Postoperative Food Intake Research Articles

Clinical efficacy of transumbilical single-port laparoscopic cholecystectomy with ultrasonic knife for directly handling cystic artery

Objective To investigate the clinical feasibility and value of transumbilical single- port laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery.Methods A retrospective analysis was performed on the clinical data of 231 patients who underwent laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery in our department from March 2011 to December 2012.According to the required surgical approaches,the patients were divided into transumbilical single- port laparoscopic group(n = 125,group A) and three- port laparoscopic group(n = 106,group B).The two groups were compared in terms of operative time,intraoperative blood loss,postoperative analgesia,postoperative food intake,length of postoperative hospital stay,and postoperative complications,as well as the performance of the ultrasonic knife in directly handling the cystic artery.Comparison of continuous data between groups was made by t test,while comparison of categorical data was made by chi- square test.Results Group A had a significantly longer mean operative time than group B(20.21 ± 1.86 min vs 18.43 ± 1.37 min,P 0.05).There was no significant difference in mean intraoperative blood loss between groups A and B(23.23 ± 6.25 ml vs 22.34 ± 5.49 ml,P 0.05).Group A had significantly fewer patients who needed postoperative analgesia than group B(5 vs 21,P 0.05).The time to postoperative food intake showed no significant difference between groups A and B(6.56 ± 1.23 h vs 6.67 ± 1.45 h,P 0.05).The mean length of postoperative hospital stay was(2.98 ± 0.23) d in group A,versus(3.02 ± 0.18) d in group B(P 0.05).No indwelling drainage tube was used after operation in either group.There were no postoperative bleeding,bile duct injury,bile leakage,incisional wound infection,and other complications in the two groups.The ultrasonic knife had reliable hemostatic effect when directly sealing the cystic artery,without causing postoperative secondary bleeding.All patients were followed up for 2- 12 months(mean,6.5 months);they recovered well without incisional hernia,and the umbilical scar was not obvious,with relatively good cosmetic results.Conclusion Transumbilical single- port laparoscopic cholecystectomy has a comparable clinical effect to three- port laparoscopic cholecystectomy,causing little trauma,postoperative pain,and scar,and it is suitable for patients with a high demand for incision appearance.Directly sealing the cystic artery with the ultrasonic knife can reduce bleeding due to careful separation of the cystic artery and shorten the operative time.Therefore,it is a safe,feasible surgical approach and worthy of clinical application.

P3–054 - Reconstruction After Total Gastrectomy in Patients with Gastric Cancer: Our Hospital Experience

Background and aims: Gastric cancer (GC) remains one of most worldwide frequent cancers. After total gastrectomy it is necessary to realize reconstructin of the upper part digestive tract. The double tract (DT) method is the optimal reconstruction procedure after total gastrectomy for patients with gastric cancer.Methods: In General hospital Sveti Vraceviin Bijeljina from January 2006 to January 2012, 67 patients who underwent a total gastrectomy with a curative resection. In all patients to the esophagojejunostomy, the side-to-end jejunoduodenostomy was performed manually, 35 cm distal to the esophagojejunal anastomosis. The end of the Y limb was anastomosed manually to the side of the Roux limb, approximately 15 cm distal to the jejunoduodenal anastomosis. It is prospectively study for all patients and included their history, clinicopathologic examinations, postoperative clinical information, and complications.Results: In these study were observed early postoperative complications and mortality, postoperative food intake and nutritional status (hemoglobin, total proteins and albumin), and incidence of diarrhea and dumping syndrome at 1 and 5 years. The overall 1-, 3-, and 5-year cumulative survival rate were 53.3%, 24.6%, and 10.8%, respectively. Concerning tumor location, tumor diffused in thee sections of stomach in 67 cases, mainly in cardia and body in 20 cases, mainly in body and antrum in 36 cases, and only in body of stomach in 11 cases. In the pathological examination, the tumors of 57 patients were diagnosed as adenocarcinoma, 7 as malignant lymphoma, and 3 as leiomyosarcoma.Conclusions: The benefits of this method are (1) a simple procedure; (2) preservation of the duodenal passage; (3) no duodenal stump, resulting in no risk of postoperative stump rupture. Background and aims: Gastric cancer (GC) remains one of most worldwide frequent cancers. After total gastrectomy it is necessary to realize reconstructin of the upper part digestive tract. The double tract (DT) method is the optimal reconstruction procedure after total gastrectomy for patients with gastric cancer. Methods: In General hospital Sveti Vraceviin Bijeljina from January 2006 to January 2012, 67 patients who underwent a total gastrectomy with a curative resection. In all patients to the esophagojejunostomy, the side-to-end jejunoduodenostomy was performed manually, 35 cm distal to the esophagojejunal anastomosis. The end of the Y limb was anastomosed manually to the side of the Roux limb, approximately 15 cm distal to the jejunoduodenal anastomosis. It is prospectively study for all patients and included their history, clinicopathologic examinations, postoperative clinical information, and complications. Results: In these study were observed early postoperative complications and mortality, postoperative food intake and nutritional status (hemoglobin, total proteins and albumin), and incidence of diarrhea and dumping syndrome at 1 and 5 years. The overall 1-, 3-, and 5-year cumulative survival rate were 53.3%, 24.6%, and 10.8%, respectively. Concerning tumor location, tumor diffused in thee sections of stomach in 67 cases, mainly in cardia and body in 20 cases, mainly in body and antrum in 36 cases, and only in body of stomach in 11 cases. In the pathological examination, the tumors of 57 patients were diagnosed as adenocarcinoma, 7 as malignant lymphoma, and 3 as leiomyosarcoma. Conclusions: The benefits of this method are (1) a simple procedure; (2) preservation of the duodenal passage; (3) no duodenal stump, resulting in no risk of postoperative stump rupture.

