abdominal X-ray method was only 46%. In terms of symptoms, the risk of perforation was 13.844 and 12.703 times greater in pediatric patients who experienced vomiting and abdominal pain with vomiting and abdominal distension, respectively, compared to patients in an asymptomatic state. There were no statistical differences between the perforation and the non-perforation groups in terms of age, gender, medical history, and the number of magnetic beads ingested (P > 0.05); however, there were statistical differences in terms of white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033). A total of 56% of cases underwent a laparotomy along with perforation repair and 19% underwent gastroscopy along with laparotomy. All pediatric patients recovered without complications following surgery. CONCLUSION: Abdominal ultrasonography and/or upright abdominal X-ray analyses should be carried out as soon as possible in case of suspicion of accidental ingestion of magnetic beads by children. In most cases, immediate surgical intervention is required. Given the serious consequences of ingesting this type of foreign body, it is essential to inform parents and/or caregivers about the importance of preventing young children from using such products.

AGA Clinical Practice Update on Endoscopic Full-Thickness Resection for the Management of Gastrointestinal Subepithelial Lesions: Commentary.

DESCRIPTION: Subepithelial lesions of the gastrointestinal tract are not encountered uncommonly during routine endoscopy. There has been remarkable progress in the development of endoscopic options for the resection of subepithelial lesions, including full-thickness resection. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to describe the various techniques for endoscopic full-thickness resection and to facilitate their appropriate application in the management of subepithelial lesions. METHODS: This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology.

Persistencia del conducto onfalomesentérico: otra causa de abdomen agudo / Persistence of the omphalomesenteric duct: another cause of acute abdomen

El conducto onfalomesentérico es una estructura embrionaria que comunica el saco vitelino con el intestino medio, generalmente desapareciendo entre la quinta y la novena semanas de vida intrauterina. La persistencia del conducto onfalomesentérico, presente hasta en un 2% de la población, es una anomalía congénita del tracto gastrointestinal que puede presentarse en forma de abdomen agudo, oclusión intestinal o hemorragia digestiva.(AU)

Enhancing Gastrointestinal Function Recovery in Post-Intestinal Surgery Patients Through Rapid Rehabilitation Nursing Therapy.

Objective: This study aimed to investigate the efficacy of rapid recovery nursing therapy in enhancing digestive tract function recovery following intestinal surgery. Methods: This study included 100 post-intestinal surgery patients between March 2020 and March 2022. A random table method was used, and patients were assigned to either a control group receiving standard nursing care or an experimental group receiving rapid rehabilitation therapy. A thorough assessment compared different outcomes such as gastrointestinal function recovery, physical recuperation, stress levels, postoperative adverse events, nutritional status, nursing efficacy, and patient satisfaction between the two groups. Results: Compared to the control group, the experimental group exhibited significant improvements in gastrointestinal function and physiological parameters (P < .05). Additionally, the experimental group experienced fewer adverse effects, improved nursing outcomes, and higher patient satisfaction post-treatment (P < .05). Conclusions: Rapid rehabilitation nursing therapy in patients undergoing intestinal surgery substantially enhances digestive tract function and overall patient well-being. It effectively reduces the incidence of postoperative complications, accelerates the patient's recovery process, and improves their quality of life. Patient satisfaction with postoperative fast recovery care was notably high. This rehabilitation approach holds significant promise for patients undergoing intestinal surgery and merits wider adoption.

Foreign body in the gastrointestinal tract in children: A tertiary hospital experience.

Background: Foreign body (FB) ingestion in the gastrointestinal tract (GIT) in children is common. Although most foreign bodies will pass spontaneously, surgical intervention is required when they fail to pass. Aims and Objectives: The aim of this study was to evaluate our experience in the management of children who presented with FB in the GIT. Materials and Methods: This was a retrospective study of children that underwent laparotomy for the removal of FB in the GIT at the paediatric surgery unit of Enugu State University Teaching Hospital, Enugu over a 10-year period. Results: A total of 272 children presented with FB in the GIT during the study period, out of which 30 patients had laparotomy. This gave an operative incidence rate of 11%. There was a slight male predominance and the ages of the patients ranged from 6 months to 5 years (median 3 years). About half of the patients had no symptoms and all the patients were investigated with an abdominal radiograph. Only one-third of the patients had a predisposing factor that could have led to FB impaction. FB impaction was the most common indication for surgery, and enterotomy with FB removal was the most performed surgical procedure. The most common FB removed were tiny parts of toys, and the most common post-operative complication was surgical site infection. There was no mortality. Conclusion: FB in GIT in children could be associated with complications that require surgical treatment. FB ingestion is preventable. Focus should be placed on caregivers preventing children from ingesting FB.

