Postoperative Diet Research Articles

Metabolic Management following Bariatric Surgery

Bariatric surgery is an effective treatment option for obesity. Commonly utilized procedures are either restrictive, malabsorptive, or both. Substantial weight loss can be achieved. Postoperatively, patients experience nutritional, metabolic, and hormonal changes that have important clinical implications. The postoperative diet should be advanced carefully, according to protocol. Micronutrient deficiencies such as vitamin C, vitamin A, and zinc deficiencies are common, especially following malabsorptive procedures. Bone metabolism is greatly affected, in part due to vitamin D deficiency, decreased calcium absorption, and secondary hyperparathyroidism. Diabetes improves acutely in malabsorptive procedures and in sequence with weight loss in restrictive procedures. Polycystic ovarian syndrome improves in nearly all women with this condition who undergo bariatric surgery. Testosterone levels in men also improve after surgery. Consideration of these nutritional, metabolic, and hormonal changes allows for optimal medical management following bariatric surgery.

Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects

Palatal obturators and microvascular free flaps are both used to treat patients with maxillectomy defects, however, the optimal technique remains controversial. A retrospective analysis of 113 patients undergoing maxillectomy for cancer was performed. Seventy-three patients received an obturator and 40 patients were reconstructed with a free flap. Speech intelligibility and postoperative diet were comparable between the obturator and free flap groups, except in cases of extensive (>50%) palatal defects, where free flap reconstruction was superior in both aspects (p = .019 and p = .043, respectively). The average time for presenting with a local recurrence in advanced cancer involving the palate was comparable in both groups (p = .33). Moderate-sized maxillectomy defects involving the palate can be successfully treated with either an obturator or free flap reconstruction. Extensive defects have a better functional outcome with free flaps. Evidence does not suggest that free flap reconstructions delay diagnosis of local recurrences.

Laparoscopy-assisted resection for gastric stump cancer and gastric stump recurrent cancer: a report of 15 cases

This study was designed to investigate the technical methods and clinical therapeutic effects of laparoscopy-assisted resection of gastric stump cancer (GSC). Laparoscopy-assisted resection was performed on 15 patients with GSC. The approach, method, difficult points, and techniques of the operation were analyzed, and its clinical therapeutic effect was evaluated. With the help of laparoscopy, D2 radical resection of gastric stump was performed on 12 patients, and palliative gastric stump resection was performed on two patients. There was one case of conversion from laparoscopic surgery to open surgery. Roux-en-Y gastric bypass was performed in all cases to reconstruct the alimentary tract. The mean operative time for laparoscopy-assisted resection was 205 ± 25 min. The mean intraoperative blood loss volume was 110 ± 40 ml. The mean number of lymph nodes removed was 18 ± 5. A gastric tube was not placed in the patients after surgery. The mean time for the recovery of intestinal function was 2.5 ± 1 days, the mean duration of postoperative liquid diet was 2.5 ± 1 days, and the mean time for the recovery of ambulatory activity was 3 ± 0.5 days. There was one case of postoperative infection of the incision site. The follow-up time was 6-40 months, with 1 case of death due to liver metastasis, 1 case of death due to peritoneal metastasis, 1 case of death due to complications from lupus erythematosus, and survival for the remaining 12 cases. Laparoscopy-assisted resection of GSC is technically feasible; determination of the short- and long-term efficacies will require a larger and comparative sample study.

