Clinical Study on the Efficacy of Abdominal Acupuncture in Promoting Gastrointestinal Function Recovery After Gynecological Laparoscopic Surgery
Phase: NA
Conditions: Postoperative Complications, Postoperative Gastrointestinal Dysfunction (POGD), Postoperative Ileus
Sponsor: Mengyao Han

Abdominal Acupuncture for Gastrointestinal Function Recovery After Gynecologic 
Laparoscopic Surgery: A Randomized Clinical Trial 
 
Guangdong Provincial Hospital of Chinese Medicine,  
Guangzhou University of Chinese Medicine 
 
 
 
 
 
Clinical sites: 
Guangdong Provincial Hospital of Chinese Medicine 
Data Management and Statistical Centers:  
Guangzhou University of Chinese Medicine 
Date of Document: 
Dec 20, 2023  
 

Confidentiality Statement 
This document constitutes the intellectual property of the investigator. The information contained 
herein is strictly confidential and is provided solely for review by the sponsor, the investigator, 
potential investigators, the appropriate ethics committees, institutional review boards, and other 
governmental regulatory authorities. No disclosure of this information is permitted without the 
prior written authorization of the investigator who developed the protocol, except where 
disclosure is required for obtaining informed consent from potential study participants. 
 
 

Table of Contents 
1. Study Contact and Organization .................................................................................................. 5 
1.1 Study Contacts .................................................................................................................................... 5 
1.2 Investigators ........................................................................................................................................ 5 
2. Study Design ............................................................................................................................... 5 
2.1 Study Overview .................................................................................................................................. 5 
2.2 Background .......................................................................................................................................... 6 
2.3 Study Objective .................................................................................................................................. 8 
2.4 Methodology ....................................................................................................................................... 8 
2.4.1 Trial Design ............................................................................................................................. 8 
2.4.2 Patients ..................................................................................................................................... 9 
2.4.3 Trial Flow .............................................................................................................................. 11 
2.4.4 Sample Size ........................................................................................................................... 13 
2.4.5 Randomization ..................................................................................................................... 14 
3. Interventions .............................................................................................................................. 14 
3.1 Basic treatment ................................................................................................................................. 15 
3.2 Abdominal acupuncture treatment ................................................................................................ 15 
3.2.1 Instrument Selection ........................................................................................................... 16 
3.2.2 Acupoint Selection .............................................................................................................. 16 
3.2.3 Point Localization ................................................................................................................ 16 
3.2.4 Procedure ............................................................................................................................... 17 
3.2.5 Treatment Course ................................................................................................................. 18 
4. Outcome Measurements ............................................................................................................ 19 
4.1 General Parameters .......................................................................................................................... 19 

4.2 Safety Parameters ............................................................................................................................. 19 
4.3 Efficacy Parameters ......................................................................................................................... 19 
4.3.1 Clinical efficacy indices ..................................................................................................... 19 
4.3.2 Laboratory Parameters........................................................................................................ 20 
4.3.3 Relevant Assessment Scales .............................................................................................. 20 
5. Adverse Events and Management ............................................................................................. 21 
6. Ethical Principle ........................................................................................................................ 21 
7. Statistical Analysis .................................................................................................................... 21 
8. References ................................................................................................................................. 22 
Appendix 1 .................................................................................................................................... 24 
Appendix 2 .................................................................................................................................... 25 
Appendix 3 .................................................................................................................................... 26 
 
 
 

1. Study Contact and Organization 
1.1 Study Contacts 
Principal Investigator for study, 
Professor Yi Chen. 
Guangdong Provincial Hospital of Chinese Medicine,111 Dade Road, Yuexiu District, 
Guangzhou City, Guangdong Province, 510120, China 
Email address: chen_yi2024@163.com. 
1.2 Investigators 
Yi Chen, Professor, supervisor and implementer of abdominal acupuncture scheme 
Meng-yao Han, PhD, Experimental management and implementation, data collection, result 
evaluation, abdominal acupuncture plan design 
Jia-xin Feng, MM, Implementation of experiment 
Si-qi Yang, MM, Implementation of experiment 
Wen-yuan Zhu, MM, Implementation of experiment 
Rui-qi Zhao, PhD, Outcome evaluation and data collection 
2. Study Design  
2.1 Study Overview 

