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Surgical Treatment and Perioperative Management of Idiopathic Abdominal Cocoon: Single-Center Review of 65 Cases

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Abstract

Background

The abdominal cocoon (AC) is a condition in which a variable length of healthy small bowel is enveloped in a fibrocollagenous membrane, giving the appearance of a cocoon. Early experiences with treatment were associated with high mortality and morbidity rates and a low preoperative diagnostic rate, leading to underestimation of the treatment benefit of surgery.

Methods

We retrospectively reviewed the medical records of 65 patients who were diagnosed as having AC from 2001 to 2011. The clinical data, surgical intervention, and perioperative management were carefully reviewed.

Results

The 65 patients (57 male, 8 female) had a median age of 39 years (range 14–79 years). Patients who received preoperative nutritional support had higher rate of grade 0 complications (p = 0.012) and a lower rate of grade II complications (p = 0.012) than those without nutritional support. Intestinal stenting during surgical intervention also decreased both grade I (p = 0.012) and grade II (p = 0.007) complications. Patients who received preoperative nutritional support and underwent intestinal stenting had a lower rate of postoperative complications (p < 0.05). In addition, patients with preoperative nutritional support were more satisfied postoperatively (p = 0.018) than those without nutritional support. This was also observed in patients with intestinal stenting versus those without it (p = 0.027).

Conclusions

Our single-center study with a large number of patients provided evidence regarding the epidemiology of AC. Preoperative nutritional support and intestinal stenting significantly reduced postoperative complications and, more importantly, increased postoperative satisfaction.

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Acknowledgments

This work was supported in part by funding from the Jiangsu Provincial Special Program of Medical Science (BL2012006).

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China

    Ning Li, Weiming Zhu, Yi Li, Jianfeng Gong, Lili Gu, Min Li, Lei Cao & Jieshou Li

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  1. Ning Li
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  2. Weiming Zhu
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  3. Yi Li
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  4. Jianfeng Gong
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  8. Jieshou Li
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Correspondence to Jieshou Li.

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Li, N., Zhu, W., Li, Y. et al. Surgical Treatment and Perioperative Management of Idiopathic Abdominal Cocoon: Single-Center Review of 65 Cases . World J Surg 38, 1860–1867 (2014). https://doi.org/10.1007/s00268-014-2458-6

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