Postoperative Supplementation Research Articles

Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery

BackgroundSmall randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS on clinical outcomes in CRS is lacking.MethodsUsing a nationwide administrative-financial database (Premier Healthcare Database), we examined the association between early ONS use and postoperative clinical outcomes in patients undergoing elective open or laparoscopic CRS between 2008 and 2014. Early ONS was defined as the presence of charges for ONS before postoperative day (POD) 3. The primary outcome was composite infectious complications. Key secondary efficacy (intensive care unit (ICU) admission and gastrointestinal complications) and falsification (blood transfusion and myocardial infarction) outcomes were also examined. Propensity score matching was used to assemble patient groups that were comparable at baseline, and differences in outcomes were examined.ResultsOverall, patients receiving early ONS were older with greater comorbidities and more likely to be Medicare beneficiaries with malnutrition. In a well-matched sample of early ONS recipients (n = 267) versus non-recipients (n = 534), infectious complications were significantly lower in early ONS recipients (6.7% vs. 11.8%, P < 0.03). Early ONS use was also associated with significantly reduced rates of pneumonia (P < 0.04), ICU admissions (P < 0.04), and gastrointestinal complications (P < 0.05). There were no significant differences in falsification outcomes.ConclusionsAlthough early postoperative ONS after CRS was more likely to be utilized in elderly patients with greater comorbidities, the use of early ONS was associated with reduced infectious complications, pneumonia, ICU admission, and gastrointestinal complications. This propensity score-matched study using real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients.

Changes of bone metabolism markers in obese individuals with laparoscopic sleeve gastrectomy

Background Bariatric surgery has proven to be a valuable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a bariatric procedure owing to its safety, low complication rate, and excellent weight loss results. As calcium requires the action of stomach acid to become solubilized, so by eliminating all HCl-secreting parietal cells and pepsin-secreting chief cells in sleeve gastrectomy, calcium becomes unable to be absorbed. A decrease in whole body bone mineral content was seen at first 2 years after SG. If bone loss continues even at slow rate, these patients may have an increased risk for fractures later in life. Aim The aim was to evaluate vitamin D, parathyroid hormone (PTH), and calcium serum after SG and its effect on modulation of postoperative nutritional monitoring and supplementation. Patients and methods This prospective study was done on 50 morbidly obese patients (33 females and 17 males), with mean age of 31.8±7.6 years and mean BMI of 41.5±4.6, who underwent LSG operation. Serum calcium, PTH, and vitamin D were measured before and 6 months after LSG. Results There was a statistically significant reduction in calcium level from baseline to postoperatively (P Conclusion LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrient deficiencies, and greater weight loss does not require higher dosage of multivitamins.

Severe Nutritional Myelopathy After Roux-En-Y Gastric Bypass: A Case Report

Abstract Objectives Roux-en-y gastric bypass (RYGB) is a surgical procedure for weight loss via volume restriction and malabsorption. Without adequate postoperative nutrition, patients can develop micronutrient deficiencies. Methods A 48-year-old male with a history of RYGB nine years ago presented with lower extremity weakness. Patient lost over 150 lbs after surgery and did not consistently take vitamin supplementation. He reported worsening lower extremity weakness accompanied by paresthesias, swelling, and ataxia along with daily episodes of nausea and vomiting, constipation and incomplete bladder emptying. MRI showed signal abnormality of the dorsal columns and lateral corticospinal tracts of the cervical and thoracic spine concerning for copper deficiency. Vitamin testing found copper, vitamin B12 and methylmalonic acid levels to be normal, but vitamin E, thiamine and vitamin D levels were low. Patient was given oral vitamin supplementation with subsequent normalization of lab values; however, his neurologic symptoms did not improve. Results RYGB can cause significant vitamin deficiencies in the absence of adequate postoperative supplementation. Although patient's B12 and copper levels were normal at the time of testing, MRI and physical exam findings of hyperreflexia were most consistent a deficiency in either one (or both). Patient's ataxia (dry beriberi) and peripheral edema (wet beriberi) were also consistent with thiamine deficiency. Conclusions Micronutrient deficiencies are a preventable complication of RYGB, and patients should be regularly screened postoperatively. Although vitamin B12 and copper are the most common causes of nutrition-related myelopathy in the setting of bariatric surgery, vitamin E, thiamine and copper deficiencies are other potential causes to consider. Funding Sources N/A.