To investigate the clinical efficacy of abdominal acupuncture in promoting gastrointestinal 
functional recovery following gynecologic laparoscopic hysterectomy, with the aim of reducing 
postoperative complications, enhancing postoperative quality of life, and providing a safe, 
convenient, and effective therapeutic strategy for clinical practice. 
2.2 Background 
Postoperative gastrointestinal dysfunction (POGD), commonly referred to as postoperative ileus 
(POI), is a well-recognized complication1。Contemporary studies indicate that POI typically 
persists for 3–5 days and is characterized by transient impairment of gastrointestinal tract (GIT) 
function following abdominal surgery. Its pathological manifestations primarily involve mucosal 
injury, disruption of barrier integrity, and impaired gastrointestinal motility. Clinically, patients 
may present with a wide spectrum of symptoms, including nausea, vomiting, abdominal pain, 
diarrhea, defecatory difficulties, and diminished or absent bowel sounds2,3. 
The pathogenesis of this condition is multifactorial, encompassing surgical techniques and 
manipulation, disturbances of internal homeostasis, alterations in blood perfusion, anesthetic and 
analgesic regimens, inflammatory responses, and neuroendocrine mechanisms. In addition, 
unique physiological characteristics in gynecologic patients, unfavorable psychological states, 
and surgical positioning further elevate the risk of POGD, underscoring the critical importance of 
prevention and management4–11。Current Western medical approaches comprise supportive 
measures (such as enemas and fluid replacement), pharmacotherapy (e.g., metoclopramide 
hydrochloride, mosapride), endoscopic interventions, gastrointestinal pacing devices, and surgical 

procedures. However, drug-related adverse effects—including somnolence, agitation, and 
paradoxical gastrointestinal symptoms—remain prevalent, while invasive procedures carry 
inherent risks and may even exacerbate gastrointestinal dysfunction. In contrast, traditional 
Chinese medicine (TCM) has demonstrated encouraging outcomes in the management of POGD. 
Treatment modalities include oral herbal preparations, acupuncture, moxibustion, herbal enemas, 
and acupoint injections. These therapies, mainly employed as adjunctive interventions, offer the 
advantages of individualized pattern-based treatment, clear therapeutic efficacy, high safety, and 
relatively low cost. Nonetheless, challenges persist, such as reliance on practitioner experience, 
methodological limitations in clinical research, lack of standardized diagnostic criteria, 
incomplete elucidation of therapeutic mechanisms, and insufficient safety evaluation. At present, 
studies specifically targeting gastrointestinal dysfunction after gynecologic laparoscopy remain 
scarce, and greater attention should be given to the potential of TCM-based strategies to enhance 
patients’ overall postoperative quality of life by leveraging their simplicity, accessibility, and cost-
effectiveness. 
Abdominal acupuncture, as both an inheritance and an innovation of traditional acupuncture, 
has been increasingly applied in clinical settings due to its broad indications, minimal discomfort, 
stable efficacy, and rapid onset of action12–14. It operates primarily through the stimulation of 
specific abdominal acupoints, thereby harmonizing congenital and acquired Qi to restore 
physiological balance. Among various approaches, Bo’s abdominal acupuncture is most widely 
utilized. By capitalizing on the therapeutic advantages of abdominal acupoints, this technique 

enhances gastrointestinal peristalsis, facilitates gastric emptying, accelerates the recovery of 
gastrointestinal hormones, and ultimately promotes restoration of gastrointestinal function. 
Compared with conventional Chinese and Western medical interventions, abdominal acupuncture 
offers fewer adverse effects, technical simplicity, reduced financial burden, and an ability to avoid 
the unpleasant sensations of soreness, numbness, distension, or pain associated with traditional 
body acupuncture, thus highlighting its unique clinical value. This study is therefore designed to 
investigate the impact of abdominal acupuncture on gastrointestinal functional recovery and long-
term quality of life in patients undergoing gynecologic laparoscopic hysterectomy, with the 
ultimate aim of providing a safer, simpler, and more effective therapeutic modality for the 
management of postoperative gastrointestinal dysfunction. 
2.3 Study Objective 
To explore the clinical efficacy and safety of abdominal acupuncture therapy in promoting 
gastrointestinal function recovery after gynecological laparoscopic surgery. 
2.4 Methodology 
2.4.1 Trial Design 
This study was conducted as a single-center, randomized, controlled clinical trial in China. 
Ethical approval was obtained from the Ethics Committee of Guangdong Provincial Hospital of 
Chinese Medicine (Approval No. YF2023-435-01), and written informed consent was secured 
from all participants. 

