Abstract
BackgroundPerioperative fluid restriction in a variety of operations has shown improvement of: complications, recovery of gastrointestinal function and length of stay (LOS). We investigated effects of crystalloid fluid restriction in pancreatic surgery. Our hypothesis: enhanced recovery of gastrointestinal function.MethodsIn this double-blinded randomized trial, patients scheduled to undergo pancreatoduodenectomy (PD) were randomized: standard (S:10ml/kg/hr) or restricted (R:5ml/kg/hr) fluid protocols. Primary endpoint: gastric emptying scintigraphically assessed on postoperative day 7.ResultsIn 66 randomized patients, complications and 6-year survival were analyzed. 54 patients were analyzed in intention to treat: 24 S-group and 30 R-group. 32 patients actually underwent a PD and 16 patients had a palliative gastrojejunostomy bypass operation in the full protocol analysis. The median gastric emptying time (T½) was 104 minutes (S-group, 95% confidence interval: 74–369) versus 159 minutes (R-group, 95% confidence interval: 61–204) (P = 0.893, NS). Delayed gastric emptying occurred in 10 patients in the S-group and in 13 patients in the R-group (45% and 50%, P = 0.779, NS). The primary outcome parameter, gastric emptying time, did not show a statistically significant difference between groups.ConclusionA fluid regimen of 10ml/kg/hr or 5ml/kg/hr during pancreatic surgery did not lead to statistically significant differences in gastric emptying. A larger study would be needed to draw definite conclusions about fluid restriction in pancreatic surgery.Trial registration ISRCTN62621488
Highlights
Perioperative fluid restriction can enhance recovery of gastrointestinal function, reduce complications and hospital stay in patients subjected to a variety of abdominal surgical procedures [1,2,3,4,5,6]
We investigated effects of crystalloid fluid restriction in pancreatic surgery
Delayed gastric emptying occurred in 10 patients in the S-group and in 13 patients in the R-group (45% and 50%, P = 0.779, NS)
Summary
Perioperative fluid restriction can enhance recovery of gastrointestinal function, reduce complications and hospital stay in patients subjected to a variety of abdominal surgical procedures [1,2,3,4,5,6]. This beneficial effect of fluid restriction is due to a decrease in visceral and interstitial edema caused by crystalloids infusion during surgery [7,8,9].
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