Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes.

Introduction Prehabilitation aims to optimise functional capacity before surgery. We present the prehabilitation programme through a mobile app (PREHapp). Methods Patients with resectable colon cancer, ≥18 years old, without comorbidities and with Android Smartphones are selected. The following programme is proposed through PREHapp during the 4 week pre- and postoperative period. Depending on the results of the 6-minute test and the initial ergospirometry, the programme would be individualised with different objectives. The app allows the patient to record their activities and synchronises with a website designed for the surgeon through which he/she can monitor compliance. Results The impact of prehabilitation on outcomes depended on compliance. Studies show that high compliance rates in ERAS programmes are associated with fewer postoperative complications. In this aspect, telemedicine could have great potential, as it has enabled the design of new health programmes that improve accessibility, including the creation of apps. The use of these apps favours therapeutic compliance and patient education, which enhances their empowerment in disease management. Conclusions There are few studies on the use of telemedicine in the field of prehabilitation. The PREHapp application could improve compliance and thus improve functional capacity before surgery.

INTRODUCTION Urgency surgeries are often performed in a stressful setting, out of hours and with critical patient involved. In this context, laparotomy closure can sometimes be deficient. Suture recommended by European Hernia Society is slowly absorbable monofilament continuous suture with a “small bites” technique. Barbed sutures appear as an alternative to conventional suture, frequently used in laparoscopic procedures due to its’ intrinsic maintenance of traction. The aim of this study is to describe the results in terms of short and mid-term rate of incisional hernia after urgency midline laparotomy, according to the suture utilized. MATERIAL AND METHODS A single-center retrospective cohort study was performed including patients with urgency midline laparotomy during 2018. Group A was represented by patients with slowly absorbable monofilament continuous suture. Group B included patients with barbed suture laparotomy closure. Main variables were hernia rates one month and one year after surgery, diagnosed by physical exploration and/or imaging. RESULTS A total of 68 of patients (36 on group A; 32 Group B) were included. On Group A, 13.9% (5) patients presented incisional hernia on the month follow-up, whereas none did on Group B. After a year, Group A only had 1 new case, but 12.5% of patients did herniate on group B; with no significantly relation with obesity neither underlying neoplasm. CONCLUSIONS Midline laparotomy closure must be performed within quality standards, as “small bites” technique with the ratio at least 4/1. Barbed suture appears as a promising closure option, especially in emergency procedures, but needs further study.

technical success. In both cases, Ovesco clips were applied to both ends of the fistula tract and post-procedure fluoroscopy did not demonstrate evidence of a leak. This technique affords several benefits over endoscopic management from only one side. Small fistula tracts can be difficult to identify endoscopically, but simultaneous upper endoscopy and colonoscopy provide the advantage of unique techniques for fistula identification. Techniques include insufflation with identification of bubbles, passage of wire across the fistula, and intubation of the fistula tract with a small endoscope. Next, the technique allows for wire assistance in placing the Ovesco clip. Ovesco clips work best with the scope in an 'end-on' position; however, this is often difficult given the location of the fistula. With a wire in place, the tissues, scope and clip can be pulled into proper alignment for optimal clip deployment. This video highlights the important point that Ovesco clips can be fired over a wire, and the wire can be easily pulled through the clip after deployment. Finally, the clinical outcomes of this technique will require further study. Both patients in this case series experienced initial recurrence after endoscopic therapy, at 21 and 62 days, respectively. It is well established that Ovesco clip application to nonacute GI tract defects such as fistulas is successful approximately 50% of the time. However, in patients with contraindications to operative management, successive endoscopic closure attempts can be the safest option and the 'kissing clips' technique can help to optimize each attempt.