2.4.2 Patients 
2.4.2.1 Patient Selection 
Between December 2023 and December 2024, patients admitted to the Department of 
Gynecology at the Dade Road Branch of Guangdong Provincial Hospital of Chinese Medicine 
who underwent laparoscopic total hysterectomy, met the inclusion criteria, voluntarily agreed to 
participate, and signed the informed consent form provided by the investigators were enrolled in 
the study. 
2.4.2.2 Diagnostic Criteria of Western Medicine 
The diagnostic criteria for postoperative gastrointestinal dysfunction were established according 
to the Expert consensus on prevention and treatment of postoperative gastrointestinal 
dysfunction15: 
(1) Nausea or vomiting; 
(2) Inability to tolerate solid or semi-liquid food within 24 hours after surgery; 
(3) Absence of flatus or defecation within 24 hours postoperatively; 
(4) Abdominal distension; 
(5) Radiological evidence of POI. 
A diagnosis can be established if any two of the above five criteria are present. 
2.4.2.3 Inclusion Criteria 

(1) Female patients who underwent gynecologic laparoscopic total hysterectomy under general 
anesthesia; 
(2) Age between 18 and 65 years; 
(3) Surgical duration ranging from 0.5 to 4.5 hours; 
(4) Anesthesia duration ranging from 1 to 5 hours; 
(5) Willingness to receive acupuncture therapy without a history of adverse reactions such as 
needle syncope; 
(6) Provision of signed informed consent. 
2.4.2.4 Exclusion Criteria 
(1) Patients with comorbid conditions that may affect gastrointestinal function, including 
intestinal obstruction or space-occupying lesions of the digestive system; 
(2) Patients with severe systemic diseases, including hepatic or renal failure, cardiovascular or 
cerebrovascular disorders, infectious diseases such as HIV/AIDS, or severe psychiatric illness; 
(3) Individuals with a history of adverse reactions to acupuncture, including needle syncope; 
(4) Patients with local skin damage, rashes, or ulcers at the proposed acupoint sites; 
(5) Patients concurrently enrolled in other clinical studies. 
2.4.2.5 Dropout Criteria 

(1) Patients who develop subcutaneous hematoma, skin damage, or rash at the primary acupoint 
sites during the trial, rendering acupuncture infeasible;   
(2) Patients who fail to comply with the prescribed treatment protocol or have incomplete data.   
2.4.2.6 Withdrawal Criteria 
(1) Patients who voluntarily request withdrawal from the clinical trial; 
(2) Patients lost to follow-up due to subjective or objective reasons. 
2.4.2.7 Criteria for Termination of Participation 
(1) Patients experiencing moderate to severe adverse reactions to acupuncture (e.g., needle 
syncope), or those unwilling to continue treatment; 
(2) Patients who develop serious adverse events or complications that preclude continuation of 
the study; 
(3) Patients who present with severe gastrointestinal dysfunction during the trial requiring 
alternative therapeutic interventions. 
2.4.3 Trial Flow 
2.4.3.1 Screening Visit 
Patients will be screened according to inclusion and exclusion criteria, eligible patients will be 
required to provide written informed consent and enter the baseline visit. Randomization will be 
performed before baseline assessment. 

2.4.3.2 Baseline Visit 
The investigators provided participants with postoperative recovery education and collected data 
on demographic information, clinical characteristics, assessment scales, and routine 
examinations. 
2.4.3.3 Abdominal acupuncture treatment 
The initial abdominal acupuncture treatment was performed 4–6 hours after surgery, followed by 
one session daily from postoperative day 1 through day 4, yielding a total of five sessions per 
treatment course. Throughout the treatment period and thereafter, patients’ clinical conditions 
were systematically recorded and evaluated, with concurrent monitoring of adverse events and 
concomitant medication use. 
2.4.3.4 Aftertreatment Visit 
On the 14th day following the final treatment, a quality-of-life assessment was conducted, and 
individualized recommendations were provided based on the patient’s current condition. 
2.4.3.5 Patient Withdrawals 
Patients may leave the study at their own discretion, and the investigator may determine if the 
patients withdraw from the trial due to violation of the trial protocol or the occurrence of a serious 
adverse event. Figure l shows the flow diagram of the trial. 