The effect of local injection of epinephrine and bupivacaine on post-tonsillectomy pain and bleeding.

Tonsillectomy is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding. The relief of postoperative pain helps increase early food intake and prevent secondary dehydration. One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic, which has been shown to produce variable results in previous studies. Study Deign: Prospective case-control study. A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department. Patients under 15 years old, who were tonsillectomy candidates, were assigned into one of three groups: placebo injection, drug injection before tonsillectomy, and drug injection after tonsillectomy. The amount of bleeding, intensity of pain, and time of first post-operative food intake were evaluated during the first 18 hours post operation. The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections, but the difference was not significant during the first 18 hours. The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group. The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections, but after 30 minutes there was no difference. Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding. The treatment also decreases swallowing pain in the hours immediately after surgery.

Preservation of the gut by preoperative carbohydrate loading improves postoperative food intake

A carbohydrate (CHO) drink given preoperatively changes the fasted state into a fed state. The ESPEN guidelines for perioperative care include preoperative CHO loading and re-establishment of oral feeding as early as possible after surgery. An intestinal ischaemia reperfusion (IR) animal model was used to investigate whether preoperative CHO loading increases spontaneous postoperative food intake, intestinal barrier function and the catabolic response. Male Wistar rats (n = 65) were subjected to 16 h fasting with ad libitum water and: A) sham laparotomy (Sham fasted, n = 24); B) intestinal ischaemia (IR fasted, n = 27); and C) intestinal ischaemia with preoperatively access to a CHO drink (IR CHO, n = 14). Spontaneous food intake, intestinal barrier function, insulin sensitivity, intestinal motility and plasma amino acids were measured after surgery. The IR CHO animals started eating significantly earlier and also ate significantly more than the IR fasted animals. Furthermore, preoperative CHO loading improved the intestinal barrier function, functional enterocyte metabolic mass measured by citrulline and reduced muscle protein catabolism, as indicated by normalization of the biomarker 3-methylhistidine. Preoperative CHO loading improves food intake, preserves the GI function and reduces the catabolic response in an IR animal model. These findings suggest that preoperative CHO loading preserves the intestinal function in order to accelerate recovery and food intake. If this effect is caused by overcoming the fasted state or CHO loading remains unclear.

