Nasogastric Tube Research Articles

How enteral nutrition modes influence nasopharyngeal carcinoma survivors with late dysphagia after radiotherapy: a randomized controlled study.

Palliation to late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC) continues to be a challenge. Intermittent oro-esophageal tube feeding (IOE) is an emerging enteral nutrition mode that can address nutrition and quality of life issues related to nasogastric tube feeding (NGT). This study aims to investigate the effect of IOE versus NGT in late dysphagia after radiotherapy for NPC. This randomized controlled study included 82 NPC survivors with late dysphagia after radiotherapy. The subjects were randomized divided into the IOE and NGT groups (n1 = n2 = 41). Both groups received standard-of-care rehabilitation. Enteral nutrition supports were administered through IOE or NGT accordingly. This study lasted 2weeks for each participant. The primary outcome was nutritional status including albumin, hemoglobin, total serum protein, and body mass index. The secondary outcomes were (i) the functional oral intake scale (FOIS), (ii) the penetration-aspiration scale (PAS), (iii) oral transit time (OTT), (iv) hyoid pause time (HPT), (v) pharyngeal transport time (PTT), and (vi) swallowing-quality of life (SWAL-QoL). Three cases quitted the study halfway and there were no significant baseline differences between the IOE (n = 40) and NGT (n = 39) groups. Both time and group effects were significant in all nutritional indicators. The time effect was significant in the FOIS levels, OTT and PTT, while the group effect was not. Either time or group effect were insignificant in the PAS levels and HPT. Both group and time effects were significant in the SWAL-QoL total scores (zGroup = 5.080, P < 0.001; zTime = 18.005, P < 0.001). The significance of time and group effects varied across different dimensions of the SWAL-QoL. Rehabilitation interventions can improve swallowing function among NPC survivors with late dysphagia after radiotherapy. In this population who received standard-of-care rehabilitation, IOE is more conducive to the improvement of nutritional status, and swallowing-related quality of life. ClinicalTrials.gov Identifier: NCT06301763.

Efficacy of enteral feeding by gastrostomy tube placement in patients with Lennox-Gastaut syndrome on body weight and days of hospitalization: A retrospective case series.

Lennox-Gastaut syndrome (LGS) is a severe form of drug-resistant epilepsy that begins during childhood and frequently leads to significant neurological impairments. Patients with LGS are likely to receive improper oral nutrition because of issues such as dysphagia and aspiration risk, potentially resulting in long-term tube feeding and eventual gastrostomy tube placement. Therefore, we investigated the effects of gastrostomy tube placement on nutrition outcomes and frequency of hospitalization in LGS. We retrospectively examined 67 patients diagnosed with LGS who had undergone gastrostomy tube placement between January 2005 and August 2022. Comprehensive clinical data and complications arising from the procedure were collected. Patients' nutrition condition and frequency of hospitalizations were analyzed before and after gastrostomy tube placement. Gastrostomy tube placement was performed for the following reasons: high risk of aspiration (50 out of 67, 74.6%), dysphagia (13 out of 67, 25.4%), persistent nasogastric tube feeding (2 out of 67, 3.0%), and severe malnutrition (2 out of 67, 3.0%). After the procedure, z scores for weight-for-age improved significantly, shifting from -3.35 ± 3.57 to -2.54 ± 2.70 over a 2-year interval (P < 0.001). Additionally, the total days of hospitalization and days of hospitalization due to respiratory symptoms reduced significantly from 41.94 ± 51.76 to 15.27 ± 26.68 (P < 0.001) and from 23.75 ± 36.92 to 10.52 ± 22.98 (P = 0.009), respectively. Among the patients, 50 (74.6%) experienced complications resulting from gastrostomy, with a relatively small proportion of major complications (11 out of 67, 16.4%) and no mortality. Gastrostomy tube placement is a relatively safe procedure with favorable effects on nutrition status and hospitalization rates in patients with LGS.