Rationale for Colonic Pre-Habilitation Prior to Restoration of Gastrointestinal Continuity.

The emergence of the gut microbiome as a complex ecosystem that plays a key role in human heath and disease has touched virtually every aspect of medical and surgical care. With the advent of next-generation technology to interrogate the microbiome at the level of its membership, community structure and production of metabolites, applying measures by which the gut microbiome can be manipulated to the advantage of both the patient and provider is now possible. Among the many proposed methods, the most practical and promising is dietary pre-habilitation of the gut microbiome prior to high-risk anastomotic surgery. In this review, we will outline the scientific rationale and molecular underpinning that support dietary pre-habilitation as a practical and deliverable method to prevent complications after high-risk anastomotic surgery.

The implication of gut microbiota in recovery from gastrointestinal surgery.

Recovery from gastrointestinal (GI) surgery is often interrupted by the unpredictable occurrence of postoperative complications, including infections, anastomotic leak, GI dysmotility, malabsorption, cancer development, and cancer recurrence, in which the implication of gut microbiota is beginning to emerge. Gut microbiota can be imbalanced before surgery due to the underlying disease and its treatment. The immediate preparations for GI surgery, including fasting, mechanical bowel cleaning, and antibiotic intervention, disrupt gut microbiota. Surgical removal of GI segments also perturbs gut microbiota due to GI tract reconstruction and epithelial barrier destruction. In return, the altered gut microbiota contributes to the occurrence of postoperative complications. Therefore, understanding how to balance the gut microbiota during the perioperative period is important for surgeons. We aim to overview the current knowledge to investigate the role of gut microbiota in recovery from GI surgery, focusing on the crosstalk between gut microbiota and host in the pathogenesis of postoperative complications. A comprehensive understanding of the postoperative response of the GI tract to the altered gut microbiota provides valuable cues for surgeons to preserve the beneficial functions and suppress the adverse effects of gut microbiota, which will help to enhance recovery from GI surgery.

Impact of gastric and bowel surgery on gastrointestinal drug delivery.

General surgical procedures on the gastrointestinal tract are commonly performed worldwide. Surgical resections of the stomach, small intestine, or large intestine can have a significant impact on the anatomy and physiological environment of the gastrointestinal tract. These physiological changes can affect the effectiveness of orally administered formulations and drug absorption and, therefore, should be considered in rational drug formulation design for specific pathological conditions that are commonly associated with surgical intervention. For optimal drug delivery, it is important to understand how different surgical procedures affect the short-term and long-term functionality of the gastrointestinal tract. The significance of the surgical intervention is dependent on factors such as the specific region of resection, the degree of the resection, the adaptive and absorptive capacity of the remaining tissue, and the nature of the underlying disease. This review will focus on the common pathological conditions affecting the gastric and bowel regions that may require surgical intervention and the physiological impact of the surgery on gastrointestinal drug delivery. The pharmaceutical considerations for conventional and novel oral drug delivery approaches that may be impacted by general surgical procedures of the gastrointestinal tract will also be addressed.

[Endoscopic management of complications of the upper and lower gastrointestinal tract]. / Endoskopisches Komplikationsmanagement am oberen und unteren Gastrointestinaltrakt.

Even when wide-ranging measures for avoidance of complications by improved techniques, training and many other activities are undertaken, postoperative and postinterventional complications still represent a daily problem in clinical medicine. The outcome of the patient is not uncommonly decided by the management of the complications. The failure to rescue or to control complications is increasingly recognized as being decisive for the success of treatment. This article therefore provides a current overview of the endoscopic management of complications of the upper and lower gastrointestinal tract. It describes when endoscopy can be used to detect or exclude a complication. The most important principles of treatment including the indications, limits of performance and technique are presented.

