Postoperative Diet Research Articles

Association of Postoperative Dieting, Exercise, Dietitian, and Surgeon Follow up With Bariatric Surgery Outcomes.

Although postoperative diet modification, exercise, and regular dietitian and surgeon follow-up are often recommended after bariatric surgery (BS), their impact on weight loss is unclear. A Retrospective chart review was conducted for patients who received sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) between August 2000 and November 2017 with telephone follow-up. Multivariable logistic regression models were used for analyses. There were 514 patients included in our study. Most were female (76.3%), mean age was 46.9years (Standard Deviation [SD] = 11.8), and mean weight loss was 11.6 (SD = 6.5) BMI points at a mean follow-up of 7years (SD = 4.3). Current surgeon follow-up OR = 2.08 (P < .01) was positively associated with postoperative weight loss, while current dietitian follow-up=OR .41 (P < .01) was negatively associated. Current weight loss supplement use OR = .45 (P = .03) was associated with reduced willingness to undergo surgery again. Increasing preoperative BMI OR = 1.06 (P = .04) and increasing age OR = 1.04 (P = .02) were associated with improved quality of life (QoL) due to BS. Lack of surgeon follow-up and regular dietician consultation was associated with suboptimal weight loss after BS. Older age was positively associated with improved QoL, while current weight loss supplement use was associated with lower likelihood of undergoing surgery again, both independent of weight loss.

Early Postoperative Exposure to High-Fat Diet Does Not Increase Long-Term Weight Loss or Fat Avoidance After Roux-en-Y Gastric Bypass in Rats.

BackgroundBariatric surgery alters food preferences in rats and reportedly decreases desire to consume high-fat high-sugar food in humans. The aim of this study was to investigate whether early post-operative exposure to high-fat food could increase body weight loss after Roux-en-Y gastric bypass (RYGB) by triggering fat avoidance.MethodsMale Wistar rats underwent either RYGB (n = 15) or sham-operations (n = 16). Preoperatively a standardized 4-choice cafeteria diet [dietary options: low-fat/low-sugar (LFLS), low-fat/high-sugar (LFHS), high-fat/low-sugar (HFLS), high-fat/high-sugar (HFHS)] was offered. First, each option was available for 4 days, thereafter rats were offered the 4 options simultaneously for 3 days preoperatively. Post-surgery, 8 rats in the RYGB- and 8 in the sham-group were exposed to a high-fat content diet (Oatmeal + 30% lard, OM+L) for 10 days, while 7 RYGB rats and 8 sham-rats received OM alone. From the 11th postoperative day, the 4-choice cafeteria diet was reintroduced for 55-days. The intake of all available food items, macronutrients and body weight changes were monitored over 8 weeks. Main outcomes were long-term body-weight and daily change in relative caloric intake during the postoperative cafeteria period compared to the preoperative cafeteria.ResultsDuring the first 12 days of postoperative cafeteria access, RYGB-rats exposed to OM+L had a higher mean caloric intake per day than RYGB rats exposed to OM alone (Δ10 kCal, Padj = 0.004), but this difference between the RYGB groups disappeared thereafter. Consequently, in the last 33 days of the postoperative cafeteria diet, the mean body weight of the RYGB+OM+L group was higher compared to RYGB+OM (Δ51 g, Padj < 0.001). RYGB rats, independently from the nutritional intervention, presented a progressive decrease in daily consumption of calories from fat and increased their daily energy intake mainly from non-sugar carbohydrates. No such differences were detected in sham-operated controls exposed to low- or high fat postoperative interventions.ConclusionA progressive decrease in daily fat intake over time was observed after RYGB, independently from the nutritional intervention. This finding confirms that macronutrient preferences undergo progressive changes over time after RYGB and supports the role of ingestive adaptation and learning. Early postoperative exposure to high-fat food failed to accentuate fat avoidance and did not lead to superior weight loss in the long-term.

Bioinformatic Characterization of Whole Blood Neutrophils in Pelvic Inflammatory Disease: A Potential Prognostic Indicator for Transumbilical Single-Port Laparoscopic Pelvic Abscess Surgery.