Acute primary gastric volvulus with open suture gastropexy: a case report

Introduction &amp; importance: Gastric volvulus is rare and may result in a closed loop obstruction. Even with appropriate management, mortality may occur in up to 50% of patients. The conventional treatment for acute gastric volvulus has been immediate operation with reducing and detorsion of the volvulus. Case Presentation: Here, we present a case of acute gastric volvulus following fasting. Our patient underwent definitive surgical treatment with detorsion and gastropexy, and discharged with no postoperative complications. Clinical Discussion: Acute gastric volvulus is a rare yet serious medical condition that requires immediate diagnosis and intervention to prevent complications. The case presented highlights the importance of recognizing both common and subtle signs of gastric volvulus, though nonspecific symptoms may delay diagnosis. In this patient, the acute onset of symptoms following a large meal and failure to pass a nasogastric tube were early indicators that prompted imaging and led to the diagnosis of mesenteroaxial gastric volvulus. CT imaging played a crucial role in confirming the diagnosis, demonstrating its value in acute abdominal presentations where symptoms overlap with other causes of gastrointestinal obstruction. This case also emphasizes the importance of early intervention to avoid ischemic complications and improve survival rates. Conclusion: Acute gastric volvulus is a rare, potentially life-threatening condition that can easily be missed due to nonspecific symptoms. Early recognition, prompt imaging, and immediate surgical intervention are critical to preventing serious complications such as strangulation and necrosis.

Implementation of enhanced recovery protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for metastatic ovarian cancer following neoadjuvant chemotherapy. A feasibility study

ObjectiveThe aim of this study is to evaluate the implementation of the elements of enhanced recovery (ERAS) protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for metastatic ovarian cancer. ERAS protocols have shown improvement in the perioperative outcomes of patients who underwent cytoreductive surgery for metastatic ovarian cancer by reducing the length of stay as well as the postoperative complications and by improving patients’ postoperative experience. MethodsThis is a feasibility study involving retrospective analysis from (31) patients who underwent cytoreductive surgery and HIPEC versus (35) a control group that underwent cytoreductive surgery only, prior to the introduction of the HIPEC programme for metastatic ovarian cancer. All patients had undergone neoadjuvant chemotherapy prior to surgery. We compared the compliance for each element of the ERAS protocol between the two study groups. ResultsWe analyzed data from 66 patients, 31 in HIPEC group and 35 in the control goup. We found no significant difference in the patients’ characteristics between the two groups and there were no differences in the implementation of 8 elements of the ERAS protocols (100 % for both groups). The use of nasogastric tube was more frequently observed in patients undergoing surgery and HIPEC compared to those undergoing surgery alone (42 % vs 0 %, respectively; p < 0.001). The number of patients who were mobilized on the first postoperative day was higher in the group undergoing surgery and HIPEC (87.1 % vs 57.1 %, respectively; p = 0.007), however there was no significant difference in the percentage of patients that had early removal of the urinary catheter (p = 0.12), nor in the percentage of patients that received early feeding (p = 0.18). Finally, there were no statistically significant differences in the complication rates, the length of hospital stay and the re-admission rates between the two groups. ConclusionEnhanced recovery protocols can be implemented safely in patients undergoing cytoreductive surgery and HIPEC for ovarian cancer.

Nasogastric tube combined with thin therapeutic endoscope to facilitate esophageal endoscopic submucosal dissection

Nasogastric tube combined with thin therapeutic endoscope to facilitate esophageal endoscopic submucosal dissection

EVALUATION OF POSTOPERATIVE AIRWAY RELATED ADVERSE EFFECTS BY USING INTRACUFF DEXAMETHASONE VERSUS INTRACUFF ALKALINISED LIGNOCAINE - RANDOMISED DOUBLE BLIND CONTROLLED STUDY