Robotic-Assisted Surgery for Primary or Recurrent Oropharyngeal Carcinoma

To determine the feasibility of robotic-assisted salvage surgery for oropharyngeal cancer. Retrospective case-controlled study. Academic, tertiary referral center. Patients who underwent surgical resection for T1 and T2 oropharyngeal cancer between 2001 and 2008 were classified into the following 3 groups based on type of resection: (1) robotic-assisted surgery for primary neoplasms (robotic primary) (n = 15), (2) robotic-assisted salvage surgery for recurrent disease (robotic salvage) (n = 7), and (3) open salvage resection for recurrent disease (n = 14). Data regarding tumor subsite, stage, and prior treatment were evaluated as well as margin status, nodal disease, length of hospital stay, diet, and tracheotomy tube dependence. The median length of stay in the open salvage group was longer (8.2 days) than robotic salvage (5.0 days) (P = .14) and robotic primary (1.5 days) resection groups (P < .001). There was no difference in postoperative diet between robotic primary and robotic salvage surgery groups. However, a greater proportion of patients who underwent open salvage procedures were gastrostomy tube dependent 6 months following treatment (43%) compared with robotic salvage resection (0%) (P = .06). A greater proportion of patients who underwent open salvage procedures also remained tracheotomy tube dependent after 6 months (7%) compared with robotic salvage or robotic primary patients (0%) (P = .48). No complications were reported in the robotic salvage group. Two patients who underwent open salvage resection developed postoperative hematomas and 2 developed wound infections. When feasible, robotic-assisted surgery is an acceptable procedure for resection of both primary and recurrent oropharyngeal tumors. Trial Registration clinicaltrials.gov Identifier: NCT00473564.

Past, present, and future: Critical analysis of use of gastric bands in obese patients

Past, present, and future: Critical analysis of use of gastric bands in obese patients Brad Snyder, Todd Wilson, Sheilendra Mehta, Kulvinder Bajwa, Emily Robinson, Todd Worley, Kanayochukwu Aluka, Carol Wolin-Riklin, Erik WilsonDepartment of Surgery, University of Texas Health Sciences Center at Houston, TX, USAAbstract: Adjustable gastric banding (AGB) is quickly becoming the most popular bariatric operation performed in the United States and Canada. Patients are particularly fond of the simplicity of the tool, the relatively low morbidity of the surgery, the quick recovery, and overall results. The gastric band has evolved over its 35-year history into a very successful adjustable tool used to restrict food consumption and limit caloric intake. The percent of excessive weight loss after banding can range from 30%&ndash;60% and depends on the time out from surgery. Along with weight loss, there is good resolution of the co-morbid conditions that are associated with excess weight and improvements in quality of life demonstrated after banding. Nutrition and follow up are extremely important after banding to ensure good compliance and adequate weight loss. Failure to follow the postoperative diet, exercise regiment, or mechanical failure of the band can lead to failure to lose adequate weight. While there are particular early and late complications associated with this surgery, the safety profile of the AGB is very appealing when compared to other bariatric operations. As we continue to reduce the morbidity of the procedure, the simple adjustable band concept has a lot of potential to remain a primary technique of maintaining long term weight loss. In conclusion, AGB has and continues to play an important role in the treatment of morbid obesity. It offers reasonably good weight loss results with very little morbidity, and the future of the adjustable band is bright.Keywords: adjustable band, gastric, bariatric, operation, surgery, weight loss, lap-band

Past, present, and future: Critical analysis of use of gastric bands in obese patients

Adjustable gastric banding (AGB) is quickly becoming the most popular bariatric operation performed in the United States and Canada. Patients are particularly fond of the simplicity of the tool, the relatively low morbidity of the surgery, the quick recovery, and overall results. The gastric band has evolved over its 35-year history into a very successful adjustable tool used to restrict food consumption and limit caloric intake. The percent of excessive weight loss after banding can range from 30%-60% and depends on the time out from surgery. Along with weight loss, there is good resolution of the co-morbid conditions that are associated with excess weight and improvements in quality of life demonstrated after banding. Nutrition and follow up are extremely important after banding to ensure good compliance and adequate weight loss. Failure to follow the postoperative diet, exercise regiment, or mechanical failure of the band can lead to failure to lose adequate weight. While there are particular early and late complications associated with this surgery, the safety profile of the AGB is very appealing when compared to other bariatric operations. As we continue to reduce the morbidity of the procedure, the simple adjustable band concept has a lot of potential to remain a primary technique of maintaining long term weight loss. In conclusion, AGB has and continues to play an important role in the treatment of morbid obesity. It offers reasonably good weight loss results with very little morbidity, and the future of the adjustable band is bright.