The purpose of this research is to determine the prognosis of patients treated with transumbilical single-port laparoscopic surgery for acute pelvic inflammatory illness. Postoperative data on 129 patients treated with laparoscopic surgery for acute pelvic inflammatory illness were obtained retrospectively. It was observed that the shorter the time required for postoperative leukocyte recovery to normal, the shorter the time required for postoperative pain and diet recovery, as well as hospital stay, in such individuals. CIBERSORT was used to examine patient data from GEO. The most significant difference between the normal and pelvic inflammatory groups was in neutrophil content. Association study found a substantial positive correlation between the quantity of neutrophils infiltrating the immune system and the abundance of monocyte M0 infiltrating the immune system. Neutrophil immune infiltration was strongly inversely linked with plasma cells, activated CD8+ Tm cells, and active CD4+ Tm cells. Four mRNAs linked with pelvic inflammatory illness were revealed to be strongly associated with neutrophil immune infiltration, notably CALML4, COQ10B, DCPS, and PPP2R1A. The ROC revealed that CALML4 (area under the curve (AUC): 0.769, 95% confidence interval (CI): 0.638–0.881), COQ10B (AUC: 0.742, 95% CI: 0.587–0.881), PPP2R1A (AUC: 0.733 95% CI: 0.593–0.857), and DCPS (AUC: 0.745, 95% CI: 0.571–0.900) were potential markers for predicting pelvic inflammatory disease. CALML4, COQ10B, PPP2R1A, and DCPS may be critical determinants determining the amount of preoperative neutrophil infiltration and the time required for leukocyte recovery after single-port laparoscopy in acute pelvic inflammatory illness.

Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study

BackgroundCytoreductive surgery followed by systemic chemotherapy is the standard of treatment in advanced ovarian cancer where feasible. Neoadjuvant chemotherapy (NACT) followed by surgery is applicable where upfront cytoreductive surgery is not feasible because of few certain reasons. Nevertheless, surgical interventions and the chemotherapy itself may be associated with postoperative complications usually entailing slow postoperative recovery. Prehabilitation programs consist of the patient’s preparation before surgery to improve the patient’s functional capacity. The aim of this study was to evaluate the impact of a prehabilitation program during neoadjuvant treatment and interval cytoreductive surgery for ovarian cancer patients.MethodsA retrospective observational pilot study of patients with advanced ovarian cancer treated with NACT and interval cytoreductive surgery was conducted. The prehabilitation group received a structured intervention based on physical exercise, nutritional counseling, and psychological support. Nutritional parameters were assessed preoperatively and postoperatively, and functional parameters and perioperative and postoperative complications were also recorded.ResultsA total of 29 patients were included in the study: 14 in the prehabilitation group and 15 in the control group. The patients in the prehabilitation program showed higher mean total protein levels in both preoperative (7.4 vs. 6.8, p = 0.004) and postoperative (4.9 vs. 4.3, p = 0.005) assessments. Up to 40% of controls showed intraoperative complications vs. 14.3% of patients in the prehabilitation group, and the requirement of intraoperative blood transfusion was significantly lower in the prehabilitation group (14.3% vs. 53.3%, p = 0.027). The day of the first ambulation, rate of postoperative complications, and length of hospital stay were similar between the groups. Finally, trends towards shorter time between diagnosis and interval cytoreductive surgery (p = 0.097) and earlier postoperative diet restart (p = 0.169) were observed in the prehabilitation group.ConclusionPrehabilitation during NACT in women with ovarian cancer candidates to interval cytoreductive surgery may improve nutritional parameters and thereby increase postoperative recovery. Nevertheless, the results of this pilot study are preliminary, and further studies are needed to determine the clinical impact of prehabilitation programs.

Adherence to ESPEN guidelines and associations with postoperative outcomes in upper gastrointestinal cancer resection: results from the multi-centre NOURISH point prevalence study.