Background Securing airway with ETT is the gold standard for General anesthesia(GA).This method confers the protection of airway from aspiration of gastric contents and facilitates positive pressure ventilation. However, post-intubation airway-related adverse effects are known to be caused by endotracheal intubation like postoperative coughing on the tube, restlessness, hoarseness and sore throat. Therefore this study was undertaken to reduce post intubation complications. ObjectiveThestudy was conducted to compare intracuff dexamethasone and intracuff alkalinised lignocaine with respect to postoperative cough, hoarseness and sore throat scores. Methods A randomized double blind study was conducted in 200 patients of ASA I,II,III and age between 18 to 60 yrs undergoing surgeries under GA for more than 2 hours, Patients who need nasogastric tube or throat pack were excluded from study. A computer generated randomisation with double blind technique was used to distribute them into Group L and Group D 100 each. In Group L, ETT cuff was inflated with 2ml of 2% lignocaine +2-3ml of 7.5% Sodium bicarbonate and in Group D cuff was inflated with 2ml of dexamethasone + 2-3ml of Normal saline. Intracuff pressure was monitored throughout the surgery and was maintained below 28 cm H2O. ResultsThe severity of cough and hoarseness was found higher in group D at 2 hours which was statistically significant (P&lt; 0.05). However, there was no significant difference at 8hrs,16hrs and 24hrs in both the groups. Conclusion We conclude that post operative airway related adverse effects are less when cuff was inflated with alkalinized lignocaine as compared to dexamethasone as liquid media.

Recent advances in the diagnosis and treatment of dysphagia in neurological diseases

Swallowing disorders are common in many neurological diseases, especially in stroke, Parkinson’s disease, amyotrophic lateral sclerosis, dementia, and multiple sclerosis. Neurogenic dysphagia is associated with an increased risk of death and serious complications, including aspiration pneumonia, dehydration, and malnutrition, which points to the importance of implementing recent advances in the diagnosis and treatment of swallowing disorders into neurological practice. If the initial screening for swallowing disorders is positive, further workup includes a combination of bedside tests and ancillary investigations, such as comprehensive clinical, videofluoroscopic and endoscopic swallowing evaluation. These measures allow to determine the type and degree of dysphagia severity, which is necessary for choosing the optimal therapeutic strategy. Treatment of patients with neurogenic dysphagia requires multidisciplinary approaches involving a team of specialists, including neurologists, speech and language therapists, gastroenterologists, and dietitians. Therapeutic strategy should include providing adequate nutritional support by diet modification and/or enteral nutrition through a nasogastric tube or gastrostomy, appropriate management of underlying and concomitant diseases, prevention and treatment of complications as well as rehabilitation interventions. Future directions to reduce swallowing disorders in neurological diseases will probably comprise a combination of rehabilitation measures with pharmacotherapy and non-invasive stimulation/neuromodulation. Early detection and effective treatment of dysphagia is crucial for achieving better outcomes and improving the quality of life in patients with neurological diseases.

The Use Of Simulation To Develop, Test And Implement A Multidisciplinary Team Care Pathway Bundle For Inpatients With Parkinson’s Disease

Abstract Background Hospitalised PD patients experience poorer outcomes. Model-2 hospitals lack onsite subspecialty neurology services whilst frequently managing PD inpatients. Aiming to enhance care of PD inpatients our multidisciplinary team (MDT) utilise simulation to design and deliver a new PD care pathway bundle. Methods The developed care bundle aims to facilitate i) screening for causes of PD deterioration, ii) identification of time sensitive and contraindicated medications and iii) prioritisation of timely MDT referral within the first 24 hours of admission. Using simulation of the NPO PD patient, usability of the bundle was tested through correct medication conversion (via Parkinsons calculator) and MDT clinical review for NG tube insertion with patient inclusion. Results Simulation delivery and structured debrief thereafter, further enhanced development and improvement of the simulation. It reinforced how the care bundle initiated early MDT referral and highlighted the pros/cons of MDT discussion with and without the patient. Once deemed satisfactory by all team members, ward-based simulation facilitated staff education and awareness of the new tool. Conclusion Simulation in the test and clinical environment facilitated implementation of a new MDT care pathway bundle at hospital level. Evaluation of effectiveness of the new care pathway require future audits and additional simulation campaigns.