Further reduction of hospital stay for laparoscopic colon resection by modifications of the fast-track care plan

Background Fast-track surgery has been described as a plan to facilitate early recovery. We present one surgeon's modifications to fast-track surgery for laparoscopic colectomy patients. Methods We performed a retrospective review of 48 consecutive patients undergoing elective laparoscopic colectomy treated by a modified fast-track plan between 2004 and 2008. Elements included preoperative education, pre-anesthesia dexamethasone, immediate postoperative general diet, no urinary catheter, no epidural anesthesia, and no flatus or bowel movement as a discharge requirement. Data collected included the following: age, sex, body mass index, resection indications, surgical time, blood loss, pain score, time to ambulation, time to bowel function, length of stay, complications, and mortality. Results The mean length of stay was 37 hours (1.5 d), with 29 of 48 patients discharged without passage of flatus or stool. Only 1 patient required readmission. Conclusions Our modified fast-track plan achieved significant improvement in length of stay for laparoscopic colectomy compared with previous results.

Do diet and activity restrictions influence recovery after adenoidectomy and partial tonsillectomy?

Objective To determine if restrictions of postoperative diet concerning hard food and hot drinks as well as excessive physical exertion influence recovery during 14 days after T&A surgery. Methods 800 patients aged 3–13 years (median 6) underwent curette adenoidectomy with or without scissors tonsillotomy. 413 adenoidectomies and 387 adenotonsillotomies were performed. Caregivers of the children completed a questionnaire reporting their child's postoperative activity, diet, pain level, peak and duration, episodes of nausea and fever, medication and caregivers’ satisfaction scores. The children were enrolled to food and effort restricted (FER), food non-restricted (FnR), effort non-restricted (EnR), and food and effort non-restricted (FEnR) groups at the end of follow-up. Results Two hemorrhages requiring repeat surgery under general anesthesia in FER group and 42 mild episodes of spontaneously subsiding bleeding from nose or mouth occurred. More than one episodes of hemorrhage were observed in other 8 individuals (total incidence of hemorrhages 9.7%). No hemorrhages were noted in the FEnR and FnR groups. There were 23 (4.4%) participants with episodes of bleeding, among them 21 mild hemorrhages, in the FER group and 21 (12.0%) in the EnR group ( p < 0.001). Peak pain level was lowest in FEnR group ( p < 0.001) and indications for antibiotics most frequent in FnR group ( p < 0.001). Parental satisfaction level was highest in FnR and FEnR groups ( p < 0.001). Conclusions The majority of caregivers reported care of children after T&A surgery according to the instructions. Most frequently disobeyed instructions were those concerning physical exertion. Diet and activity restrictions seem to influence postoperative recovery. Parental satisfaction scores were highest in non-restricted groups.

Hypophosphatemia in Cats After Renal Transplantation

To report the prevalence of hypophosphatemia after renal transplantation in a historical cohort of cats. Case series. Cats (n=86) that received a renal allograft. Medical records (January 200-June 2006) were reviewed. Signalment, clinical signs, pre- and postoperative diet, pre- and postoperative clinicopathologic variables, renal histopathology, and outcome were retrieved. Prevalence, onset, duration, treatment and associated clinical signs of hypophosphatemia were recorded. A chi(2) test was used to compare hemolysis frequency between cats with normal serum phosphorus concentration or a single spurious low serum phosphorus concentration for <24 hours duration (group 1) and confirmed hypophosphatemia for >24 hours (group 2). A Cox proportional hazards model was used to evaluate the effects of hypophosphatemia on survival while controlling for other potentially confounding variables (age, sex, weight, body condition score, and pre- and 24 hours postoperative clinicopathologic variables). Eighty-six cats (mean age, 7.7 years) were identified. Hypophosphatemia occurred in 32 cats (37%), with a median onset of 2 days and median duration of 4 days. Treatment was initiated in 48 (56%) of hypophosphatemic cats. Survival and hemolysis frequency was not significantly different between groups, and no risk factors were identified. Hypophosphatemia occurs in cats after renal transplantation and does not affect survival. The clinical importance of hypophosphatemia in renal transplant recipients remains unknown.