OP043 PRE-OPERATIVE CARBOHYDRATE LOADING IMPROVES POST-OPERATIVE FOOD INTAKE

Rationale: The “Enhanced Recovery of patients After Surgery” (ERAS) program recommends pre-operative carbohydrate loading 2 hours prior to surgery, and reestablishment of oral feeding as early as possible after surgery. The aim of this study was to investigate whether a pre-operative carbohydrate drink improves spontaneous post-operative food intake in rats. Methods: Male Wistar rats were subjected to 16h fasting with ad libitum water and: A) sham laparotomy (Sham fasted, n = 16); B) intestinal ischemia (IR fasted, n = 18); and C) intestinal ischemia with ad libitum access to a carbohydrate drink (Nutricia preOp, Nutricia N.V., Zoetermeer) (IR CHO, n = 14). The mesenteric superior artery was clamped during 70min. After surgery, animals were allowed to recover for 24h with ad libitum access to food. Spontaneous food intake was measured every hour after surgery for 24 hours. Results: In the first 24h post-operatively, rats in the IR CHO group had a significantly higher food intake (p < 0.05) compared to the rats in the IR fasted group (5.69±2.47 versus 3.82±2.01 g/24h). Moreover, rats in the IR CHO group started eating significantly earlier (p < 0.01) than the IR fasted group (4.14±1.10 versus 7.28±2.95h). Accordingly, the mean starting time of eating of the IR CHO group was equal to the time the Sham fasted group started eating. Conclusion: Pre-operative carbohydrate loading improved food intake in the first 24h post-operative. The animals started eating earlier and more during the first 24 hours than the fasted group. Moreover, after pre-operative carbohydrate loading the time point the rats started eating was normalized and equal to a sham laparotomy. There is an important role of carbohydrate loading in allowing early post operative food intake, as recommended in the ERAS guidelines. These findings suggest that pre-operative carbohydrate loading facilitates other nutritional key aspects of postoperative care.

Probiotics Are Sensitive Microorganisms: Lactobacillus Can Be Affected by Stomach Acid, Antibiotic, and Bowel Cleansing

We read with great interest the article by Mangell et al. entitled ‘‘Lactobacillus plantarum 299v does not reduce enteric bacteria or bacterial translocation in patients undergoing colon resection’’ [1]. The authors show that Lactobacillus plantarum 299v did not reduce enteric bacteria or bacterial translocation in patients undergoing colon resection. Although the study was well presented, there are some limitations and a few points on the affects of probiotics in the study protocol that we would like to address. Bowel cleansing before surgery can change the concentration of gut microbiota. Also, the patients had consumed food with L. plantarum 299v for 8 days in the preoperative period; however in the postoperative period, the patients had consumed L. plantarum 299v without food for 5 days. Foods typically contain fermentable substrates that can help nourish probiotic organisms as they transit through the gastrointestinal tract. Gastric pH following food intake is usually in the range of 4–7. Many lactobacilli and bifidobacteria secrete hydrolytic enzymes that can aid in the digestion of foods. Gastric pH is below 2 in the fasting state, which rapidly kills probiotics [2]. The main factors affecting the viability of probiotics in the gastrointestinal tract are the acidic environment of the stomach and the presence of bile in the duodenum. Significant numbers of probiotic bacteria can be destroyed unless they have some acid protection. Low pH is one of the most important factors that restricts the growth and stability of probiotic bacteria [3, 4]. Recent evidence shows that the dual-coating technology of probiotic bacteria enhances the survival and the amount of bacteria reaching the distal gut [5]. If there is an encapsulation technique of acid protection against L. plantarum 299v, it should be mentioned in this article. Preoperative and postoperative food intake might influence the transit of L. plantarum 299v to the distal gastrointestinal tractus. On the other hand, preoperative antibiotic prophylaxis may alter gut microbiota as well. The detection of bacterial genome in the lymph node does not reliably indicate recent bacterial translocation. Some bacteria might have already translocated in the preprobiotic phase, and scant amounts of these translocated bacteria might not be clinically important. Supporting this hypothesis, the authors did not mention any correlation with bacterial translocation and postoperative septic complications. And finally, two of these patients had translocation of lactobacilli, which is not a pathogenic bacterium. The rate of postoperative complications, although not significant between groups, is markedly decreased in the probiotic group. The overall complication rate, 16 versus 31 % (nearly twice as much in the control group), needs further comment. As a conclusion, probiotics are sensitive microbial agents to various noxious stimuli. Viability of probiotics in gastrointestinal tractus depends on some factors such as gastric acidity, bile acids, enzymes in intestine, antibiotics and bowel cleansing.