 
Figure 1 Flow chart 
2.4.4 Sample Size 
This study was designed as a randomized controlled trial, with the treatment group receiving 
abdominal acupuncture and the control group receiving conventional therapy. The primary 
outcome measure was the time to first postoperative flatus. Based on published literature, the 
mean ± standard deviation of the time to first flatus in the control group was 37.60 ± 4.11 

hours. It was anticipated that abdominal acupuncture would reduce this time by approximately 
8.1 hours. Assuming a two-sided α = 0.05 and a statistical power of 90%, the sample size was 
calculated using the standard formula: 
The required sample size was determined to be 33 participants per group. With a 1:1 
randomization ratio, both the abdominal acupuncture group and the control group required 33 
participants each. Allowing for a potential 15% dropout or loss to follow-up, the minimum 
enrollment target was set at 38 participants per group, resulting in a total sample size of no fewer 
than 76 participants. 
2.4.5 Randomization 
Randomization was performed using SPSS version 26.0. To ensure reproducibility of the 
randomization process, a Random Number Seed was first applied, followed by the generation of 
random numbers using the UNIFORM(Max) function. These random numbers were then used to 
assign participants into groups, and a randomization table was created accordingly. During 
clinical implementation, participants were allocated sequentially according to their order of 
enrollment by matching them to the corresponding numbers in the randomization table, and the 
designated treatment protocol was applied. In this study, the intervention group received 
abdominal acupuncture, while the control group received standard care. 
3. Interventions  

3.1 Basic treatment 
The standardized postoperative management protocol consists of the following components: 
(1) Early oral intake: patients may commence a liquid diet 6 hours after surgery, advance to a 
semi-liquid diet following the passage of flatus, and transition to a regular diet after bowel 
movement. 
(2) Early mobilization: patients are encouraged to turn in bed and initiate physical activity as 
early as 6 hours postoperatively, and to ambulate as soon as their condition permits. 
(3) Adequate fluid supplementation. 
(4) Maintenance of fluid–electrolyte and acid–base balance. 
(5) Prophylactic antibiotic therapy to prevent infection. 
(6) Early removal of urinary catheters, drainage tubes, and other indwelling devices. 
(7) Postoperative analgesia: implementation of a multimodal pain management strategy. 
(8) In critically ill patients, supplemental oxygen and continuous electrocardiographic monitoring 
are required. 
Note: During routine management, any interventions potentially impairing gastrointestinal 
function—such as prokinetic agents, enemas, or traditional herbal therapies—are strictly 
contraindicated.   
3.2 Abdominal acupuncture treatment 

3.2.1 Instrument Selection 
Acupuncture needles were supplied by HanYi (Changchun Aikang Medical Equipment Co., Ltd., 
Production License No. Jiyao Device Manufacturing Xu 20150075), with specifications of 1.5 
cun (0.30 mm × 40 mm) and 2.0 cun (0.30 mm × 50 mm). 
3.2.2 Acupoint Selection 
Acupoint selection for abdominal acupuncture was based on Abdominal Acupuncture Therapy14: 
Primary points: Zhongwan (CV12), Xiawan (CV10), Qihai (CV6), Guanyuan (CV4), and 
bilateral Daheng (SP15). 
Secondary points: bilateral Huaroomen (ST24) and Wailling (ST26). 
3.2.3 Point Localization 
Point localization was standardized according to the National Standard of the People’s Republic 
of China (GB/T 12346-2021): Nomenclature and Location of Acupuncture Points. The anatomical 
positions include: Zhongwan (CV12), Xiawan (CV10), Qihai (CV6), Guanyuan (CV4), Daheng 
(SP15), Huaroomen (ST24), and Wailling (ST26) (Figure 2). 

 
Figure 2 Abdominal divine turtle diagram and selected acupoints. 
The acupoints marked with red dots indicate the sites selected for treatment in this study. 
3.2.4 Procedure 
Patients were placed in the supine position with the abdominal region fully exposed. Acupoint 
selection and needling techniques followed the standards outlined in Abdominal Acupuncture 
Therapy. For localization: the distance from the umbilicus (CV8) to Zhongting (CV16) was 
defined as 8 cun above the navel; from the umbilicus to the pubic symphysis was defined as 5 cun 
below the navel; and the transverse distance from the umbilicus to the lateral abdominal margin 
was defined as 6 cun. All acupoints were measured precisely with a straight ruler and 
proportionally located. After strict hand hygiene and aseptic preparation of the acupoint sites, 