MP-16.11: Comparison of Extraperitoneal and Transperitoneal Robot-Assisted Radical Prostatectomy in Prostate Cancer: A Single Surgeon's Experience

Purpose: To evaluate the feasibility and safety of the extraperitoneal robotic radical prostatectomy (ERP), we compared the results of transperitoneal robotic radical prostatectomy (TRP) with those of ERP performed by a single surgeon. Materials and Methods: All operation was performed by a single surgeon, who had the experience of more than 150 transperitoneal cases. Recently, 30 cases were performed through transperitoneal approach, and then extraperitoneal approach was applied to next 30 cases. We compared the clinicopathologic parameters and perioperative outcomes between two groups. Results: There were no significant differences in mean age, body mass index (BMI), preoperative prostate-specific antigen (PSA) level, prostatectomy Gleason scores and pathologic T stage between two groups, whereas positive surgical margin rate was significantly lower in ERP. There was no significant difference in total operation time, whereas console time, and vesicourethral anastomosis time significantly decreased in ERP. There were no significant differences in postoperative normal diet start day, the duration of hospital stay and bladder catheterization. There were no significant differences in the amount of estimated blood loss and the number of resected lymph nodes. In both groups, there were no inadvertent organ injury during trocar placement and conversion to open surgery, whereas 1 case of lymphocele in ERP was recovered with conservative care. Conclusions: ERP showed similar perioperative outcomes compared to TRP. Considering the potential risk of bowel injury in TRP and reduced peritoneal irritation in ERP, ERP may be alternative in robotic radical prostatectomy. (Korean J Urol 2009;50:251-255) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Comparison of Gap Arthroplasty With and Without a Temporalis Muscle Flap for the Treatment of Ankylosis

The purpose of this study was to compare gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis. Sixteen patients with temporomandibular joint ankylosis from 2001 to 2006 were included in the study, of which 7 were female and 9 were male. Fourteen patients had unilateral ankylosis and 2 patients had bilateral ankylosis. Sixteen patients were divided into 2 groups with 8 patients in each group. In group I patients, gap arthroplasty was performed with a mean follow-up of 20.3 months and in group II patients, interpositional arthroplasty with temporalis myofacial flap was performed with a mean follow-up of 23.1 months. All patients were assessed for mouth opening, diet consistency, and weight postoperatively. All patients were subjected to postoperative mouth opening exercises from the second postoperative day. There is no significant difference in postoperative mouth opening, diet consistency, and weight of the patients in both groups. Reankylosis occurred in 1 patient in both groups. We conclude that there is no significant difference in maximal interincisal opening, diet scores, and weight of the patients in both groups. The overall outcome of the treatment depends on patient cooperation, active physiotherapy, and regular follow-up.

Robotic Radical Prostatectomy for Patients with Locally Advanced Prostate Cancer Is Feasible: Results of a Single-Institution Study

The aim of this study was to compare the outcomes of robotic prostatectomy (RP) in patients with clinically localized or locally advanced prostate cancer (PC). Between July 2005 and February 2008, we performed RP in 357 patients by using the da Vinci robot system and a transperitoneal approach. We defined locally advanced PC as cases with a clinical T-stage >/=T3a with any serum prostate-specific antigen (PSA) or Gleason score. Among the 321 men not treated with neoadjuvant hormonal therapy, 200 patients had clinically localized PC and 121 patients had locally advanced PC. We compared perioperative variables and early surgical outcomes between the two groups. Although advanced PC patients had significantly higher mean preoperative PSA levels, prostatectomy Gleason scores, and extracapsular extension rates, there were no significant differences in mean operation time, estimated blood loss, duration of bladder catheterization, hospital stay, or initiation of a regular postoperative diet between the two groups. Except for some early cases, a bilateral extended lymphadenectomy was performed without difficulty in both groups. Although both the frequency of lymph node invasion and the positive surgical margin rates were higher in the advanced PC patients, the positive surgical margin rate (48.8%) in the present study was similar to those of open radical retropubic prostatectomy in other studies. The overall complication rate did not differ between the two groups. Two intraoperative rectal injuries occurred in patients with locally advanced PC and were closed primarily without specific problems, except for 1 case. Our results suggest that RP may be performed safely on patients with locally advanced PC.