Impact of jejunal pouch interposition reconstruction after proximal gastrectomy for early gastric cancer on quality of life: short- and long-term consequences

BackgroundProximal gastrectomy with jejunal pouch interposition (JPI) reconstruction has been advocated as a function-preserving surgery in patients with early gastric cancer located in the upper third of the stomach. MethodsThis study clinically investigated 22 patients who underwent JPI reconstruction and 22 patients who underwent Roux-en-Y (RY) reconstruction after total gastrectomy for stage IA/IB gastric cancer. Patients in the 2 groups were compared to evaluate the short- and long-term postoperative outcomes. ResultsMorbidity and nutritional parameters were no different between the 2 groups. Although postoperative food intake volume was significantly superior in JPI patients than in RY patients 1 year postsurgery, the change in body weight was equal. JPI patients outperformed RY patients with a better quality of life (QOL) at 1 year postgastrectomy. However, 5 years after the surgery, both groups had a similar QOL except for fatigue. ConclusionsJPI reconstruction leads to better outcomes including QOL than RY reconstruction in the short term. However, this short-term positive impact of JPI decreases over time.

Comparative study on digestive reconstruction after tota1 gastrectomy

Objective To explore the type of the rational digestive reconstruction after total gastrectomy for gastric malignancy.Metlhods Three types of digestive reconstruction were performed after total gastrectomy in 121 cases with gastric carcinoma.The operating time,morbidity and mortality,digestive tract symptoms,nutritional status in 1 year after operation were compared.Results There were no signifioant differences among the three procedures in operative morbidity and mortality,postoperative food intake,nutritional status,incidences of diarrhea and dumping syndrome.Roux-en-Y esophajejunostomy and P-type esophajejunostomy had an advantage d anti-esophageal reflux,and are obviously superior to Lahey + Braun anastomosis.Roux-en-Y esophajejunostomy was simpler with shorter operating time and less complication.Condusion Roux-en-Y esophajejunostomy and P-type esophajejunostomy could be recommended as suitable methods for digestive reconstruction after total gastrectomy. Key words: Stomach neoplasms; Total gastrectomy; Digestive reconstruction

Histopathological and Postoperative Behavioral Comparison of Rodent Oral Tongue Resection

To compare operative time and hemostasis of fiber-enabled CO(2) laser (FECL) energy to that of the electrocautery (EC) technique for oral tongue resection, to compare return to oral intake and preoperative weight after FECL and EC resection, and to compare histologic changes in adjacent tissue after FECL and EC resection. Prospective animal study. Research laboratory. The CO(2) laser fiber and the Bovie cautery were each used to resect the anterior tongue in 15 adult rats. Fixative perfusion and killing were performed on postoperative day 0 (n = 10), 3 (n = 10), or 7 (n = 10). Body weight, food intake, and water intake were recorded daily for 3- and 7-day survival rats. After preparation for histologic analysis, the tongue tissue was graded with a mucosal wound-healing scale (MWHS). A higher incidence of intraoperative bleeding and shorter operative times were noted in the EC group. No statistically significant difference in postoperative food or water intake between the EC and FECL groups was noted. The FECL group returned to baseline weight by postoperative day 6. MWHS scores were lower in the EC group by postoperative day 3 and lower in the FECL group by postoperative day 7. Both EC and FECL are effective for resection of the tongue in rats. EC has the advantage of shorter operative time and lower MWHS scores by postoperative day 3; FECL has the advantages of less intraoperative bleeding, faster return to baseline body weight, and lower MWHS score by postoperative day 7.

A new pouch reconstruction method after total gastrectomy (pouch-double tract method) improved the postoperative quality of life of patients with gastric cancer

Many reconstruction methods after total gastrectomy (TG) lead patients to dumping syndrome, reflux esophagitis, and poor postoperative quality of life (QOL). To improve patients' postoperative QOL after TG, we introduce a new reconstruction method named "pouch-double tract" (PDT). A prospective randomized study was performed between 2005 and 2007 in 29 patients who were diagnosed as stage I or II gastric cancers preoperatively. Patients were followed until the end of 2009. Conventional Roux-en-Y reconstruction (RY) was performed in 15 patients, and PDT was used in 14 patients. Postoperative patients' nutritional assessments and patients' QOL were compared between the groups. PDT did not increase morbidity or mortality compared with RY. Patients in the PDT group did not complain of dumping and showed better postoperative food intake. Body weight recovered better in PDT than in RY. PDT is safe and associated with better nutritional status compared with the RY.