Postoperative nutrition support is an essential component of management in upper gastrointestinal (UGI) cancer resection, however there is limited knowledge of current clinical practice. This study aimed to describe the postoperative nutrition support received by patients undergoing UGI cancer resections, assess adherence with ESPEN surgical guideline recommendations, and to investigate differences between oesophageal, gastric and pancreatic surgeries. The secondary aim was to explore the association of adherence with ESPEN guidelines and provision of nutrition support, with surgical complications and length of stay (LOS). The NOURISH point prevalence study was conducted between September 2019-June 2020 across 27 Australian tertiary centres. Malnutrition was diagnosed using subjective global assessment. Data on postoperative diet codes, prescription of nutrition support (oral (ONS), enteral (EN), parenteral (PN)) and nutritional adequacy were collected by dietitians for the first 10 days of admission. Fisher's exact test was used to determine differences in nutritional management and adherence to ESPEN guidelines between surgery types. Multivariate regression analysed associations with surgical outcomes. Two-hundred participants were included (42% pancreatic, 33% oesophageal, 25% gastric surgery). Overall, only 34.9% (n=53) met the guideline recommendations that were applicable to them. Early oral intake of fluids or solids (within 24h post surgery) was initiated for 23.5% (n=47), whilst ONS/EN/PN was initiated for 49.5% (n=99). Only 25% of pancreatic surgeries had nutrition support initiated on the first postoperative day compared to 86.4% of oesophageal and 42.0% of gastric surgeries (p<0.001). In those who were 'nil by mouth', EN/PN were commenced within 24h for 51.0% (n=78), with 18.5% and 45.2% for pancreatic and gastric surgeries compared to 86.0% in oesophageal surgeries (p<0.001). In malnourished patients, 35.7% (n=30) commenced EN within 24h, with 11.1% and 31.8% for pancreatic and gastric compared to 73.1% in oesophageal surgeries (p<0.001). For patients meeting <60% energy/protein requirements for ≥7 days, only 14.8% (n=9) received EN/PN, with 2.5% and 16.7% of pancreatic and gastric compared to 75.0% of oesophageal surgeries (p<0.001). The number of days spent 'nil by mouth' or 'clear fluids' without EN/PN, as well as number of days with <60% estimated requirements met were independently associated with increased LOS and complications. Overall, there was poor adherence to the majority of assessed ESPEN guidelines, and care for patients undergoing pancreatic and gastric surgeries was less compliant than oesophagectomy. Poor nutritional adequacy was associated with increased LOS and complications. There is a clear need for knowledge translation and implementation studies to increase adherence to evidence-based recommendations in the Australian setting supported by an understanding of barriers and enablers to optimal postoperative nutrition management.

A study on postoperative nursing of minimally invasive surgery for lumbar disc herniation

In order to explore the effective nursing methods and clinical therapeutic effects for patients with lumbar disc herniation after receiving minimally invasive surgery. In this study, a total of 50 patients receiving minimally invasive surgery for lumbar disc herniation in our hospital over the past year were selected and randomly divided into trial group and control group, with 25 patients in each group. Patients in control group were given routine nursing, and those in trial group were given postoperative comprehensive nursing including postoperative rehabilitation exercise, psychological nursing, diet nursing and other aspects. Visual analogue scale (VAS) was used to score the pain of patients in both groups before and after surgery; The final result shown that patients in trial group had better postoperative recovery time and hospital stays than patients in control group after nursing, with statistically significant difference (P < 0.05); the score of visual analogue scale (VAS) in trial group was better than that in control group, and with statistically significant difference (P < 0.05); the effective rate of trial group was 92.5%, compared with the 75% of control group with statistically significant difference (P < 0.05); the score of Barthel index of trial group was obviously better than that of control group, with statistically significant difference (P < 0.05). Therefore, the postoperative comprehensive nursing can not only help to improve the postoperative therapeutic effect, but also reduce the pain, accelerate the postoperative recovery and shorten the hospital stays of patients. Therefore, it shall be paid attention to and widely used in clinical practice.

Severity of Menopausal Symptoms in Women Posthysterectomy at a Tertiary Care Hospital,Tamil Nadu, India: A Cross-sectional Study

Introduction: Menopause, a natural occurrence in women’s lives, is characterised by a drop in ovarian hormones, oestrogen, and progesterone levels. Sudden hypoestrogenic state, that is caused by hysterectomy leads to the development of menopausal symptoms. Aim: To assess the occurrence and severity of menopausal symptoms in women who underwent hysterectomy for benign gynaecologic conditions. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India, over a period of three months. The study included 100 women in the age group of 35-55 years who had undergone hysterectomy for benign conditions were invited to participate in the study. Those who agreed to the study and completed the questionnaire after six weeks and three months postoperatively were included in this study. Menopausal symptoms and severity were assessed using modified Menopause Rating Scale (MRS) scale. Posthysterectomy menopausal symptoms at six weeks and three months were compared using Chi-square test. Results: The mean age of the study participants was 45.85±6.24 years. Most of them, 52 (52%) had heavy menstrual bleeding, 28 (28%) of the study participants had no associated comorbidities. A total of 54 (54%) of the women of this study was diagnosed as Abnormal Uterine Bleeding-Leiomyomas (AUB-L). Majority 76 (76%) of them had undergone total abdominal hysterectomy with or without bilateral salphingoopherectomy. Mean duration of hospital stay 7.48±2.02 days. Postoperative diet of these women included calcium containing foods 57 (57%), iron containing foods 68 (68%). There was a statistically significant difference in majority of menopausal symptoms like hot flushes, palpitations, night sweats, reduced duration of sleep, anxiety, lack of interest in sex, forgetfulness and joint and muscle pains between six weeks and three months postoperatively. Conclusion: The present study concluded that the symptoms of hot flushes, difficulty in urinating, anxiety, joint and muscle pain was significantly higher at six weeks when compared to three months.