IH-106: Postoperative dietary adherence and the potential utility of postoperative dietary counseling to improve outcomes

A significant minority of patients appear to experience suboptimal weight losses following bariatric surgery. These outcomes often are attributed to preoperative psychosocial characteristics and/or eating behaviors as well as poor adherence to the recommended postoperative diet. The present study was designed to investigate the relationship between preoperative eating behavior, postoperative dietary adherence and weight loss following bariatric surgery.

Nutritional Deficiency of Post-Bariatric Surgery Body Contouring Patients: What Every Plastic Surgeon Should Know

Bariatric surgery, particularly the Roux-en-Y gastric bypass, is currently the most effective method of sustainable weight loss for the morbidly obese patient population. Unfortunately, the nutritional adequacy of the postoperative diet has frequently been overlooked, and in the months to years that follow, many nutritional deficiencies have become apparent. Furthermore, once weight loss has reached a plateau, many patients become candidates for body contouring surgery and other aesthetic operations. The aim of this review was to highlight the nutritional deficiencies of post-bariatric surgery patients as related to planned body contouring surgery. This review was prepared by an extensive search of the bariatric surgery literature. The current data indicate that many post-bariatric surgery patients have protein-calorie malnutrition as well as various vitamins and mineral deficiencies that may limit optimal health and healing. It is essential that those plastic surgeons who treat post-bariatric surgery patients are aware of these nutritional deficiencies, which can be minimized by adhering to eating guidelines and supplemental prescriptions. Although there are many studies documenting relationships between malnutrition and poor wound healing, the optimal nutrient intake in the post-bariatric surgery state to promote wound healing is unknown. It is, however, clear that proteins, vitamin A, vitamin C, arginine, glutamine, zinc, and selenium have significant beneficial effects on wound healing and optimizing the immune system.

Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery

Background To investigate the relationship between preoperative eating behavior, postoperative dietary adherence and weight loss after gastric bypass surgery in a major, urban medical center with a comprehensive bariatric surgery program. Despite the significant weight loss and dramatic improvements in co-morbidities associated with bariatric surgery, a significant minority of patients appear to experience suboptimal weight loss. The reasons for this are not well understood, but the suboptimal weight loss is often attributed to preoperative psychosocial characteristics and/or eating behaviors, as well as poor adherence to the recommended postoperative diet. Methods A prospective investigation was performed of 200 female and male patients who were studied both preoperatively and 20, 40, 66, and 92 weeks postoperatively. All patients underwent either open or laparoscopic Roux-en- Y gastric bypass surgery. The measures were the percentage of weight loss, macronutrient intake, dietary adherence, and eating behavior. Results Gender, baseline cognitive restraint, and self-reported adherence to the postoperative diet at postoperative week 20 were associated with the percentage of weight loss at postoperative week 92. Those high in dietary adherence had lost 4.5% more weight at postoperative week 92 than those low in dietary adherence. Conclusion Baseline cognitive restraint and adherence to the recommended postoperative diet were associated with the percentage of weight loss after gastric bypass surgery. These results suggest the potential utility of pre- and/or postoperative dietary counseling interventions to improve the postoperative outcomes.

