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Background/aim: Enteral feeding and immunonutrition (ImN) have been shown to be associated with a number of favorable effects in patients undergoing cancer surgery. In this prospective study, we aimed to assess the perioperative use of enteral immunonutrition in patients undergoing radical gastrointestinal surgery for malignancy.Materials and methods: Forty-one patients with malignancy were included in this study and were randomized into one of the two following nutritional strategies: enteral only (EN) or enteral with enteral immunonutrition (ENIN). These regimens were followed for 7 days perioperatively by all patients. Nutritional parameters and postoperative morbidity, mortality, and length of hospital stay (LHS) were assessed.Results: Serum prealbumin levels increased significantly in the ENIN group (P = 0.033). Moreover, patients in the ENIN group showed a more marked decrease in the rate of postoperative infections (P = 0.021) and anastomotic leakage (P = 0.018) than patients fed with EN. In the EN group, LHS was significantly longer than that in the ENIN group (18 vs. 12 days) (P = 0.032). Rates of overall morbidity and mortality were similar in the two groups (P > 0.05). Conclusion:ENIN was found to have a favorable effect on the outcome of radical gastrointestinal surgery for malignancy. Meticulous preoperative assessment of malnutrition and at least a 7-day perioperative enteral use can increase the effectiveness of immunonutrition.

BackgroundForeign bodies in rectum and colon is an uncommon problem in surgical practice. Anal eroticism leads amongst etiologic factors. In some patients accidents or forceful application of foreign bodies are causative factors. This study was designed to describe our experience in diagnosis and treatment of this exciting clinical problem.MethodsData were collected prospectively from 1998 to 2013 in 30 patients. Patient demographics, diagnostic findings, location, type, extraction method, and postextraction period were reviewed.ResultsAll the 30 patients were their first admission in emergency service of a hospital. On admission high alcohol intake was determined in 15(50%) patients. All the patients were hospitalized. Most of the rectal foreign bodies (23 of 25) was located distal 2/3 of the rectum. Colorectal perforation was diagnosed in 5 patients who had not any retained foreign body. Under adequate anesthesia transanal extraction was implemented in 23 (92%) patients in the operating room. In the patients with proximal located rectal foreign bodies (2/25), grade III and IV rectal injury or colonic perforation (7/30) laparotomy was carried out.ConclusionA careful physical and rectal examination is essential for correct diagnosis and localization of retained foreign bodies. Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation. The operating room provides adequate anaesthesia for muscle relaxation and technical advantages in transanal extraction of rectal foreign bodies. Therefore, nonoperative success rate improves. If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.