Grade IV gastric ulceration, pyloric aplasia, and an ectopic duodenal papilla in a 13-year-old Quarter Horse gelding evaluated for recurrent colic.

The objective of this Case Report was to describe the clinical manifestation and postmortem findings of a horse evaluated for recurrent colic diagnosed with pyloric aplasia and an ectopic duodenal papilla. 13-year-old Quarter Horse gelding. The horse was presented to a referral center for signs of colic that were unresponsive to management on the farm. No abnormalities were noted on rectal palpation; however, upon passage of a nasogastric tube, 31 L of net gastric reflux was obtained. Gastroscopy noted grade IV squamous ulceration and moderate glandular ulceration, severe gastric dilatation, an abnormally positioned gastric outflow tract, and an ectopic duodenal papilla leaking bile-like fluid directly into the stomach. The horse was initially treated with gastroprotectants, promotility agents, and dietary modifications. Following treatment failure and repeated episodes of colic with increasing severity, the horse was euthanized and a necropsy performed. At necropsy, it was confirmed that the aboral aspect of the stomach formed a dilated pouch and continued directly into the proximal duodenum with no discernible pyloric sphincter. The area of the pylorus was delineated by a faint indentation. The ectopic duodenal papilla was traced to the liver. Congenital gastric abnormalities, even in adult horses, should be considered as differential diagnoses when investigating horses presenting with a history of chronic colic. Neither pyloric aplasia nor an ectopic duodenal papilla have been described in the equine literature, and this Case Report raises awareness of the presence of such malformations and their manifestations.

Factors associated with oropharyngeal dysphagia and unsuccessful nasogastric tube removal after endovascular thrombectomy for anterior circulation stroke.

To identify the predictive variables for post-stroke dysphagia (PSD) among anterior circulation large vessel occlusion (LVO) stroke patients who underwent endovascular thrombectomy (EVT). This retrospective cohort study enrolled hospitalized patients with anterior LVO stroke who underwent EVT between January 1, 2018 and October 31, 2022. PSD was defined as the unsuccessful removal of the nasogastric (NG) tube. Factors, such as premorbid characteristics, laboratory results, EVT, rehabilitation-related parameters, and neuro-imaging, were analyzed for correlations to PSD at 4 and 12weeks. The study enrolled 136 patients, with a mean age of 72.9 ± 13.0years, and 59 patients (43.4%) were male. At 4weeks, 47.1% of the patients needed an NG tube, and at 12weeks, 16.2% still required an NG tube. We found that lower albumin, lower body mass index (BMI), higher initial and 24-h post-EVT National Institute of Health Stroke Scale (NIHSS) scores, stroke-associated pneumonia, poor initial sitting balance and ability to sit up, insula or frontal operculum lesions, and bilateral hemisphere involvement were all associated with PSD at both 4 and 12weeks in the univariate logistic regression. Multivariate analysis revealed that significant predictors of unsuccessful NG tube removal at 4weeks included lower BMI (adjusted OR [aOR] 0.73, p = 0.005), hemorrhagic transformation (aOR 4.01, p = 0.0335), higher NIHSS scores at 24h post-EVT (aOR 1.13, p = 0.0288), poor initial sitting ability (aOR 0.52, p = 0.0231), insular cortex ischemia (aOR 7.26, p = 0.0056), and bilateral hemisphere involvement (aOR 41.19, p < 0.0001). At 12weeks, lower BMI (aOR 0.78, p = 0.0098), poor initial sitting balance (aOR 0.57, p = 0.0287), insular cortex lesions (aOR 4.83, p = 0.0092), and bilateral hemisphere involvement (aOR 4.07, p = 0.0139) remained significant predictors. In patients with anterior LVO following EVT, PSD was associated with lower BMI, higher NIHSS scores, poor initial sitting balance and sitting ability, insular lesions, and bilateral hemisphere involvement.