Impact of outcomes data on the management of postoperative hypocalcemia in head and neck endocrine surgery patients.

Postoperative hypocalcemia is a well-described outcome following thyroid and parathyroid surgery with symptoms ranging from clinically insignificant laboratory findings to tetany and seizures. The aims of this study were 1. To identify the characteristics and management patterns of postoperative hypocalcemia in head and neck endocrine surgery patients and 2. To compare outcomes between patients treated with empiric calcium and patients treated using a biochemically driven calcium replacement algorithm. Clinical electronic medical record (EMR) data was collected from patients who had undergone total thyroidectomy, completion thyroidectomy, and/or parathyroidectomy at Wake Forest Baptist Medical Center (WFBMC), a tertiary referral and academic institution. Between July 1, 2016, and June 30, 2017, 298 adult patients underwent surgery by a WFBMC Head & Neck (H&N) endocrine surgeon. Objective calcium and parathyroid hormone levels, postoperative supplementation with calcium and Vitamin D, 30-day physician access line (PAL) phone call utilization, emergency department (ED) encounters, and readmission rates were queried. The overall rate of hypocalcemia was 17.4%. No statistically significant difference in PAL utilization, ED visits, or readmissions was found between the empiric supplementation group and those whose supplementation was biochemically directed (PAL 5.0% vs. 5.0% [p=0.983], ED visit 3.3% vs. 2.5% [p=0.744], Readmission 1.7% vs. 0% [p=0.276]). The overall postoperative rates of hypocalcemia and hypoparathyroidism following H&N endocrine surgery were consistent with the reported literature. Neither method of calcium supplementation was superior in reducing PAL utilization, ED encounters, or readmission.

Effect of postoperative hypoalbuminemia and supplement of human serum albumin on the development of poor wound healing following lumbar internal fixation surgery

Objective: To analyze the association between postoperative hypoalbuminemia and poor wound healing, and to evaluate whether postoperative supplementation of human serum albumin can improve postoperative wound healing after lumbar internal fixation surgery. Methods: From January 2014 to December 2018, 602 patients who underwent lumbar internal fixation surgery in the Department of Orthopedics, Zhujiang Hostiptal of Southern Medical University were identified. There were 250 males (41.5%) and 352 females (58.5%), with an average age of (60±12) years. All patients' clinical records were reviewed, including demographics data, comorbidity data, preoperative serum laboratory values, intraoperative factor, postoperative serum laboratory values and wound healing, and the incidence rate of poor wound healing was calculated. The statistical analyses were performed with R software and Empower(R) to analyze the factors related to poor wound healing. Multiple logistic regression models were performed with adjustment for the potential confounders to evaluate the effect of postoperative hypoalbuminemia and supplementation of human serum albumin on the development of poor wound healing. Results: Poor wound healing occurred in 51(8.47%) patients. After adjusting for the confounding factors, multiple regression analysis showed that there was no correlation between postoperative albumin levels and poor wound healing(OR=1.00, 95%CI: 0.91-1.10, P=1.000). Compared with patients with postoperative normal albumin level, postoperative hypoalbuminemia would increase the risk of poor wound healing by 13% (OR=1.13, 95%CI: 0.47-2.70, P=0.787). There was no correlation between supplementation of human serum albumin and poor wound healing in patients with normal albumin levels or postoperative hypoalbuminemia (P>0.05). Conclusions: There is no correlation between postoperative hypoalbuminemia and poor wound healing after lumbar internal fixation surgery. Postoperative supplementation of human serum albumin can't improve wound healing.

Comparison of Bariatric Branded Chewable Multivitamin/Multimineral Formulations to the 2016 American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines.