Patient Engagement Towards Delivery of Quality Care - A Study Amongst Elective Surgical Cases in Two Private Hospitals in India

Background Patients and their families may play a major role in the improvement of healthcare outcome. Modern healthcare scenario focuses on enhancing patient well-being with a closer participation between payer and provider. ldquoNothing about me is without merdquo is the true essence of healthcare which requires first-hand knowledge of the ailment treatment options risks and benefits and a host of other information for the patients to be completely involved in the care process.Objectives To assess the level of involvement of patients undergoing elective surgeries during the phases such as surgical decision making written consent and post-surgical recovery.Methodology The present study was conducted at two tertiary care hospitals in India with a sample size of 50 each from the selected surgical specializations. Structured questionnaires were designed to obtain relevant data from the participants admitted under selected surgical specialisations. Data was collected to assess their involvement at three phases viz. pre surgical decision making written consent and post-surgical recovery phases. Data from all three phases were compiled and the involvement of patients was computed in terms of percentage using descriptive statistics. Chi-square test was performed to determine the association between patient involvement and demographic variables. Significance level at 5.Results The study showed good involvement of patients at all the three levels with ge75 score. However association was not found between demographic variables and the level of involvement.Conclusion Many patients felt the need to receive more information regarding post-operative recovery time post-operative diet care for incision site and post-operative movement or exercises.

Emergency Laparoscopic Management of Perforative Peritonitis: A Retrospective Study.

BackgroundPeritonitis was previously considered a contraindication for minimally invasive surgery due to the risk of malignant hypercapnia partial pressure of carbon-dioxide (PCO2) and toxic shock syndrome. The objective of this retrospective study was to evaluate the role of laparoscopic surgery (LS) in selected patients with perforative peritonitis and to study its feasibility, safety, and outcomes.Patients and methodsThis was a retrospective study of 25 patients spanning over five years from 2015 to 2020. This study comprised all patients who were diagnosed with perforative peritonitis on preoperative physical/clinical examination, radiological evaluations, and who were stable enough to withstand pneumoperitoneum. Patients were evaluated for causes, operative time, duration of hospital stay, intra-, and postoperative complications, time taken to resume normal activity, and conversion to open surgery. Data was extracted from the hospital electronic medical records, for the above-mentioned parameters.ResultsTwenty-five patients with perforative peritonitis underwent diagnostic and therapeutic LS in our institute. The mean age was 46 years (35-79 years). Ten patients (40%) were diagnosed with gastro-duodenal perforation. Out of these ten patients, ninepatients (90%) were managed totally laparoscopically, while one patient (10%) required conversion to open surgery. There were 15 patients (60%) with small bowel perforation. Thirteen of the 15 patients were managed laparoscopically, with the remaining two requiring conversion to open surgery. The average time taken for the procedure was 90 minutes. The mean time to initiate the postoperative peroral liquid diet was 3.4 days. The mean postoperative stay was 6.9 days. The time taken to resume normal activity was 10-12 days.ConclusionsLaparoscopic management is feasible and safe for patients with perforative peritonitis. Careful patient selection and the surgeon’s experience with the procedure are critical determinants of success.