Psychosocial Status in Adolescents Undergoing Bariatric Surgery

Little is known about the psychosocial status of adolescents who undergo bariatric surgery. Our objective was to describe the psychological and behavioral characteristics of patients in this age group who underwent bariatric surgery at our institution. A review of clinical charts of patients aged 14-21 years who had bariatric surgery at our institution between 2000 and 2005 was conducted. Abstracted data included clinical information and the results of a psychosocial evaluation consisting of a clinical interview with a psychologist and self-reported data from the Weight and Lifestyle Inventory and the Beck Depression Inventory-II. Twenty-five patient records were reviewed. Nineteen patients (76%) were female. The mean (+/-SD) age was 18.7 +/- 1.6 years, and mean body mass index was 50.6 +/- 7.9 kg/m(2). Depression was the most common psychiatric comorbidity (68%). Abnormal eating behaviors were frequent and included binge eating (48%), rapid eating (44%), having guilt associated with eating (36%), eating until uncomfortably full (36%), loss of control (24%), eating without hunger (24%), and eating alone (20%). Sixteen patients were judged to be appropriate for surgery by the bariatric surgery team; surgery was delayed for nine patients primarily because of concerns about ability to adhere to the postoperative diet. These patients were recommended for additional dietary counseling and/or psychotherapeutic treatment prior to surgery. Among adolescent bariatric surgery candidates, depression and aberrant eating behaviors were very common. Early identification and management of these conditions may enable most of these patients to undergo bariatric surgery and optimize the likelihood for a successful outcome.

Gout and the postoperative bariatric surgery patient

Gout is an important associated disease of our bariatric surgery population because the underlying cause, hyperuricemia, intersects all those conditions that predispose to the flares: morbid obesity, postoperative state, metabolic syndrome and the associated dietary habits, hypertension and treatment with diuretics, sudden starvation diet, high-protein postoperative diet, insulin resistance/type II diabetes, advancing age, and renal insufficiency, to name a few [ [1] Chen S.Y. Chen C.L. Shen M.L. Manifestations of metabolic syndrome associated with male gout in different age strata. Clin Rheumatol. 2007; 26: 1453-1457 Crossref PubMed Scopus (31) Google Scholar ]. Furthermore, acute gouty exacerbations in the postoperative setting can lead to marked disability, thus setting the stage for potential cardiopulmonary complications. As the age limits and criteria for obesity surgery expand, this timely report has demonstrated that so might the incidence of postoperative acute attacks of gout. Gouty attacks occur frequently in postoperative gastric bypass patientsSurgery for Obesity and Related DiseasesVol. 4Issue 1PreviewBoth obesity and surgery are known risk factors for instigating gouty attacks. We describe the incidence and management of postoperative gouty attacks after bariatric surgery. Full-Text PDF

Preoperative Immunonutrition Suppresses Perioperative Inflammatory Response in Patients with Major Abdominal Surgery—A Randomized Controlled Pilot Study

Perioperative administration of immunoenriched diets attenuates the perioperative inflammatory response and reduces postoperative infection complications. However, many questions still remain unresolved in this area, such as the length of diet administration, diet composition, and the mechanisms involved. We performed an open, randomized, triple-arm study comparing the effect of two perioperative feeding regimens with a postoperative one. 46 candidates for major elective surgery for malignancy in the upper gastrointestinal tract were randomized to drink preoperatively either 1 L of an immunoenriched formula (Impact) for 5 days (IEF group) or 1 L of Impact plus (Impact enriched with glycine) for 2 days (IEF plus group). The same product as the patient received preoperatively was given to both groups for 7 days postoperatively. In the control group (CON group), patients only received Impact for 7 days postoperatively; there was no preoperative treatment. The main outcome measures were postoperative C-reactive protein (CRP) serum levels. In the two preoperatively supplemented groups (treatment groups), perioperative endotoxin levels, CRP (postoperative day 7), and TNF-alpha (postoperative days 1 and 3) levels were significantly lower compared to the CON group (p < .01). Furthermore, the length of postoperative IMU/ICU stay (Impact 1.9 +/- 1.3 days; Impact plus 2.2 +/- 1.1 days; control group 5.9 +/- 0.8 days) and length of hospital stay (Impact 19.7 +/- 2.3 days; Impact plus 20.1 +/- 1.3 days; control group 29.1 +/- 3.6 days) were both reduced in the treatment groups compared to the control group. Infectious complications (Impact 2/14 (14%); Impact plus 5/17 (29%); control group 10/15 (67%)) also showed a trend toward reduction in the treatment groups. Perioperative administration of an immunoenriched diet significantly reduces systemic perioperative inflammation and postoperative complications in patients undergoing major abdominal cancer surgery, when compared with postoperative diet administration alone. A shortened preoperative feeding regimen of 2 days with Impact enriched with glycine (Impact plus) was as effective as Impact administered for 5 days preoperatively.