Postoperative vitamin and mineral supplementation are integral components of the management of the weight loss surgery patient. Supplements differ in type, amount, and salt form. No recent publication has compared bariatric branded commercially available products with current practice guidelines. Registered dietitians belonging to the New England Bariatric Dietitians LinkedIn group were surveyed to identify their recommendation practices. These results were then used to compare and discuss in a comprehensive fashion the most widely recommended bariatric branded chewable supplements to the 2016 American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines.

Calcium and Vitamin D supplementation in the prevention of post-operative hypocalcaemia in thyroidectomy

Introduction: The incidence of transient hypocalcaemia after thyroidectomy varies in centres. It increases morbidity and delays discharge. This randomised controlled trial aimed to ascertain the usefulness of calcium and Vitamin D supplementation for 1 week pre-operatively in the prevention of hypocalcaemia in patients undergoing total thyroidectomy (TT) for multi-nodular goitre. Methodology: Patients undergoing TT for multi-nodular goitre from January 2019 to August 2019 were included in the study. They were randomly divided into two groups by block randomisation. Group A received oral calcium (500 mg every 6 h) and Vitamin D (calcitriol 0.25 mg every 6 h) 7 days before surgery and Group B did not receive supplementation. Symptoms and signs of hypocalcaemia were monitored. Calcium profile was measured pre-operatively and post-operatively at 6 h, 24 h, 72 h and 14th day. Serum calcium level ≤8.5 mg/dl was considered as hypocalcaemia. Results: 8/62 patients in Group A and 26/62 in Group B had symptoms of hypocalcaemia. 11/62 patients in Group A and 34/62 in Group B developed signs of hypocalcaemia. 15/62 patients in Group A and 36/62 in Group B had biochemical hypocalcaemia. 9/62 patients in Group A and 25/62 in Group B developed post-operative hypocalcaemia, which required post-operative oral supplementation. 3/62 patients in Group A and 16/62 in Group B needed post-operative intravenous calcium supplementation. Conclusions: It is concluded that post-operative hypocalcaemia which manifested as signs and symptoms and correlated with biochemical values was lower after receiving pre-operative oral calcium and Vitamin D3 supplement for 7 days. The need for post-operative supplementation was lower in this group.

Postoperative supplementation of propionate and silicon dioxide in patients after total gastrectomy - preliminary report.

IntroductionPost-operative impairment of gastrointestinal tract function and metabolic consequences occur in patients after gastrectomy by Roux-en-Y method. Short-chain fatty acids and silicon dioxide may prove beneficial in the treatment of these conditions.AimTo evaluate a preparation containing propionic acid and silicon dioxide on the body weight, number of stools and their consistency (the Bristol scale), and pain and a feeling of gastric fullness after a meal, in patients after gastrectomy by Roux-en-Y method.Material and methodsMeasurements were performed at the beginning of the study, on day 7 and 14 of application (Colostop®; Miralex, 2 × 15 g/day).Results and conclusionsInitially the average daily number of movements was 10/day, after the therapy it was 3.8/day. At the beginning of the study, 3 patients described their faeces as type 6 and two as type 7 on the Bristol scale. After supplementation, 3 patients described stool consistency as type 5, and two as type 4. Initially, patients rated their pain at 3.4/10 on average, the stomach fullness as 4.6/10. At the end of the study, 3 patients did not feel any pain, while others reported pain at 1/10. Four patients described their feeling of gastric fullness as 1/10, and 1 no longer observed this feeling. Patients disclaimed any adverse effects, and satisfaction after therapy reached 9–10/10 points. Patients’ body weight did not change significantly. An improvement in standard diet tolerance was observed. Despite the limited study group, clinical benefits of the supplementation were observed.