An Enhanced-Recovery Protocol Improves Outcome After Colorectal Resection Already During the First Year

This study was designed to investigate the clinical outcome and recovery before and immediately after implementation of the enhanced recovery after surgery enhanced recovery after surgery protocol in colonic and rectal resection. One hundred and sixty-eight consecutive patients in a single center underwent colorectal surgery before (traditional, n = 69) and immediately after implementing enhanced recovery after surgery (n = 99). Rectal surgery was performed in 77 patients. Postoperative food and fluid intake, mobilization, physiologic function, and clinical outcome were measured prospectively. Resumption of oral diet was achieved on postoperative day postoperative day 1 in the enhanced recovery after surgery group. In the enhanced recovery after surgery group, mobilization more than 6 hours daily was achieved on postoperative day 2 to 3 and passage of stool occurred on postoperative day 2 vs. postoperative day 5 in the traditional group (P < 0.0001). Muscle strength and lung function were less reduced in the enhanced recovery after surgery group (P < 0.05). Median hospital stay was reduced by 2 days (P < 0.01). Readmission rates increased (4 percent vs. 15 percent, P < 0.01) but total hospital stay was still lower in the enhanced recovery after surgery group (P < 0.01). After colonic resection, postoperative complications decreased in enhanced recovery after surgery (37 percent vs. 18 percent, P < 0.05), whereas no change was found after rectal resection. Immediately after implementing enhanced recovery after surgery, recovery was improved and length of hospital stay was reduced. Notably, postoperative morbidity decreased only in patients undergoing colonic resection.

The effect of postoperative fasting on vomiting in children and their assessment of pain

Mandatory postoperative food intake has been shown to increase nausea and vomiting, and so postoperative fasting has become common practice even if patients request food or drink. We sought to investigate whether postoperative fasting reduces the incidence of postoperative vomiting in children when compared with a liberal regimen in which they are allowed to eat and drink upon request. One hundred forty-seven children scheduled for outpatient surgery were randomized to one of two groups. After anesthesia, patients in the 'fasting' group were expected to fast for 6 h. The children in the 'liberal' group were allowed to eat and drink according to their own needs. The incidence of vomiting and the children's well-being were recorded at several time points over a 24-hour period. Parents were also asked to rate, on a scale of 0-6, how much their children were bothered by fasting, pain, and nausea/vomiting. Age (4.8 +/- 2.6 years), weight (20 +/- 9 kg) and gender (73% boys) were comparable between the groups. The incidence of vomiting was 15% in the liberal and 22% in the fasting group (P = 0.39) and, between 1 and 12 h after extubation, children in the liberal group were significantly happier (P < 0.001). Children in the liberal group were significantly less bothered by their pain than those in the fasting group (P < 0.001). Postoperative fasting did not reduce the incidence of vomiting after general anesthesia in children when compared with a liberal regimen. Furthermore, the ability to eat and drink at will decrease the bothersome aspects of pain and lead to happier patients.

Comparative Study on Three Types of Alimentary Reconstruction After Total Gastrectomy

BackgroundMore than 70 alimentary reconstruction procedures after total gastrectomy have been proposed to reduce the postoperative syndromes such as dumping syndrome, reflux esophagitis, and malnutrition. However, the optimal alimentary reconstruction method is still a matter of debate. The aim of the current study was to investigate the rationality of different alimentary tract reconstruction methods after total gastrectomy for gastric malignancy. MethodsThree types of digestive reconstruction methods were performed after total gastrectomy in 285 cases of gastric malignancy from May 1996 to December 2006, including Orr-type Roux-en-Y reconstruction (Orr-type), P-type Roux-en-Y reconstruction (P-type), and Moynihan-type reconstruction (Moynihan-type) methods. The operative time, early postoperative complications and mortality, food intake, alimentary symptoms, Visick scores, nutritional status at 1 and 3years after surgery, and cumulative survival at 1, 3, and 5years were comparatively analyzed. ResultsThere were no significant differences among the three methods in early postoperative complications and mortality, postoperative food intake and nutritional status (hemoglobin, total proteins and albumin), and incidence of diarrhea and dumping syndrome at 1 and 3years (p > 0.05). The overall 1-, 3-, and 5-year cumulative survival rate were 75.30%, 39.86%, and 21.48%, respectively, without significant differences among the three groups (p > 0.05). However, the average operative time used in the Orr-type reconstruction method (2.9 ± 0.1h) was comparatively shorter than that used in the P-type (3.4 ± 0.2h) and the Moynihan-type (3.2 ± 0.1h). The incidences of reflux esophagitis after the gastric reconstruction with the Moynihan-type method at 1 and 3years (72% and 65%) were significantly higher than that with the Orr-type (3% and 0%) and P-type (5% and 0%; p < 0.01). Constituent ratio of Visick scores I–II of the Moynihan-type method at 1 and 3years (54% and 73%) were smaller than that of the Orr-type (94% and 96%) and the P-type (93% and 96%) methods (p < 0.01). ConclusionOrr-type Roux-en-Y reconstruction method can avoid reflux esophagitis, and the procedure is simpler than the other two methods. Therefore, Orr-type Roux-en-Y reconstruction can be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer.