Determinants of late recovery following elective colorectal surgery.

Despite the implementation of enhanced recovery protocols, a significant proportion of patients experience delayed recovery. Identifying potential determinants of delayed recovery is crucial for optimizing perioperative protocols and tailoring patient pathways. This study aims to identify possible determinants of delayed recovery. Retrospective observational study based on a prospectively collected dedicated register spanning from 2015 to 2022. Twenty-two Italian hospitals specializing in high-volume colorectal surgery and trained in enhanced recovery protocols. Patients undergoing elective colorectal resection for cancer or benign disease. Recovery status on postoperative day 2. Late recovery was defined as the failure to meet at least two indicators of postoperative recovery (oral feeding, removal of the urinary catheter, cessation of intravenous fluids, and mobilization) on postoperative day 2. A total of 1535 patients were analyzed. The median overall adherence to pre- and intraoperative enhanced recovery protocol items was 75.0% (range: 66.6%-83.3%). Delayed recovery was observed in 487 (31.7%) patients. Multiple regression analysis revealed six enhanced recovery protocol items that independently positively influenced postoperative recovery: pre-admission counseling (adjusted odds ratio [aOR] 2.596), a preoperative carbohydrate drink (aOR 1.948), intraoperative fluid infusions < 7ml/kg/h (aOR 1.662), avoidance of thoracic epidural analgesia (aOR 2.137), removal of nasogastric tube at the end of surgery (aOR 4.939), and successful laparoscopy (aOR 2.341). The rate of delayed recovery progressively decreased with increasing adherence to these six positive items, reaching 13.0% when all items were applied (correlation coefficient [r] = - 0.99, p < 0.001). This study is limited by its retrospective analysis of a register containing data from multiple centers and a diverse patient population. Adherence to specific pre- and intraoperative enhanced recovery protocol items, including counseling, preoperative carbohydrate intake, restrictive intraoperative fluid management, avoidance of thoracic epidural analgesia, early removal of nasogastric tube, and successful laparoscopy, appears crucial for promoting early recovery following elective colorectal resection.

Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)

BackgroundEnhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy. Study designProspective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 ​h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo). ResultsFifty patients were randomized into ERAS(n ​= ​25) and conventional care(n ​= ​25) groups. Ninety-two percent of patients were young males, 58 ​% had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 ​%). ERAS group had a reduced median LOH(days) (6 versus 8, p ​= ​0.007), early recovery of bowel function(p ​= ​0.010) and shorter times for nasogastric tube(p ​= ​0.001), urinary catheter(p ​= ​0.007) and drain(p ​= ​0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p ​= ​0.009)]. ConclusionERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.

Oropharyngeal Dysphagia in Hospitalized Older Adults with Dementia: A Prospective Cohort Study

ObjectiveOropharyngeal dysphagia (dysphagia) is highly prevalent (up to 86%) in hospitalized patients with Alzheimer disease and related dementias (ADRD). This study aims to describe the management and clinical course of dysphagia in hospitalized patients with ADRD. DesignProspective observational cohort study. Setting and ParticipantsThe study was conducted across 10 hospitals within a large health system in New York. Participants were older adults with ADRD admitted to the medicine service and diagnosed with dysphagia to liquids on speech-language pathologist (SLP) assessment and were recruited between January and June 2023. MethodsBaseline characteristics [eg, dementia Functional Assessment Staging Tool (FAST)], dysphagia management (eg, prescribed diet), and clinical course (eg, dysphagia improvement, respiratory complications) were collected. ResultsOf patients with ADRD and dysphagia (n = 62), the average age was 86.5 and 66.1% were FAST Stage 7. On admission, 48.4% had pneumonia, 79.0% had delirium, and 69.4% were made nil per os (NPO) for aspiration risk. Of those who received SLP reassessment after diet initiation (n = 25), 76% demonstrated dysphagia improvement; 75% of patients with FAST stage 7 demonstrated improvement. Respiratory complications occurred in 21.0% of patients on the following diets: NPO, nasogastric tube feeding, dysphagia diets, and comfort feeds. In univariate analyses, hospital-acquired dehydration, no dysphagia improvement, and delirium were associated with respiratory complications. Conclusions and ImplicationsThe potential for dysphagia improvement in hospitalized patients with ADRD (even those with advanced dementia) highlights the critical need for standardizing reassessment. Further studies are needed to evaluate factors associated with respiratory complications in this population.