routine skin disinfection was performed. Disposable sterile acupuncture needles were inserted 
perpendicularly. Care was taken to ensure minimal or no pain during insertion. Needle 
manipulation employed gentle rotational techniques without lifting or thrusting. Primary 
acupoints were needled to the Di level (deep layer, at the base of subcutaneous fat or on the 
fascia, insertion depth approximately 1.0–1.5 cun), primarily for treating visceral disorders. 
Secondary acupoints were needled to the Ren level (intermediate layer, within the mid-fat tissue, 
insertion depth approximately 0.5–1.0 cun), predominantly for stimulating peripheral systems. 
Needle depth was adjusted according to body habitus, and patients were not required to 
experience the typical deqi sensations of soreness, numbness, distension, or heaviness. 
Needles were retained for 30 minutes, during which an infrared therapeutic lamp was applied for 
concurrent warming therapy. After treatment, needles were withdrawn carefully, and sterile cotton 
was applied with gentle compression at the insertion sites to prevent bleeding. 
Note: Needling was avoided directly at surgical incisions. In such cases, acupoints were either 
slightly displaced for adjusted localization or omitted as appropriate. 
3.2.5 Treatment Course 
The first abdominal acupuncture session was performed 4–6 hours postoperatively. From 
postoperative Day 1 through Day 4, one session was administered daily, with a total of five 
sessions constituting a complete treatment course. Clinical condition was carefully documented 
and evaluated throughout and following the treatment period. 

4. Outcome Measurements 
4.1 General Parameters 
Collected variables included age, body mass index (BMI), intraoperative blood loss, operative 
duration, and length of postoperative hospitalization. 
4.2 Safety Parameters 
Laboratory and clinical assessments—including complete blood count, electrocardiography, and 
liver function tests—were performed preoperatively (upon admission), on the day of surgery 
before treatment, and on postoperative Day 5. 
Adverse events related to acupuncture were monitored during treatment, such as syncope, needle 
breakage, bending or retention, palpitations, and excessive perspiration. 
4.3 Efficacy Parameters 
4.3.1 Clinical efficacy indices 
 
Recovery of gastrointestinal motility including time to first postoperative passage of flatus 
(recorded to the exact hour and minute), time to first postoperative bowel movement 
(recorded precisely), and restoration of bowel sounds. 
 
Incidence of postoperative gastrointestinal dysfunction related complications: including 
abdominal distension or pain, nausea, vomiting, and diarrhea. 
All the above parameters were observed starting on the day of surgery and continued to be 

recorded daily until the fifth postoperative day or discharge, whichever came first. 
4.3.2 Laboratory Parameters 
Inflammatory markers included C‑reactive protein (CRP), serum interleukin‑6 (IL‑6), serum 
tumor necrosis factor‑α (TNF‑α), and the systemic immune‑inflammation index [SII, SII = 
(platelet count × neutrophil count) / lymphocyte count]. 
Each parameter was assessed once preoperatively, on the day of surgery prior to treatment, and on 
postoperative Day 5. 
4.3.3 Relevant Assessment Scales 
 
Pain assessment: The Visual analogue scale (VAS) was applied (Appendix 1). Abdominal 
pain scores were recorded before and after treatment on the day of surgery (5 days after 
surgery). 
 
Gastrointestinal symptom assessment Symptom scoring was based on the Perioperative 
Clinical Evaluation Standards for Gastrointestinal Motility (Guangdong Provincial Standard, 
Appendix 2). Scores were documented daily from the day of surgery (before treatment) 
through postoperative Days 1–5, according to observed gastrointestinal function. 
 
Quality of life assessment The Gastrointestinal Quality of Life Index (GIQLI) was 
employed (Appendix 3). Assessments were performed on the day of surgery prior to 
treatment, on postoperative Day 5, and again on Day 14 following the final treatment 
session. 