EP.WE.135Analysis of National Bariatric Surgery Related Clinical Incidents

Abstract Background Hundreds of thousands of patient-safety clinical incidents are reported to the National Reporting and Learning System (NRLS) database in the United Kingdom (UK) every year. The purpose of this study was to identify bariatric surgery-related learning points from these incidents. Methods We analysed bariatric surgery-related clinical incidents reported to the UK NRLS database between 01 April 2005 and 31st October 2020. Results We identified 541 bariatric surgery-related clinical incidents in 58 different themes. Preoperative incidents represented 30.31% (N = 164), intraoperative 38.09% (N = 206), and postoperative accounted for 31.61% (N = 171). In terms of severity of incidents, (150;27.7%) were of high severity, whereas medium and low severity incidents were (244;45.1%) and (147;27.2%) respectively. The most common high severity theme was failure of thromboprophylaxis (50;9.2%). Intraoperative high severity incidents included 17 incidents of stapling of orogastric/nasogastric tubes or temperature probes, 8 missed needles, 8 broken graspers, and 6 incidents of band parts left behind. Postoperatively, the most common high severity theme was improper management of diabetes mellitus (DM) (35;6.5%). Medications errors represented a significant proportion of the medium severity incidents and included (26;4.8%) incidents of improper or missed prescription of routine medications and anticoagulants preoperatively and (45;8.3%) wrong prescriptions, dosage or prescribing of contraindicated medications postoperatively. Among the low severity themes identified there were (23;4.3%) incidents of postoperative diet problems, and (19;3.5%) patients listed for wrong procedures. Conclusion We identified 58 specific themes of bariatric surgery-related clinical incidents. Awareness of these themes should help to improve the safety of bariatric surgery worldwide.

Open versus laparoscopic lateral lymph node dissection for mid- and low- rectal cancer: a propensity score matching study.

This study aimed to evaluate the perioperative, pathological and oncological outcomes of open versus laparoscopic total mesorectal excision (TME) plus lateral lymph node dissection (LLND) for mid- and low- rectal cancer using propensity score matching. Between September 2009 and December 2018, consecutive patients who underwent open or laparoscopic TME plus LLND were collected. Based on the propensity score matching analysis, laparoscopic TME plus LLND was compared with open TME plus LLND for the perioperative, pathological, and oncological outcomes. A total of 77 patients were collected. There were 13 patients who underwent open TME plus LLND (open group) and 64 patients who underwent laparoscopic TME plus LLND (laparoscopic group). After propensity score matching, 13 patients in the open group were matched to 39 patients in the laparoscopic group (1:3). The laparoscopic group had a significantly shorter length of incision (5cm vs. 20 cm, p< 0.01), less intraoperative blood loss (80 mL vs. 100 mL, p= 0.02), and shorter time to postoperative liquid diet (72 h vs. 96 h, p= 0.05). There were no significant differences in both early and late postoperative complications. The 3-year overall survival was 85.9% in the laparoscopic group and 76.9% in the open group (p= 0.75), respectively. The 3-year disease-free survival was 70.6% in the laparoscopic group and 74.1% in the open group (p= 0.83), respectively. Laparoscopic LLND had comparable oncological outcomes to open LLND. Moreover, laparoscopic LLND had postoperative recovery advantages over open LLND.

Peptide-based enteral formula vs a whole protein enteral formula after major intestinal surgeries in children

BackgroundMalnutrition is a common finding after major abdominal surgeries especially after prolonged period of fasting in children. Enteral feeding is the commonest support way postoperatively for stimulating gut hormones, modulating immunity, and maintaining the barrier function of the intestinal mucosa.Our aim was to compare the results and outcome regarding tolerance, nutritional status, and hospital stay following a postoperative diet of peptide-based enteral formula against a whole protein enteral formula after major intestinal surgeries in pediatric patients who had resection and re-anastomosis after intussusception.ResultsThis is a prospective cohort study on two groups of patients with a total of 30 patients during the period between January 2019 and June 2020.All patients in both groups underwent major intestinal surgeries (resection and re-anastomosis after intussusception). The first group received postoperative whole protein formula exclusively on the 3rd postoperative day while the other group received peptide-based formula exclusively on the same day.Postoperative mean serum albumin and pre-albumin levels were significantly higher in peptide-based formula group compared to those who had protein-based formula as their initial feeds (P value < 0.05). The average hospital stay was also significantly shorter in the peptide group (P value < 0.05). Peptide formula was easily tolerated than protein formula in postoperative children who had major intestinal surgeries.ConclusionPeptide-based enteral formulas are better tolerated and more useful as regards nutritional status than whole-protein formulas in post-operative course of pediatric patients regarding clinical outcome and better economically with shorter hospital stay.