SUN-PO310: A Randomized Controlled Clinical Trial of Pre- and Postoperative Supplementation with Zinc, Vitamin C, Arginine and Multivitamin in Patients Operated for Head and Neck Cancer

SUN-PO310: A Randomized Controlled Clinical Trial of Pre- and Postoperative Supplementation with Zinc, Vitamin C, Arginine and Multivitamin in Patients Operated for Head and Neck Cancer

SAT-117 Prevalence of Vitamin D Depletion and Associated Factors among Patients Undergoing Bariatric Surgery in Southern Brazil

Low levels of 25(OH) vitamin D [25(OH)D] are frequent in obese patients undergoing bariatric surgery. Hypovitaminosis D is a concern in these patients, since it could contribute to the bone loss seen after surgery, and potentially increase fracture risk . Despite post-operative supplementation, 25(OH)D often remains below recommended levels following surgery. Guidelines recommend that vitamin D levels are determined preoperatively. Nevertheless, the systematic determination of 25(OH)D in thousands of patients every year is costly. The prevalence of low levels of 25(OH)D seems to be high among Southern Brazilians. In this scenario, it may be unnecessary to check blood levels prior to introduction of supplementation in bariatric patients. The aim of this study was to evaluate the prevalence of vitamin D deficiency and associated factors in patients undergoing bariatric surgery in Southern Brazil. This was a Cross-sectional, observational study of all patients presenting for bariatric surgery at Hospital de Clínicas de Porto Alegre (a teaching hospital), from 2013 to 2018. Clinical and laboratory data were extracted from electronic records. Patients who were taking supplements containing vitamin D, had renal insufficiency or had missing data for 25(OH)D levels were excluded. Vitamin D status was determined using established cut-offs (deficient ≤19.9 ng/ml; insufficient 20-29.9 ng/mL; sufficient ≥30 ng/mL). Factors associated with vitamin D deficiency were analysed by univariate and multivariable robust Poisson Regression. 297 patients met the inclusion criteria. Mean patient age was 44.7(SD 10.8), and BMI 49,9(SD 8.1) kg/m²; 77.1% were women, and 87.5% were white. More than half the patients (54.5%) were vitamin D deficient, whereas 37% were insufficient, and only 8.4 % had sufficient levels. Mean vitamin D level was 19.7 ng/mL(SD 7.7). Vitamin D deficiency was significantly more prevalent in patients with higher BMI [PR 1.02; CI 95% (1.00-1.03)] and in nonwhite patients [PR 1.71; CI 95% (1.43-2.04)]. Vitamin D insufficiency and deficiency is highly prevalent among patients presenting for bariatric surgery in Southern Brazil. These results are in accordance with studies in Europe and North America. Although sunnier and located in a smaller latitude, Brazil has no food fortification policy and the average vitamin D dietary intake is below the recommendation in almost 100% of its population. Thus, treatment for hypovitaminosis D might routinely be considered in bariatric surgery candidates, especially in those with characteristics identified as independent risk factors for vitamin D deficiency, such as higher BMI and being non-white. Long-term studies are required to assess the eventual advantages and side effects of systematic vitamin D supplementation in this population.

Correcting micronutrient deficiencies before sleeve gastrectomy may be useful in preventing early postoperative micronutrient deficiencies.

Micronutrient deficiencies (MD) shortly after sleeve gastrectomy (SG) are frequent and patients with obesity often show MD preoperatively. Our aim was to assess whether the correction of MD before SG could play a role in preventing early postoperative MD. Eighty patients (58 females, 22 males) who underwent SG were evaluated retrospectively. Patients were divided according to whether they had received preoperative MD correction (Group A, n = 42; 30 females, 12 males) or not (Group B, n = 38; 28 females, 10 males). Micronutrient status was assessed preoperatively, at 3 and 12-months after SG in both groups. After SG, Group A and Group B patients received the same multivitamin supplement and followed the same diet. Nutrient intake of all patients was evaluated by food frequency questionnaires. Before SG, patients of Group A had no MD, whereas patients of Group B were mostly deficient in vitamin B12 (10.5%, 3 women, 1 man), folate (15.8%, 5 women, 1 man), 25-vitamin D (39.5%, 10 women, 5 men), iron (26.3%, 8 women, 2 men), and zinc (7.9%, 2 women, 1 men). At 3- and 12-month follow-up, no patient in group A had developed new MD, whereas all patients of Group B continued to be deficient in one or more micronutrient, despite systematic postoperative supplementation. No statistical differences (p<0.05) in estimated nutrient intake were observed in either group. Based on our findings, we are able to support the hypothesis that pre-SG correction of MD may be useful in preventing early post-SG MD.