[Multidimensional thinking in the era of gastrointestinal minimally invasive surgery].

Minimally invasive surgery represented by laparoscopic technique has been carried out in China for more than 30 years. Gastrointestinal minimally invasive surgery has been widely recognized and popularized. Today, when the development of minimally invasive technology has reached the ceiling, the authors, who have experienced the innovation of minimally invasive gastrointestinal surgery for more than 30 years, review the gradual, unpredictable but inevitable characteristics of the innovation and development of minimally invasive surgery; figure out that standardized promotion and systematic training are the main reasons for the success of minimally invasive surgery in gastrointestinal surgery; realize that the application and promotion of new medical technology are inseparable from the support of solid clinical and basic evidence; recognize that the re-innovation after the popularization and standardization of gastrointestinal minimally invasive surgery and how to avoid involution are the driving force to seize the development momentum of minimally invasive technology. We make a multidimensional thinking on the development of gastrointestinal minimally invasive surgery, and objectively analyze its development track, in order to calmly rise to the challenges of future technological development.

[Safety and feasibility of overlapped delta-shaped anastomosis technique for digestive tract reconstruction during complete laparoscopic right hemicolectomy].

Objective: To explore the clinical safety and feasibility of overlapped delta-shaped anastomosis (ODA) in totally laparoscopic right hemicolectomy (TLRHC). Methods: From May 2017 to October 2019, of the 219 patients who underwent TLRHC at the Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 104 cases underwent ODA (ODA group) and 115 cases underwent conventional extracorporeal anastomosis (control group) were compared the surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications. Results: The length of the skin incision in the ODA group was significantly shorter than that in the control group [(5.6±0.9) cm vs. (7.1±1.7) cm, P<0.05], and the time to first flatus and first defecation after surgery in the ODA group was significantly earlier than that in the control group [(1.7±0.7) days vs. (2.0±0.7) days; (3.2±0.6) days vs. (3.3±0.7) days, P<0.05]. While the anastomosis time, operation time, intraoperative blood loss, the time of first ground activities, the number of bowel movements within 12 days after surgery, postoperative hospital stay, tumor size, the distal and proximal margins, the number of lymph node harvested and postoperative TNM stage in the ODA group did not differ from that of the control group (P>0.05). The postoperative complication rates of patients in the ODA group and the control group were 3.8% (4/104) and 4.3% (5/115), respectively, and the difference was not significant (P>0.05). Conclusion: The application of ODA technology in TLRHC can significantly shorten thelength of skin incisionand the recovery time of bowel function, and can obtain satisfactory short-term efficacy.

Gastrointestinal foreign bodies in pet pigs: 17 cases.

BACKGROUND: Pigs have an indiscriminate eating behavior placing them at high risk of developing foreign body (FB) obstructions. OBJECTIVES: Describe the clinical and diagnostic features, treatments, and outcome of pet pigs diagnosed with gastrointestinal (GI) FBs. Medical and surgical treatments, pig outcomes, and post-mortem findings were also investigated. ANIMALS: Seventeen pet pigs. METHODS: A multicenter retrospective study was conducted. Gastrointestinal FBs were defined as swallowed objects that became lodged within the gastrointestinal tract distal to the cardia identified during exploratory laparotomy. RESULTS: Common clinical signs were anorexia/hyporexia, tachypnea, vomiting, dehydration, tachycardia, and ileus. Diagnostic imaging identified the presence of a FB in 4 cases. Upon celiotomy, the FBs were in the stomach and small intestine in 17 cases and large colon in 2 cases. Types of FB included fruit pit, diaper, and metallic objects. Of the 17 pigs, 15 (88%) were discharged from the hospital and 2 (12%) were euthanized. CONCLUSION AND CLINICAL IMPORTANCE: Clinical signs of GI FB were similar to those reported in obstipated pigs. Diagnostic imaging has limitations for detection of FB. Surgical removal of FBs in pigs carried a good prognosis.