Hiatal hernia repair: postoperative diet, activity, and optimal long-term follow-up

Hiatal hernia repair: postoperative diet, activity, and optimal long-term follow-up

An observational report of swallowing outcomes following corpus callosotomy

AimDetermine swallowing outcomes following corpus callosotomy (CC) surgery. MethodsRetrospective chart review of patients undergoing CC between July 2016 and November 2018 at a large, urban children’s hospital. ResultsOf the 18 patients without prior history of dysphagia who underwent CC, 15 received speech pathology consults for bedside swallowing evaluation (BSE). Four patients were referred for a videofluroscopic swallow study (VFSS), and 3 showed no signs of difficulty and were advanced to regular diets with thin liquids. One patient demonstrated swallowing difficulties during the VFSS and was placed on a regular diet with nectar thick liquids. Following a repeat swallow study 17 days post-surgery, the patient was advanced to thin liquids. InterpretationPostoperative dysphagia following CC is an uncommon and transient complication. Patients undergoing CC should have their swallowing evaluated prior to advancing their postoperative diet but are likely to return to normal diet and thin liquids by discharge.

Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients

IntroductionThe best strategy to manage an interarytenoid defect [Type 1 laryngeal cleft (LC-1) or deep interarytenoid groove (DIG)] in pediatric aerodigestive patients with dysphagia remains uncertain. This study compared benefit of interarytenoid augmentation (IAA) to suture repair or clinical observation alone in pediatric patients. MethodsA 3-year retrospective, single-center analysis of children with dysphagia undergoing endoscopic airway evaluation was performed. Physician preference guided treatment plan: suture repair with CO2 laser, IAA (carboxy methylcellulose or calcium hydroxyapatite), or observation. Primary outcome was improved post-operative diet. Significance was assumed at p < 0.05. Results449 patients underwent diagnostic endoscopy. Mean age (±SD) at procedure was 21 ± 13 months, with nearly one fourth (28 %) of children ≤ 12 months. Eighty (18 %) had either an LC-1 (n = 55) or DIG (n = 25). Of these, 35 (42 %) underwent suture repair, 22 (28 %) IAA, and 23 (30 %) observation only. Aspiration improved overall in the interventional groups compared to observational controls (58 % vs. 9 %, p < 0.05), with no change in benefit observed by age of intervention. IAA was as effective as suture repair (59 % vs 55 %, p = 0.46). In patients with only a DIG, IAA intervention alone significantly improved swallow function (66.6 % vs. 0 %, p < 0.05). ConclusionIn pediatric aerodigestive patients with dysphagia, 18 % of children have an addressable lesion. IAA or suture repair similarly improves dietary advancement. IAA improves swallow function in patients with DIG. These findings support a novel protocol to intervene in dysphagia patients with LC-1 or DIG via IAA at the initial operative evaluation.

Application value of hand-sewn anastomosis in totally laparoscopic total gastrectomy for gastric cancer

BackgroundDigestive tract reconstruction in totally laparoscopic total gastrectomy can be divided into two types: instrument anastomosis and hand-sewn anastomosis. This study explored the feasibility and safety of hand-sewn sutures in esophagojejunostomy of totally laparoscopic total gastrectomy, compared with instrument anastomosis using an overlap linear cutter.MethodsThis retrospective cohort study was conducted from January 2017 to January 2020 at one institution. The clinical data of 50 patients who underwent totally laparoscopic total gastrectomy, with an average follow-up time of 12 months, were collected. The clinicopathologic data, short-term survival prognosis, and results of patients in the hand-sewn anastomosis (n=20) and the overlap anastomosis (n=30) groups were analyzed.ResultsThere were no significant differences between the groups in sex, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative complications, abdominal operation history, tumor size, pTNM stage, blood loss, first postoperative liquid diet, exhaust time, or postoperative length of hospital stay. The hand-sewn anastomosis group had a significantly prolonged operation time (204±26.72min versus 190±20.90min, p=0.04) and anastomosis time (58±22.0min versus 46±15.97min, p=0.029), and a decreased operation cost (CNY 77,100±1700 versus CNY 71,900±1300, p<0.0001). Postoperative complications (dynamic ileus, abdominal infection, and pancreatic leakage) occurred in three patients (15%) in the hand-sewn anastomosis group and in four patients (13.3%) in the overlap anastomosis group (anastomotic leakage, anastomotic bleeding, dynamic ileus, and duodenal stump leakage).ConclusionThe hand-sewn anastomosis method of esophagojejunostomy under totally laparoscopic total gastrectomy is safe and feasible and is an important supplement to linear and circular stapler anastomosis. It may be more convenient regarding obesity, a relatively high position of the anastomosis, edema of the esophageal wall, and short jejunal mesentery.