5. Adverse Events and Management 
If adverse reactions occurred during the trial—such as needle stagnation, syncope, breakage, 
hematoma, or infection—investigators promptly managed the event, ensured patient safety, 
reassured the participant with an explanation, and documented the details in the case report form. 
6. Ethical Principle 
This clinical trial was reviewed and approved by the Ethics Committee of Guangdong Provincial 
Hospital of Traditional Chinese Medicine prior to participant enrollment (Approval No. 
YF-2023-435-01). The study was conducted in full compliance with the principles of the 
Declaration of Helsinki. 
7. Statistical Analysis 
Data were organized and managed using Microsoft Excel to establish a primary database, which 
was subsequently converted into an SPSS 26.0 database for statistical analysis. The Shapiro–Wilk 
test was employed to assess the normality of continuous variables. According to data distribution, 
descriptive statistics were presented as mean ± standard deviation (SD) for normally distributed 
variables, and as median with interquartile range [P25, P75] for non-normally distributed variables. 
Between-group comparisons of normally distributed data were performed using independent-
samples t tests, while within-group pre- and post-treatment comparisons were conducted using 
paired t tests. For non-normally distributed data, the Mann–Whitney U test was applied for 
between-group comparisons, and the Wilcoxon signed-rank test for within-group comparisons. 

Categorical variables were expressed as frequencies (n) and percentages (%), with between-group 
comparisons analyzed using the chi-square test or Fisher’s exact test, as appropriate. Repeated 
measures analysis of variance (ANOVA) was applied for comparisons across multiple time points 
between groups. All statistical analyses were two-tailed, and a P value of less than 0.05 was 
considered statistically significant. 
8. References 
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Accessed September 24, 2025. http://www.ncbi.nlm.nih.gov/books/NBK560780/ 
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2009;58(9):1300-1311. doi:10.1136/gut.2008.169250 
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Ileus Management: A Narrative Review. Medicina (Kaunas). 2025;61(8):1344. 
doi:10.3390/medicina61081344 
4. Mythen MGM. Postoperative gastrointestinal tract dysfunction: an overview of causes and 
management strategies. Cleve Clin J Med. 2009;76 Suppl 4:S66-71. 
doi:10.3949/ccjm.76.s4.11 
5. Kehlet H. Surgical Stress Response: Does Endoscopic Surgery Confer an Advantage? World 
J Surg. 1999;23(8):801-807. doi:10.1007/s002689900583 
6. Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative 
ileus: Recent developments in pathophysiology and management. Clinical Nutrition. 
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existence of the vagal anti-inflammatory reflex in the intestine: The vagal anti-inflammatory 
reflex. Neurogastroenterology & Motility. 2012;24(2):191-e93. doi:10.1111/j.1365-
2982.2011.01824.x 
8. Schietroma M, Carlei F, Cecilia EM, et al. A Prospective Randomized Study of Systemic 
Inflammation and Immune Response After Laparoscopic Nissen Fundoplication Performed 
With Standard and Low-pressure Pneumoperitoneum. Surgical Laparoscopy, Endoscopy & 
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9. Mazzotta E, Villalobos-Hernandez EC, Fiorda-Diaz J, Harzman A, Christofi FL. 
Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic 
Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After 
Surgery Protocols. Frontiers in Pharmacology. 2020;11. Accessed September 28, 2023. 
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2000;87(11):1480-1493. doi:10.1046/j.1365-2168.2000.01595.x 
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Physiological Ileus and Postoperative Pain in Major non Laparoscopic Gastrointestinal 
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Appendix 1 
Visual Analogue Scale (VAS) 
□Not Assessed 
□Assessed: Score: 
□No pain (0) □Mild pain (1-3) □Moderate pain (4-6) □Severe pain (7-10) 
 
 
 
 

Appendix 2 
Gastrointestinal symptom rating scale 
Observation 
items 
Symptom grading 
Anal 
exhaustion 
 15 points: Present    0 points: Absent   Postoperative exhaust time: 
Defecation 
 15 points: Present    0 points: Absent   Postoperative defecation time: 
Abdominal 
distension/pain 
 10 points: No distension or pain     5 points: Mild distension or discomfort 
 0 points: Intolerable distension or pain 
Bowel Sounds  10 points: Normal    5 points: Reduced  0 points: Absent 
Nausea 
 10 points: No nausea   5 points: No nausea at rest, mild nausea upon activity 
 0 points (i) Intermittent nausea at rest   0 points (ii) Persistent nausea at rest 
with aggravation during activity 
Vomiting 
 10 points: None   5 points: 1–2 episodes/day   0 points (i) 3–5 
episodes/day；0 points (ii) ≥6 episodes/day 
Diarrhea 
 10 points: None   5 points: 1–2 episodes/day   0 points (i) 3–5 
episodes/day；0 points (ii) ≥6 episodes/day 
Surgical 
Incision 
 10 points: Well-approximated, without redness, swelling, or pain   0 points: 
Redness, swelling, heat, pain, fat liquefaction, or wound dehiscence 
Body 
Temperature 
℃   10 points: ≤37.5℃   5 points: 37.5–39℃   0 points: ≥39℃ (Record 
highest temperature of the day) 
7:00-9:00 
Time: ___ h ___ min /10 points  5 points  0 points   Not recorded 
11:00-13:00 
Time: ___ h ___ min /10 points  5 points  0 points   Not recorded 
17:00-19:00 
Time: ___ h ___ min /10 points  5 points  0 points   Not recorded 
Time of first 
tolerance 
to 
food 
Semi-liquid diet   None   Yes: ___ h ___ min 
Solid diet        None   Yes: ___ h ___ min 