Fast-track und Laparoskopie - Ergänzung oder Alternative? - Kombination könnte weiteren Fortschritt bringen

The introduction of laparoscopic technique and fast track concepts have been substantial new developments in visceral surgery during the past 15 years. Common purposes of both are the reduction of operative trauma and the increase of surgical efficiency. Numerous studies involving laparoscopy also in colorectal procedures showed benefits of the new technique like less postoperative pain, earlier mobilization and oral food intake and a shorter hospital stay. Studies comparing fast track regimens with conventional perioperative patient management are still quite rare. However, similar results as in the application of laparoscopic techniques with faster postoperative rehabilitation have been documented. In studies combining fast track and laparoscopy even further improvements seem achievable.

Comparative study on three types of digestive reconstruction after total gastrectomy

To investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy. Three types of digestive reconstruction were performed after total gastrectomy in 189 cases with gastric carcinoma. The operating time, morbidity and mortality, food intake, digestive tract symptoms, nutritional status at 1 and 3 years after surgery and 1-, 3-, 5-year cumulative survival were compared. There were no significant differences among the three procedures in operative morbidity and mortality, postoperative food intake, nutritional status (Hemoglobin, total protein and labium), and incidences of diarrhea and dumping syndrome (P > 0.05). The overall 1-, 3-, 5-year survival rates were 75.3%, 38.2% and 20.5% respectively, and there were no significant differences among the three groups (P > 0.05). Orr-type and P-type esophagojejunostomy had an advantage of anti-esophageal reflux, and were obviously superior to Moynihan-type anastomosis (P< 0.01). Compared with P-type reconstruction, Orr-type reconstruction was simpler with shorter operating time, and less complications. Orr-type Roux-en-Y esophagojejunostomy can be recommended as an adaptable method of digestive reconstruction after total gastrectomy for gastric cancer because of its avoiding reflux esophagitis, maintaining better nutritional status and quality of life, and simpler procedure.

How Long Should Patients Refrain from Oral Food and Fluid Intake after General Anaesthesia? An Assessment of the Swallowing Reflex of Postoperative Neurosurgical Patients

Our aim was to detect swallowing abnormalities in patients after short-term neurosurgical interventions under general anaesthesia, comparing patients with supratentorial operations with a group undergoing extracranial neurosurgery (nucleotomy). 20 patients in each group were examined by fiberoptic endoscopic evaluation of swallowing (FEES) after general anaesthesia. No patient demonstrated dysphagia, aspiration, or oxygen desaturation. In these patient groups, early postoperative feeding was safe. Postoperative food intake can probably be allowed early after general anaesthesia.

Postoperative ileus: part II (Clinical therapy)

To avoid or reduce postoperative ileus, the operative trauma should be minimized and epidural anesthesia for spinal inhibition of the sympathetic nervous system or i. v. lidocaine should be used, all of which probably act by reducing visceral afferent nerve fiber activity. Recent data suggest that perioperative fluid restriction might reduce postoperative ileus. Epidural anesthesia with local anesthetics and replacing opioids by non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain treatment improve the recovery of gastrointestinal motility disturbances. Prior to the operation, the patient should be informed regarding postoperative motility disorders, its length and the presumed resumption of oral food intake, which has been shown to shorten hospital stay. Early postoperative food intake stimulates small and large bowel motility via interenteric reflex arches, avoids i. v. lines and renders discharge acceptable for the patient. Treatment of postoperative ileus includes osmotic laxatives and prokinetic drugs like erythromycine and acetylcholinesterase inhibitors. By combining epidural anesthesia and the sparse use of i. v. opioids with early food intake and, if necessary, laxatives or prokinetics, postoperative ileus should be coped adequately. Nevertheless, the development of new specific prokinetic drugs with minimal or no side effects should remain a target for drug companies to further improve treatment of postoperative ileus.