Effects of aqueous seed extract of &lt;i&gt;Garcinia kola&lt;/i&gt; on spray paint-induced histological changes in the lungs of Wistar rats

The most common cause of lung diseases among people with spray paint-related occupations is hydrocarbon poisoning which has significant morbidity and mortality if left untreated. This study aimed to investigate the effects of aqueous seed extract of Garcinia kola on spray paint-induced interstitial pneumonitis in the adult Wistar rats. Thirty adult Wistar rats weighing between 240 g and 270 g were divided into five groups of six rats each. Animals in group A were placed on feed and water only. Animals in group B were exposed to 100 ml of spray paintfumes via inhalation. Animals in group C received 500mg/kg body weight per day of Garcinia kola. Animals in group D were exposed to 100 ml of spray paint fumes via inhalation and received 250mg/kg body weight per day of Garcinia kola. Animals in group E were exposed to 100 ml of spray paint fumes via inhalation and received 500mg/kg body weight per day of Garcinia kola. The extract was administered for 30 consecutive days via an orogastric tube. Groups A, C, D and E revealed normal histoarchitecture of the lung; normal alveoli and normal interstitial space. There were observable histological variations in the lung tissues of Group B rats which include severe alveolar dilation, interstitial haemorrhage, interstitial infiltrates of inflammatory cells, severe vascular ulceration and congestion (evidence of interstitial pneumonitis). It is concluded that Garcinia kolahasan ameliorative effect on spray paint-induced histological changes in the lungs of Wistar rats.

EP274 - A clinical audit on nasogastric tube placement documentation and adherence with NICE guidelines in general surgical patients across a district general hospital

Abstract Aims NICE provide clear guidelines on confirming correct nasogastric (NG) tube siting using pH testing of aspirates or with X-rays where indeterminate samples are drawn. We aimed to audit documentation following nasogastric tube insertion to ascertain adherence to NICE guidelines. Methods A single-cycle snapshot audit was conducted on all surgical inpatients who had nasogastric tubes inserted over their admission across a single-centre district general hospital general surgery department. Data was collected on indication for NG tube insertion (drainage or feeding), length of initial tube insertion, whether pH testing was used to confirm position, and whether correct tube placement has been confirmed by a competent person through x-ray where indeterminate samples were tested from NG aspirate (pH &amp;gt; 5.5). Results A total of 15 patients had an NG tube inserted over their admission with mean age 77.3 years (range 47-97). 60% of patients had correctly documented confirmation of NG tube siting. 4/15 NG tubes were inserted for feeding purposes (26.7%), all of which were documented correctly. Only 45.5% of NG tubes for drainage were documented correctly and only 33.3% of all NG tubes had length of insertion documented. Where pH testing was inconclusive, a chest X-ray was requested for all patients and sufficiently documented by a doctor qualified to confirm position. No complications relating to NG tubes occurred across the audit study. Conclusions Implementation of improvement measures are warranted to improve overall adherence with NICE guidelines and prevent risk of incorrect confirmation of NG tube siting.

