The optimal timing of temporary ileostomy closure following restorative colorectal surgery remains controversial. Although previous randomized studies have demonstrated the feasibility of early closure in carefully selected patients, the influence of closure timing on operative complexity has not been prospectively evaluated. This multicenter randomized controlled trial compared a standardized 3-week ileostomy closure strategy with conventional delayed closure, with particular emphasis on technical and postoperative outcomes. In this prospective multicenter randomized controlled trial, 224 patients undergoing restorative colorectal resection with temporary diverting ileostomy were randomized to either early ileostomy closure at 3 weeks (n = 112) or conventional delayed closure (n = 112). Eligibility for reversal required rigorous confirmation of anastomotic healing using standardized clinical and endoscopic assessment, with selective computed tomography using rectal contrast when clinically indicated. The primary outcome was operative complexity, evaluated using operative duration, intraoperative adhesion severity, and the requirement for extended adhesiolysis. Secondary outcomes included postoperative morbidity, Clavien–Dindo complication grade, length of hospital stay, readmission, reoperation, re-diversion, and delay in adjuvant chemotherapy. Baseline demographic, clinical, and operative characteristics were comparable between the study groups. Early ileostomy closure was associated with significantly shorter operative duration (90 ± 12 vs. 130 ± 18 min; P < 0.001), substantially lower intraoperative adhesion severity (P = 0.04), and a markedly reduced requirement for extended adhesiolysis (5.4
To explore the effect of 580 μg linaclotide combined with 2 L polyethylene glycol (PEG) in bowel preparation for overweight individuals and compare it with the 3 L PEG split-dose regimen. Patients aged 18–70 years who were overweight were randomly assigned to two groups: 2 L PEG + 580 μg linaclotide (2 L PEG + 2 L) and 3 L PEG split-dose. The primary outcome was adequate bowel preparation, as assessed by the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included cecal intubation rate, terminal ileum intubation rate, adverse events (AEs), willingness to repeat the preparation next time, and patient satisfaction score. A total of 240 patients were included in the analysis: 121 in the 2 L PEG + 2 L group and 119 in the 3 L PEG group. Adequate bowel preparation did not differ significantly between the two groups (p > 0.05). The incidence of nausea, vomiting, and abdominal discomfort was significantly lower in the 2 L PEG + 2 L group than in the 3 L PEG group (p < 0.05). The patient satisfaction score was significantly higher in the 2 L PEG + 2 L group than in the 3 L PEG group (p < 0.05). The 2 L PEG +2 L group had a significantly higher willingness to repeat bowel preparation than the 3 L PEG group (p < 0.05). Binary logistic regression revealed a significant increase in inadequate bowel preparation with increased BMI. Among overweight individuals, the 2 L PEG + 2 L regimen provides equally effective bowel cleansing quality compared with the 3 L PEG regimen, while offering superior tolerability and patient satisfaction. It represents a preferable modified bowel preparation strategy for this population.
Although perioperative care has advanced significantly, postoperative morbidity remains a major contributor to adverse clinical and oncological outcomes. This has shifted the focus from merely lowering complication rates toward enhancing system responsiveness and preventing failure-to-rescue (FTR). This review examines how the interaction among several factors, including prevention, surveillance, multidisciplinary rescue and recovery protocols, and effective healthcare systems, influences outcomes after colorectal cancer surgery. A conceptual 4P–3R–FTR model is proposed. The 4P component is a preventive framework including prediction, prehabilitation, precision surgery, and pathway optimisation, emphasising tailored risk stratification, physiological optimisation, high-quality surgery, and enhanced recovery protocols. The 3R component is management-oriented, including recognition, rescue, and recovery, focusing on timely detection of deterioration, timely escalation and rescue protocols, and restoration of functional and oncological recovery. This framework provides a practical roadmap linking prevention, complication management, and healthcare system performance. Special consideration is critical for high-risk cohorts, including elderly, frail, and patients with obesity. Additional high-risk contexts include emergency CRC surgery and low-resource settings, which are associated with higher rates of complications and failure-to-rescue. Improvement in precision and perioperative care may be achieved by adopting emerging innovations. Future directions for improving outcomes after CRC surgery depend on evolving strategies such as AI-based predictive models, remote monitoring, digital ERAS platforms, immunonutrition, and microbiome modulation.
Patients increasingly use large language models (LLMs) for health information, yet the evaluation of the quality of fecal incontinence (FI) content from these models is limited. We aimed to evaluate the quality, understandability, and actionability of LLM responses to FI queries. We hypothesized that LLMs would provide variable quality responses with variable understandability and actionability. Search data was extracted from Google Trends’ top five search queries related to FI to create identical prompts used to generate responses from four LLMs: ChatGPT version 4o mini (OpenAI), Perplexity version sonar (Perplexity AI), LLaMA version 3.2 (Meta AI), and Gemini version 2.0 flash (Google). Responses were assessed using DISCERN, Patient Education Materials Assessment Tool (PEMAT), and the Flesch–Kincaid Grade Level (FKGL). Statistical analysis was performed using R version 4.4.2 (R Core Team, 2025). Response quality was moderate (median DISCERN 44 out of 80), nominal understandability was median 77
Complications following ileoanal pouch surgery, including anastomotic leak and pouch-related fistula, carry significant morbidity and a high risk of failure following ileostomy reversal. Standard radiological and endoscopic assessments may not reliably reflect the biological and functional integrity of a defunctioned pouch. We describe a novel application of chyme reinfusion through a diverting ileostomy as a dynamic functional stress test of ileoanal pouch integrity, and as a means of bowel rehabilitation prior to stoma reversal, in three patients with complex pouch-related complications. In all cases, the technique was technically feasible, well tolerated, and provided functional information beyond that afforded by conventional imaging. No procedure-related complications were observed. Chyme reinfusion may complement standard assessment tools and help prepare the bowel for future reversal surgery.