Nutritional Deficiencies after Bariatric Surgery

A current review of nutritional complications following bariatric procedures is presented, focusing on the most common and clinically important deficiencies. A brief outline of nutritional supplementation protocol is presented, highlighting the need for a standardized, national or international set of guidelines for pre- and postoperative nutritional screening and appropriate supplementation.

Outcomes in patients with renal hyperparathyroidism requiring cinacalcet pre-operatively followed by parathyroidectomy

BackgroundCinacalcet is an effective treatment for renal hyperthyroidism when traditional medical therapy has failed. We studied the impact of pre-operative cinacalcet administration on post-surgical outcomes. MethodsA retrospective analysis was performed of patients from 2002 to 2017 diagnosed with renal hyperparathyroidism requiring parathyroidectomy to evaluate the need for post-operative supplementation and outcomes. Results102 patients were identified; 34 patients were treated with cinacalcet prior to undergoing parathyroidectomy. The cinacalcet treatment cohort (CT) demonstrated a greater duration of renal replacement therapy (p = 0.03) relative to the untreated cohort (NC). NC had greater proportion receiving peritoneal dialysis (p=<0.0001) compared to other forms of renal replacement, greater pre-operative PTH levels (p = 0.001) and greater decrease in PTH after resection (p = 0.0086). Post-operative vitamin D supplementation was more frequent in the CT group (p = 0.02). After propensity matching for pre-operative PTH and duration of renal replacement therapy, there were no differences in post-operative supplementation or outcomes. ConclusionsCinacalcet patients may have advanced disease. These patients have longer duration of renal failure and higher PTH levels. After propensity matching, no significant differences were noted in terms of need for supplementation or outcomes.

HUMAN CHORIONIC GONADOTROPHIN FOLLOWING ORCHIDOPEXY FOR UNILATERAL PALPABLE UNDESCENDED TESTIS: EFFECT ON TESTICULAR VOLUME AND VASCULARITY

Background: Cryptorchidism is a common male genital anomaly discovered at birth. Orchiopexy is the sole curative option. However, hormonal treatment has its potential role. The type and regimen of hormonal treatment is widely different. Objective: To evaluate the effect of the use of human chorionic gonadotrophin (hCG) as an adjunctive therapy after orchiopexy. Patients and Methods: The study included 60 boys presented with unilateral palpable undescended testis. Their ages at presentation ranged between 10 months and 6 years. All patients were subjected to history taking, clinical and radiological examination and orchiopexy. Patients were randomized into two equal groups. Randomization was done by a closed envelope that opened 2 weeks postoperatively by a nurse not included in the study. Group A received supportive hCG injection, two weeks after operation by single intramuscular injection weekly for 4 consecutive weeks. The dose was adjusted according to patient weight (< 10kg received 500 IU/week; 10-20 kg received 1000 IU/week and above 20 kg received 1500 IU/week). Group B received orchiopexy without postoperative hormonal support. Results: About 88.4% of studied children were underwent orchiopexy in the first two years of life. Both groups were comparable as regard to pre-intervention hormonal profile, and testicular volume before intervention, while after the intervention, volume significantly increased in group A with good blood supply. Conclusion: hCG postoperative supplementation for children with unilateral palpable undescended testis appears to be beneficial in subsequent outcome as expressed by increase in the size and vascularity of the testis.