Appendix 3 
Gastrointestinal Quality of Life Index 
1. During the past week, how often have you experienced abdominal pain (frequency and severity)? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
2. During the past week, how often have you experienced a sense of gastric (epigastric) fullness or 
distension? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
3. During the past week, how often have you experienced abdominal bloating (excessive gas in the 
abdomen)? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
4. During the past week, how frequently have you passed flatus? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
5. During the past week, how often have you experienced belching (release of gastric gas through the 
mouth)? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
6. During the past week, how often have you noticed bowel sounds (audible abdominal gurgling)? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
7. During the past week, how often have you experienced excessive bowel movements? 
 A. Very pronounced  B. Pronounced  C. Moderate  D. Slight  E. No change 
Please mark √ in the box corresponding to the option that best applies to you, for example: ☑ E. 
Scoring Criteria: A = 0 points, B = 1 point, C = 2 points, D = 3 points, E = 4 points. 
The sum of all item scores constitutes the GIQLI total score. 
Total Score:        

8. During the past week, how often have you lacked appetite during meals? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
9. During the past week, how often did you have to avoid certain preferred foods due to illness? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
10. During the past week, how well were you able to cope with and manage daily life stress? 
 A. Very poor  B. Poor  C. Fair  D. Good  E. Excellent 
11. During the past week, how often have you felt sad because of your illness? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
12. During the past week, how often have you felt tense or fearful because of your illness? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
13. During the past week, how often have you felt dissatisfied with your life? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
14. During the past week, how often have you felt discouraged because of your illness? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
15. During the past week, how often have you felt fatigued? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never 
16. During the past week, how often have you felt unwell? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
17. During the past week, how frequently have you experienced insomnia at night? 
 A. Every night  B. 5–6 nights per week  C. 3–4 nights per week  D. 1–2 nights per week £ E. 
Never 
18. Do you feel that your appearance has changed due to illness (e.g., pallor, weight loss)? 
 A. Very evident  B. Evident  C. Moderate  D. Slight  E. No change 

19. To what extent has your physical strength declined? 
 A. Very evident  B. Evident  C. Moderate  D. Slight  E. No change 
20. To what extent has your endurance decreased? 
 A. Very evident  B. Evident  C. Moderate  D. Slight  E. No change 
21. To what extent has your overall health deteriorated? 
 A. Very evident  B. Evident  C. Moderate  D. Slight  E. No change 
22. During the past week, to what extent has your illness interfered with daily work (including household 
tasks or study)? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Not at all 
23. During the past week, to what extent has your illness interfered with leisure activities? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Not at all 
24. During the past week, how much distress have you experienced due to treatment? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Not at all 
25. To what extent has your illness affected your relationships with family and friends? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
26. To what extent has your sexual life been restricted? 
 A. Very evident  B. Evident  C. Moderate  D. Slight  E. No change 
27. During the past week, how often have you experienced regurgitation (return of food or fluid from the 
stomach to the mouth)?  
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
28. During the past week, how often has your eating speed been restricted? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
29. During the past week, how often have you experienced difficulty swallowing food? 

 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
30. During the past week, how often have you experienced a sudden urge to defecate? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
31. During the past week, how often have you experienced diarrhea? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
32. During the past week, how often have you experienced constipation? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
33. During the past week, how often have you experienced nausea? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
34. During the past week, how often have you noticed blood in your stool? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
35. During the past week, how often have you experienced heartburn (a burning sensation in the stomach 
or chest)? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never  
36. During the past week, how often have you experienced fecal incontinence? 
 A. All the time  B. Most of the time  C. Sometimes  D. Occasionally  E. Never