EP442 - An Audit on the Application of Enhanced Recovery Post Emergency Laparotomy

Abstract Aim This audit aims to evaluate the efficiency of NG tube and catheter removal post emergency laparotomies, assess the occurrence of postoperative complications, and analyse hospital practices related to enhanced recovery in the context of emergency laparotomies. Methods Data was collected retrospectively from [Hospital Name] for a specified time period, including patient demographics, surgical details, time to NG tube and catheter removal, postoperative complications, and adherence to enhanced recovery protocols. The audit included a thorough review of medical records, nursing notes, and relevant documentation. Results Preliminary findings indicate variations in the time taken for NG tube and catheter removal across emergency laparotomy cases. The occurrence of postoperative complications, such as infections, delayed recovery, and prolonged hospital stays, was also assessed. Furthermore, an analysis of hospital practices, including the implementation of enhanced recovery protocols, was conducted. Conclusion The results of this audit will contribute valuable insights into the effectiveness of current practices related to NG tube and catheter management post emergency laparotomies. The findings may highlight areas for improvement in enhancing recovery, optimising patient outcomes, and minimising complications. Recommendations for refining hospital protocols and promoting timely interventions will be proposed based on the audit results, with the ultimate goal of improving the overall quality of care for patients undergoing emergency laparotomies.

Postoperative Feeding in Cleft Surgery: A Systematic Review.

Postoperative feeding is crucial for the recovery of children after cleft surgery. The literature outlines diverse feeding methods with varying recommendations on the duration of non-nipple feeding postsurgery. This study aims to explore reported postoperative feeding modalities for infants undergoing primary cleft lip/palate repair, concentrating on their influence on feeding improvement and complication reduction. PubMed, Cochrane, and Web of Science databases were queried for original English articles without any date restrictions. This review was conducted in accordance with the 2020 PRISMA. The MINORS criteria was used to assess quality of studies. Of 696 abstracts, 9 full-text articles were included, consisting of 459 children with cleft lip (n = 221) & cleft lip/palate (n = 238). Feeding modalities included bottle, breastfeeding, spoon, syringe, and nasogastric tube. Two studies found a significant increase in weight with breastfeeding compared to spoon or cup. Two studies found partial wound dehiscence using spoons, and two studies reported dehiscence using bottles. Post-palatoplasty, two studies showed a decrease in hospital stay in infants breastfed (2.1 & 5.8 days) vs spoon-fed (6 days). Analgesia was reduced in the breastfed group vs spoon/nasogastric tube. This review highlights the importance of postoperative feeding in the recovery of infants with cleft lip/palate. Evidence suggests that breastfeeding may offer advantages in terms of weight gain and reduced hospital stay, while potentially minimizing the need for postoperative analgesia. The limited number of studies and variability in their outcomes underscore the need for further research to establish evidence-based guidelines for postoperative feeding.

FP3.11 - Postoperative ileus (POI) in colorectal cancer resections: A cohort study

Abstract Aims Postoperative ileus (POI) has reported incidence of &amp;lt; 30 % in malignant colorectal surgery. POI leads to delayed recovery, increase morbidity, prolonged hepatization &amp; increased healthcare costs. Aim of study is to assess management of POI at single centre. Methods Cohort study was carried out from Jan'2008 to Jan'2023. Descriptive demography &amp; post-operative outcomes were evaluated for POI patients, with non-ileus used as controls. Results Ileus (n = 275) Non ileus (n = 1436) Mann Whitney U (p value) Age(yrs) 71.8 70.1 NS Sex(M:F) 191 : 84 766 : 670 &amp;lt; 0.0001 ASA(median) 2 2 NS BMI(kg/m2) 26.9 26.4 NS Elective () 209 1139 Emergency(n) 66 297 Laparoscopic(n) 140 819 Open(n) 135 617 LN harvest(n) 12 12 NS Complications (n) (%) Leaks 14 52 HAP 64 125 Anaemia (transfusions) 10 43 Wound infections 41 115 Collection 27 69 Sepsis 37 49 Operation time(mins) 186.0 172.8 &amp;lt; 0.05 LOS(days) 14 ± 6 7 ± 3.5 &amp;lt; 0.0001 POI onset(days) 5 ± 2 NG tube(days) 3 ± 1 POI diagnosis (n) Clinical 62 AXR 70 Gastrograffin 64 CT scan 113 Mortality (n) 30 day 10 48 60 day 16 68 90 day 18 80 Survival rates (%) 1st year 89.0 87.6 Logrank 5th year 73.5 70.5 P = NS 10th year 64.3 62.4 (uncensored) 15th year 62.1 59.2 Conclusion POI occurred in 15.6 % of all CRC resections. Prolonged operative time, resulted in ileus, but did not adversely affect survival. POI can be diagnosed clinically or radiologically. POI resulted in prolonged hospitalization. Early diagnosis &amp; intervention (NG tube decompression, fasting, IV fluids, gastrograffin &amp; prokinetics) is key to reducing the adversity of POI