HUMAN CHORIONIC GONADOTROPHIN FOLLOWING ORCHIDOPEXY FOR UNILATERAL PALPABLE UNDESCENDED TESTIS: EFFECT ON TESTICULAR VOLUME AND VASCULARITY

Background: Cryptorchidism is a common male genital anomaly discovered at birth. Orchiopexy is the sole curative option. However, hormonal treatment has its potential role. The type and regimen of hormonal treatment is widely different. Objective: To evaluate the effect of the use of human chorionic gonadotrophin (hCG) as an adjunctive therapy after orchiopexy. Patients and Methods: The study included 60 boys presented with unilateral palpable undescended testis. Their ages at presentation ranged between 10 months and 6 years. All patients were subjected to history taking, clinical and radiological examination and orchiopexy. Patients were randomized into two equal groups. Randomization was done by a closed envelope that opened 2 weeks postoperatively by a nurse not included in the study. Group A received supportive hCG injection, two weeks after operation by single intramuscular injection weekly for 4 consecutive weeks. The dose was adjusted according to patient weight (< 10kg received 500 IU/week; 10-20 kg received 1000 IU/week and above 20 kg received 1500 IU/week). Group B received orchiopexy without postoperative hormonal support. Results: About 88.4% of studied children were underwent orchiopexy in the first two years of life. Both groups were comparable as regard to pre-intervention hormonal profile, and testicular volume before intervention, while after the intervention, volume significantly increased in group A with good blood supply. Conclusion: hCG postoperative supplementation for children with unilateral palpable undescended testis appears to be beneficial in subsequent outcome as expressed by increase in the size and vascularity of the testis.

Association of Preoperative Calcium and Calcitriol Therapy With Postoperative Hypocalcemia After Total Thyroidectomy

Hypocalcemia is the most common complication after total thyroidectomy and can result in prolonged hospital admissions and increased hospital charges. To determine the effectiveness of preoperative calcium and calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. A retrospective cohort study was conducted at a tertiary care center in 65 patients undergoing total thyroidectomy by a single surgeon. Patients were divided into 2 groups: those receiving preoperative as well as postoperative supplementation with calcium carbonate, 1000 to 1500 mg, 3 times daily and calcitriol, 0.25 to 0.5 µg, twice daily, and those receiving only postoperative supplementation with those agents at the same dosages. Data on patients who underwent surgery between January 1, 2008, and December 31, 2011, were acquired, and data analyses were conducted from March through June 2012, and from October through December 2016. Calcium and calcitriol therapy. Postoperative serum calcium levels and development of postoperative hypocalcemia. Of the 65 patients who underwent total thyroidectomy 27 (42%) were men; mean (SD) age was 49.7 (16.7) years. Thirty-three patients received preoperative calcium and calcitriol supplementation, and 32 patients received only postoperative therapy. In the preoperative supplementation group, 15 of 33 (45%) patients underwent complete central compartment neck dissection and 11 of 33 (33%) had lateral neck dissection, compared with 16 of 32 (50%) and 12 of 32 (38%), respectively, patients without preoperative supplementation. The mean measured serum calcium level in those without preoperative supplementation vs those with supplementation are as follows: preoperative, 9.6 vs 9.4 mg/dL (absolute difference, 0.16; 95% CI, -0.12 to 0.49 mg/dL); 12 hours postoperative, 8.3 vs 8.6 mg/dL (absolute difference, -0.30; 95% CI, -0.63 to 0.02 mg/dL); and 24 hours postoperative, 8.4 vs 8.5 mg/dL (absolute difference, -0.13; 95% CI, -0.43 to 0.16 mg/dL). In patients not receiving preoperative supplementation, 5 of 32 (16%) individuals became symptomatically hypocalcemic vs 2 of 33 (6%) in the preoperative supplementation group; an absolute difference of 10% (95% CI, -6.6% to 26.3%). Compared with the group not receiving preoperative supplementation, the mean [SD] length of stay was significantly shorter in the preoperative supplementation group (3.8 [1.8] vs 2.9 [1.4] days; absolute difference, -0.9; 95% CI, -1.70 to -0.105 days). Preoperative supplementation resulted in an estimated $2819 savings in charges per patient undergoing total thyroidectomy. Preoperative calcium and calcitriol supplementation, in addition to routine postoperative supplementation, was associated with a reduced incidence of symptomatic hypocalcemia, length of hospital stay, and overall charges following total thyroidectomy.

