POSSUM and P-POSSUM: Predictors of Morbidity and Mortality in Laparoscopic Roux-En-Y Gastric Bypass?

Abstract

Purpose: The objective of the study is to assess the clinical relevance of ultrasonography evaluation of hemodynamics in the bowel wall arteries for determining the optimal time of the initiation of enteral feeding in neonates with gastroschisis. Patients and methods: The sample consisted of 28 newborns with gastroschisis. Doppler ultrasonography was used to evaluate hemodynamic patterns in the bowel wall arteries in the pre- and postop periods to determine the optimal time for the initiation of enteral nutrition. Swelling of the bowel wall and indefinite differentiation into layers were observed during the first 2-3 days upon gastroschisis surgery. The blood flow in the intestinal wall arteries was varying in different quadrants, demonstrating a mosaic pattern. Hyperemia, i.e. a dramatic blood flow increase, was documented. The peripheral resistance dropped with RI equal to 0.49-0.54, but there were also areas with definite RI increases up to 0.85. By days 5-6 of life, the intestinal wall still remained moderately thickened. The resistive index (RI) values for the intestinal wall arteries were approaching the norm, ranging from 0.58 to 0.72. By days 7-9 after birth, the bowel loops remained slightly thickened, but already gained a clear differentiation into layers. The peripheral resistance indices were within the normal limits, ranging from 0.62 to 0.67. Results: In our study RI values based on Doppler evaluation of the intestinal wall hemodynamics were within 0.62-0.67. Conclusions: The hemodynamic parameters were consistent with clinical characteristics of the normal passage of food through the digestive tract. Thus, a physician can rely on both clinical signs and ultrasonography data while monitoring the bowel function during pre- and postoperative periods to decide on the optimal time for the initiation of enteral feeding.