WP4.11 - Oral Gastrograffin Usage in Adhesive Small Bowel Obstruction: a re-audit

Abstract Aim to establish the successful usage of oral gastrograffin in patients presenting with adhesive small bowel obstruction (SBO). Methods This is a retrospective follow-up study, using a combined data collected from two NHS Trusts, from July 2022 to January 2024. Patients presented with adhesive SBO were included in this study, who were given 100 ml of oral gastrograffin after diagnosis for SBO. Patients were arranged to have plain abdominal x-ray approximately 8-hours post-gastrograffin drinks/or infusion via nasogastric (NG) tube to ascertain if oral contrast had passed the transition point, identified on initial abdominal CT scan. Patients were then reviewed for their symptomatic relief including bowels movement. Results 132 patients were identified but 108 patients were included, who had surgery. 24 patients were excluded because they did not have post-gastrograffin x-ray. Average age of patients was 63+/-14 years. It was observed that 82 patients (75.9%) opened their bowels after administration of first dose of gastrograffin, while 26 patients (24%) did not. 16 out of these 26 patients required surgery; and the remaining 10 (38.4%) had 2nd dose of gastrograffin, of which 4 patients (40%) moved bowels but 6 (60%) still did not and required surgery. Post-contrast x-rays, showed that contrast passed through into large bowel in 76 patients (70.3%) after 1st dose of gastrograffin and in further 40% after 2nd dose. Conclusion clinically significant number of patients responded to such conservative measures. Therefore, routine oral gastrograffin usage is suggested as an effective adjunct to non-operative measures in adhesive SBO management.

ThP6.9 - Endoluminal vacuum-assisted closure (EndoVAC) therapy in spontaneous duodenal perforation: a novel approach to an undertreated problem

Abstract Introduction Duodenal perforation is a rare but critical condition, with management ranging from conservative to surgical depending on timing of presentation, patient status, and clinician preference. In recent years, minimally invasive techniques have been emerging alternatives for their safety and efficacy. Notably, there have been cases promoting endoluminal vacuum-assisted closure (EndoVAC) therapy as a viable alternative for use among patients with iatrogenic oesophageal perforations. To our knowledge, there has been no reported use of this novel approach specifically in spontaneous duodenal perforations. Case presentation A 55-year-old female with no history of trauma, surgery, NSAID use, or gastrointestinal conditions presented with epigastric pain and vomiting. A CT scan revealed a contained duodenal perforation at the D2/3 junction, accompanied by a complex retroperitoneal collection unsuitable for imaging-guided drainage. Initial management was conservative with intravenous hydration, antibiotics, proton pump inhibitors, and nasogastric tube decompression. She underwent oesophagoduodenoscopy and EndoVAC therapy resulting in complete resolution of collection and a small diverticulum on repeat CT. Discussion Current standard of care for duodenal perforations would be conservative management, though this carries the risk of deterioration due to biliopancreatic leakage and slow resolution of sepsis. Surgical management, when needed, is often technically challenging with high morbidity. EndoVAC gives the benefit of providing targeted drainage and negative pressure therapy to the site of perforation, reducing ongoing contamination, and promoting wound granulation. Conclusion EndoVAC therapy offers a minimally invasive alternative to treatment of duodenal perforations and has the potential for broader application in specialist and tertiary healthcare settings.