Alpha-lipoic Acid After Median Nerve Decompression at the Carpal Tunnel: A Randomized Controlled Trial

The postoperative course of median nerve decompression in carpal tunnel syndrome may be associated with complications. The aim of this study was to explore the possible effects of alpha-lipoic acid (ALA) in the postoperative period after surgical decompression of the median nerve at the wrist. We conducted a double-blind prospective, randomized, controlled trial. A total of 64 patients with proven carpal tunnel syndrome were enrolled and randomly assigned into 1 of 2 groups: group A (n= 32) patients had surgical decompression of the median nerve followed by ALA for 40 days, and group P (n= 32) patients had surgical decompression followed by placebo. The primary end point of the study was a comprehensive indicator of sensory and motor nerve conduction velocity (electrophysiology score) at 3 months after surgery, Other end points were static 2-point discrimination, Boston Carpal Tunnel score, presence or absence of pillar pain, and use of analgesics beyond the second postoperative day. Alpha-lipoic acid did not improve nerve conduction velocity or Boston Carpal Tunnel score significantly. However, a statistically significant reduction in the postoperative incidence of pillar pain was noted in the ALA group. In addition, static 2-point discrimination improved in both groups. Postoperative administration of ALA for 40 days after median nerve decompression may result in a lower incidence of pillar pain. This treatment is relatively well tolerated, which may support its value as standard postoperative supplementation after carpal tunnel decompression if further studies on larger samples confirm these preliminary findings. Therapeutic I.

A Prospective Study on Role of Supplemental Oral Calcium and Vitamin D in Prevention of Postthyroidectomy Hypocalcemia.

Background:Postoperative transient hypocalcemia is sequelae of total thyroidectomy (TT), which is observed in up to 50% of patients. Routine oral calcium and Vitamin D supplementation have been proposed to prevent symptomatic hypocalcemia preventing morbidity and facilitating early discharge.Patients and Methods:A total of 208 patients with nontoxic benign thyroid disorders, undergoing TT, were serially randomized into four groups: Group A (no supplements were given), Group B (oral calcium – 2 g/day given), Group C (calcium and calcitriol – 1 mcg/day are given), and Group D (calcium, calcitriol, and cholecalciferol – 60,000 IU/day are given). Patients were monitored for clinical and biochemical hypocalcemia (serum calcium, [Sr. Ca] <8 mg/dl), along with serum intact parathormone (Sr. PTH) and magnesium 6 h after surgery and Sr. Ca every 24 h. Intravenous (IV) calcium infusion was started, if any of the above four groups exhibit frank hypocalcemia. Patients are followed up with Sr. Ca and Sr. PTH at 3 and 6 months.Results:All groups were age and sex matched. Hypocalcemia was observed in 72/208 (34.61%) cases. Incidence of hypocalcemia was higher in Group A (57.69%) and Group B (50%) compared to Group C (15.38%) and Group D (15.38%). Hypocalcemia necessitating IV calcium occurred in 31/208 (14.90%) patients. IV calcium requirement exceeded in Group A (26.92%) and Group B (23.07%) compared to Group C (5.76%) and Group D (3.84%). There was no statistical difference in basal levels of serum Vitamin D, calcium, magnesium, intact PTH, and 6 h after surgery. Permanent hypoparathyroidism developed in five patients on follow-up.Conclusion:Routine postoperative supplementation of oral calcium and Vitamin D will help in the prevention of postthyroidectomy transient hypocalcemia significantly. Preoperative Vitamin D levels do not predict postoperative hypocalcemia.

Influence of silicone oil tamponade on self-sealing sclerotomy using 25-gauge transconjunctival sutureless vitrectomy: a retrospective comparative study