Dysphagia After Endoscopic Repair of Zenker's Diverticulum

To determine whether patient outcomes after endoscopic staple-assisted diverticulectomy(ESD) were correlated with demographic or disease-specific patient characteristics. Retrospective chart review with followup. A survey was sent to all eligible subjects who had undergone ESD from February 1995 to June 2004 to gather information about their postoperative weight, diet, dysphagia symptoms, distress, and overall satisfaction. Thirty-five individuals responded(49% response rate) at a mean of 29 (range,3-83) months postoperative. There was a significant reduction in the following symptoms: food avoidance,regurgitation, dysphagia for pills, choking, coughing,difficulty finishing a meal, heartburn/reflux, and halitosis. There was no significant difference for dysphonia.Swallow-related distress had decreased from a preoperative level of 7.86 to 2.23 at follow-up (P <.001). Overall satisfaction with the surgery was high. There were no significant differences in outcome by any demographic characteristic, duration of preoperative symptoms, presence of gastroesophageal reflux disease, Zenker's diverticulum size, time since surgery,or number of surgeries. Ninety-one percent of subjects reported improvement in their swallowing after surgery, but 22% reported some decline since that time. Symptomatic subjects reported significantly higher swallow-related distress and lower satisfaction(P < .01). Preoperative variables were not correlated with a return of symptoms. Individuals who underwent multiple procedures had similar levels of benefit and satisfaction as those who underwent a single ESD procedure. ESD results in high levels of patient satisfaction, significant reduction in postoperative symptoms, low levels of complications,and the opportunity to safely and successfully repeat the procedure if necessary.

Postoperative care in fast‐track rehabilitation for elective colonic surgery

SUMMARYThe success of a ‘fast‐track’ rehabilitation program in colonic surgery depends on multiple factors. The major factor post surgery is the prevention of postoperative ileus (POI), resulting in a faster recovery and a shorter hospital stay. All fast‐track programs led to an accelerated intake of oral fluids and solid foods and normalization of intestinal function, thus reducing both the primary and overall hospital stay. Fortunately, the postoperative treatment was not accompanied by an increase in morbidity or mortality. Nevertheless, fast‐track surgery may mean a higher rate of hospital readmissions in the first 2 weeks after discharge. Besides the prevention of POI and postoperative nausea and vomiting through restricted intraoperative fluid management, early oral food intake, rigorous pain control and early mobilization, education – on the part of patient, nurses and other medical staff – is equally as important. Ensuring that the patient takes an active rather than a passive role in the recovery process empowers the patient and avoids needless suffering. The patient is thus surrounded by encouraging staff members who motivate him or her not as a patient but as a ‘partner’ in a precarious situation. Early oral food intake and early mobilization suggest to the patient (and, possibly, to the nursing staff) that the surgical procedure was less invasive than believed and that the postoperative phase need not be eventful or traumatic. In contrast to the conventional treatment with infusions, the typical postoperative diet consisting of tea and soup for days, the fast‐track protocol gives the patient the feeling that he or she is actually in good health and about to leave the hospital. All optimistic signals received during the postoperative phase undoubtedly have a very suggestive and positive influence psychologically on the patient. It is therefore reasonable to assume that the psychological effect of fast‐track rehabilitation, although not assessed in clinical trials, is very important and influences the recovery substantially. Good clinical practice should be based on an ongoing audit of the outcome. In order to ensure the success of a fast‐track rehabilitation program in surgery, it is essential to assess the outcome in terms of morbidity and mortality. Moreover, such an ambitious protocol has to take into account new clinical trial findings in order to introduce improvements to the postoperative phase. Besides an understanding of the pathophysiology and new therapeutic approaches to prevent POI and improve pain control, such measures include the development of an intradepartmental infrastructure and staff education initiatives.