Protein Metabolism in Cachectic Tumor-Bearing Rats: Effect of Tumor Excision

The effect of tumor resection on protein metabolism in cancer-bearing subjects is poorly documented. We explored changes in nitrogen (N) and protein metabolism after excision of tumors both at the whole body level (N balance) and at the tissue level, including skeletal muscle, small intestine, and liver. Sixteen male Sprague–Dawley rats (∼375 g) bearing subcutaneous Morris hepatoma 7777 for 6 weeks were either operated for tumor excision and studied for 10 days postoperatively (n= 10) or sacrificed on the day of surgery as tumor-bearing controls; operated and unoperated tumor-bearing rats were compared with healthy rats (n= 16). Tumors, which grew to a mass of 74 ± 7 g (mean ± SEM), induced significant loss of body mass (−27 ± 13 g) and protein depletion in epitrochlearis muscle (EPI) (−38%) and small intestine (−42%) vs healthy rats. Tumor significantly decreased muscle protein synthesis vs healthy rats (7.14 ± 0.5 vs 10.7 ± 0.5 nmol phenylalanine (Phe)/EPI/3 hr), net degradation (21.7 ± 2.9 vs 30.6 ± 2.5 nmol Phe/EPI/3 hr) and degradation (28.8 ± 2.7 vs 41.4 ± 2.5 nmol Phe/EPI/3 hr). In 50% of operated rats, tumor removal was followed immediately by increased food intake, body weight, and N balance; in other rats, this was delayed by 2–4 days. By 6 days postoperative, all rats were gaining weight and had normal food intake; wasting was abolished in small intestine, but not in skeletal muscle (protein mass −43% vs healthy rats,P< 0.05). Postoperative rats maintained lower muscle protein degradation (28.2 ± 2.0 vs 41.4 ± 2.5 nmol Phe/EPI/3 hr,P< 0.05) than healthy rats; protein synthesis was no longer reduced. In skeletal muscle, protein synthesis and protein deposition were related to levels of postoperative food intake (r= 0.91 and 0.98, respectively;P< 0.05). Following tumor excision, reversal of cancer cachexia appeared to be highly dependent on the level of postoperative food intake.

Cholecystokinin is partly responsible for reduced food intake and body weight loss after total gastrectomy in rats

To determine the cause of body weight loss after total gastrectomy. We evaluated the acute effect of exogenous cholecystokinin (CCK) on food intake and the chronic effect of CCK receptor blockade on food intake and body weight after total gastrectomy in rats. Exogenous CCK significantly reduced food intake in gastrectomized rats; this was blocked by administration of a CCK-A but not a CCK-B receptor antagonist. Chronic treatment with a CCK-A or CCK-B receptor antagonist after total gastrectomy in rats significantly increased postoperative food intake and body weight. Our data indicate that endogenous CCK is partly responsible for reduced food intake and body weight loss after total gastrectomy in rats.

Dynamics of oral intake resumption after general anesthesia and operation in rats.

The influence of general anesthesia and operation on dynamics of postoperative food intake resumption was investigated in eight rats. A laparotomy was performed on each rat under anesthesia induced by intraperitoneally injected chloral hydrate. Spontaneous food intake and feeding indexes were continuously measured using an Automated Computerized Rat Eater Meter (ACREM) before and after operation. Although spontaneous food intake and all feeding indexes were depressed immediately following anesthesia and operation, each feeding index was depressed to a greater degree during the dark vs. the light cycle. Initially, rats fully capable of eating ate fewer, smaller, and shorter meals. The return to normal of each feeding index differed temporally. Thus, although meal number normalized by the third postoperative day, meal size by the sixth postoperative day, and meal duration by the fourth postoperative day, normalization of meal number during the light cycle occurred sooner than during the dark cycle, while the converse occurred with meal size and meal duration.