BackgroundCharacteristic complications have been reported for transconjunctival sutureless vitrectomy, such as postoperative sclerotomy leakage and postoperative hypotony. Particular attention to sclerotomy closure is required in cases of silicone oil tamponade, because postoperative supplementation of silicone oil implies reoperation, whereas postoperative supplement of gas is comparatively easy. This study investigated sclerotomy closure in cases of silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy.MethodsWe enrolled 19 consecutive eyes with silicone oil injection (Group A, self-sealing sclerotomies, n = 10) (Group B, sutured sclerotomies, n = 9) and 10 eyes with silicone oil removal (Group C, self-sealing sclerotomies) using 25-gauge TSV. Postoperative intraocular pressure was compared between Groups A and B, and between Groups A and C using repeated-measures analysis of variance (ANOVA), one-way factorial ANOVA, and the Tukey-Kramer test.ResultsNo significant differences in age or axial length were seen among groups, but surgical time differed significantly between Group C and the other groups. Mean duration of silicone oil tamponade was 3.2 ± 1.4 months in Group C, and no sclerotomies in Group A or C required suture placement. Postoperative silicone oil leakage to the subconjunctival space was not encountered in Group A. No cases showed postoperative hypotony (defined as intraocular pressure <5 mmHg). Significant differences in intraocular pressure within the same postoperative period were not identified between Groups A and B. Conversely, significant differences in intraocular pressure within the same postoperative period were identified at postoperative days 1 and 2, although not at postoperative week 1 or postoperative month 1 between Groups A and C.ConclusionsThe procedure for sclerotomy closure seems to have little influence on postoperative intraocular pressure in eyes with silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy, because silicone oil tamponade may avoid postoperative hypotony by decreasing sclerotomy leakage in the early postoperative period.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-015-0159-z) contains supplementary material, which is available to authorized users.

Nutritional Markers after Loop Duodenal Switch (SADI-S) for Morbid Obesity: A Technique with Favorable Nutritional Outcome

Background: A reduction of body weight can be achieved after Biliopancreatic diversion, but there is a risk ofmalnutritionanddiarrhea. This risk may be reduced by pyloric preservation with duodenalswitch. Loop duodenal switch (Single anastomosis duodeno-ileal bypass with sleeve gastrectomy=SADI-S) is hybrid operation combining moderate intake restriction with moderate malabsorption for treatment of morbid obesity. It is considered a modified version of the original duodenal switch operation in which after the sleeve gastrectomy, the duodenum is anastomosed in end to side, ante colic and isoperistaltic manner to the selected ileal loop with a length of 2 meters from ileocacal valve. Objective: To evaluate the nutritional outcomes as well as to determine weight loss success of Loop duodenal switch Procedure as surgical treatment for morbid obesity on a series of 37 consecutively operated patients in Endocrine surgery Unit, Mansoura University hospital, Mansoura University, Mansoura, Egypt. Patients and methods: A prospective study conducted during the period from July 2010 to January 2013. The mean age was 35.37 ± 7.78years. The mean BMI was 56.25 ± 8.43 kg/m². All patients were subjected to Loop Duodenal Switch after preoperative preparation and laboratory investigations including: Haemoglobin, serum iron, serum ferritin, serum vitamin B12, serum folic acid, serum albumen, serum calcium, serum magnesium, serum phosphorus, serum alkaline phosphatase, serum cupper, serum zinc, serum sodium, serum potassium, serum albumen, Aspartate Aminotransferase (AST), Alanine Transaminase (ALT) and serum bilirubin were followed up over 1 year. Results: Most of the patients had smooth postoperative course with no major morbidity and single mortality. The BMI decreased significantly, from: 56.52 ± 8.47, to 33.21 ± 3.91, with decrease of the amount of food ingested. Both hemoglobin and calcium in Loop DS readilyreturned to within the reference range followingsupplementation with iron and calcium respectively. The mean serum iron,serum ferritin, serum vitamin B12, serum folic acid, , serum calcium, serum magnesium, serum phosphorus,serum Alkaline phosphatase,serum cupper, serum zinc, serum sodium, serum potassium, serum albumen, Aspartate Aminotransferase (AST), Alanine Transaminase (ALT) and serum bilirubinremained within the normal range with no significant nutritional deficiency. Conclusion: LoopDS is not associated with broad nutritional deficiencies and does not appear to pose a threat to nutritional status. It provides excellent weight loss with preservation of good alimentation, even in the super obese. Postoperative supplementation with iron, multivitamins, calcium and vitamin D may be required continuously to prevent nutritional deficiency especially for adults and females in the Child bearing period.