Laparoscopic adrenalectomy: comparison of outcomes between posterior retroperitoneoscopic and transperitoneal adrenalectomy with 10 years' experience.

Laparoscopic adrenalectomy is widely used for treating various adrenal tumors. Posterior retroperitoneoscopic adrenalectomy was introduced after transperitoneal laparoscopic adrenalectomy. The comparability and superiority of posterior retroperitoneoscopic adrenalectomy have been widely investigated. We aimed to compare the outcomes of posterior retroperitoneoscopic adrenalectomy and transperitoneal laparoscopic adrenalectomy using 10 years' data. The changes in outcomes over time were also analyzed. This was a retrospective observational study. A total of 505 patients who underwent laparoscopic adrenalectomy between 2009 and 2018 were included. The patients were divided into two groups: transperitoneal (n=114) and retroperitoneal (n=391) groups. Patients who underwent posterior retroperitoneoscopic adrenalectomy were further classified into sub-groups (sub-group 1: 2009-2012; sub-group 2: 2013-2015; and sub-group 3: 2016-2018) based on time periods. Clinicopathological factors and postoperative outcomes were retrospectively reviewed and analyzed. The retroperitoneal group showed significantly shorter operation time, diet initiation time, and hospital stay compared to the transperitoneal group (P=0.000, 0.000 and 0.000, respectively). Analgesics were used less frequently in the retroperitoneal group than in the transperitoneal group (P=0.048). In the retroperitoneal group, the time to postoperative diet initiation shortened over time (P=0.000). Posterior retroperitoneoscopic adrenalectomy is a favorable surgical method that results in patient outcomes that are comparable to those of conventional transperitoneal laparoscopic adrenalectomy, without compromising patient safety.

Postoperative poor oral intake after open distal pancreatectomy

Besides the causes we know including adhesive ileus, it is not uncommon for poor oral intake (POI) in patients after distal pancreatectomy (DP). This study investigated the occurrence of POI and identify the risk factors of POI in patients after DP. In this retrospective study, prospectively collected data of patients who received DP in National Cancer Center, Korea between April 2013 and December 2020 were reviewed. The diet protocol after DP in our institution as follows; sips of water (SOW) on postoperative day (POD) 1, soft blended diet (SBD) on POD 2 or 3, and normal regular diet (NRD) after POD 5, if the patient was tolerable on diet protocol. POI after distal pancreatectomy was defined as the delay of postoperative diet protocol after DP or the reverse of postoperative diet progression sequence. A total of 148 patients received open distal pancreatectomy during the study period. Patients who were diagnosed adhesive ileus were excluded (n = 14), and finally 134 patients were enrolled. Including 7 patients with postoperative delayed gastric emptying, 39.2 (52/134)% patients experienced POI after distal pancreatectomy. multi-visceral resection (HR 2.901, 95% CI 1.041-8.085, p = 0.042), celiac axis resection (HR 12.369, 95% CI 1.113-137.451, p = 0.041), operation time > 180 minutes (HR 3.146, 95% CI 1.265-7.822, p = 0.014), and postoperative major complication (HR 3.778, 95% CI 1.205-11.847, p = 0.023), clinically significant POPF (HR 3.642, 95% CI 1.065-12.451, p = 0.039) were independent risk factors for POI after DP. Therefore, especially in patients with these risk factors.

Role of bioactive lipids in metabolism of obese patients and prospects for their use in the postoperative period

The scientific review analyzes publications that prove the positive effects of bioactive lipids on human health. It is noted that certain lipids have a prophylactic effect on the body and can inhibit the development of certain diseases. The increased speed of passage of food masses after bariatric surgery affects the completeness of lipid breakdown and absorption in the stomach and small intestine. In case of significant violations, this can cause some complications in the operated patients. The effect of bioactive lipids on the metabolism of obese patients and the possibility of including lipids in the postoperative diet were analyzed.

Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway.

To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.