Postoperative Nutrition Research Articles

Nutrition in surgical patients: how soon is too soon?

Preoperative nutrition support has been extensively studied; however, data on the timing of postoperative nutrition initiation are scarce. The current review focuses on the importance of early nutritional support in surgical patients and their impact on outcomes. Early nutrition support during the postoperative course may be the most important step that can be taken toward preventing subsequent malnutrition-related complications. European Society for Parenteral and Enteral Nutrition guidelines recommends early nutrition to improve outcomes after surgery and accelerates the recovery. Moreover, nutritional support should be personalized, and disease process-based. Existing studies appear to focus mostly on abdominal and gastrointestinal surgery. Further prospective observational and randomized clinical trials across different surgical populations will aid surgeons to better understand how early feeds in either form can reduce morbidity, quality of life, and increase recovery rates.

Analysis on operational safety of chronic radiation intestinal injury

Objective: To investigate the safety and efficacy of surgical treatment for chronic radiation intestinal injury. Methods: A descriptive cohort study was performed. Clinical data of 73 patients with definite radiation history and diagnosed clinically as chronic radiation intestinal injury, undergoing operation at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to February 28, 2019, were reviewed and analyzed retrospectively. Patients did not undergo operation or only received adhesiolysis were excluded. All the patients had preoperative examination and overall evaluation of the disease. According to severity of intestinal obstruction and patients' diet, corresponding nutritional support and conservative treatment were given. Surgical methods: The one-stage bowel resection and anastomosis was the first choice for surgical treatment of chronic radiation intestinal injury. Patients with poor nutritional condition were given enterostomy and postoperative enteral nutrition and second-stage stoma closure and intestinal anastomosis if nutritional condition improved. For those who were unable to perform stoma closure, a permanent stoma should be performed. Patients with severe abdominal adhesion which was difficult to separate, enterostomy or bypass surgery after adhesiolysis would be the surgical choice. For patients with tumor metastasis or recurrence, enterostomy or bypass surgery should be selected. Observation parameters: the overall and major (Clavien-Dindo grades III to V) postoperative complication within 30 days after surgery or during hospitalization; mortality within postoperative 30 days; postoperative hospital stay; time to postoperative recovery of enteral nutrition; time to removal of drainage tube. Results: Of the 73 patients who had been enrolled in this study, 10 were male and 63 were female with median age of 54 (range, 34-80) years. Preoperative evaluation showed that 61 patients had intestinal stenosis, 63 had intestinal obstruction, 11 had intestinal perforation, 20 had intestinal fistula, 3 had intestinal bleeding, and 6 had abdominal abscess, of whom 64(87.7%) patients had multiple complications. Tumor recurrence or metastasis was found in 15 patients. A total of 65(89.0%) patients received preoperative nutritional support, of whom 35 received total parenteral nutrition and 30 received partial parenteral nutrition. The median preoperative nutritional support duration was 8.5 (range, 6.0-16.2) days. The rate of one-stage intestine resection was 69.9% (51/73), and one-stage enterostomy was 23.3% (17/73). In the 51 patients undergoing bowel resection, the average length of resected bowel was (50.3±49.1) cm. Among the 45 patients with intestinal anastomosis, 4 underwent manual anastomosis and 41 underwent stapled anastomosis; 36 underwent side-to-side anastomosis, 5 underwent end-to-side anastomosis, and 4 underwent end-to-end anastomosis. Eighty postoperative complications occurred in 39 patients and the overall postoperative complication rate was 53.4% (39/73), including 39 moderate to severe complications (Clavien-Dindo grade III-V) in 20 patients (27.4%, 20/73) and postoperative anastomotic leakage in 2 patients (2.7%, 2/73). The mortality within postoperative 30 days was 2.7% (2/73); both patients died of abdominal infection, septic shock, and multiple organ failure caused by anastomotic leakage. The median postoperative hospital stay was 13 (11, 23) days, the postoperative enteral nutrition time was (7.2±6.9) days and the postoperative drainage tube removal time was (6.3±4.2) days. Conclusions: Surgical treatment, especially one-stage anastomosis, is safe and feasible for chronic radiation intestine injury. Defining the extent of bowel resection, rational selection of the anatomic position of the anastomosis and perioperative nutritional support treatment are the key to reduce postoperative complications.

P71 NUTRITIONAL JEJUNOSTOMY IN ESOPHAGECTOMY FOR CANCER, A NATIONAL REGISTER-BASED COHORT STUDY OF ASSOCIATIONS WITH POSTOPERATIVE OUTCOMES AND SURVIVAL

Abstract Aim The aim was to increase the knowledge about nutritional jejunostomies in curative intended treatment of esophageal and gastroesophageal junction cancer. Background and Methods The insertion of a jejunostomy in conjunction with esophagectomy is performed to decrease the risk for malnutrition and improve recovery. These possible benefits have, however, not been scientifically proven. All patients in Sweden, treated with esophagectomy due to cancer 2006-2017 in the Swedish National Register for Esophageal and Gastric Cancer, were included in this retrospective population-based cohort study. The indication for jejunostomy was not defined in the register. The patients were stratified into two groups: esophagectomy with jejunostomy, and esophagectomy alone. Results A total of 1024 patients (54.73%) had a jejunostomy inserted in conjunction with esophagectomy, while 847 patients (45.27%) were treated without jejunostomy. The median age was 66 years, and 79% of the patients were male. The groups were similar in regard to age, performance status, baseline dysphagia and weight, ASA-score, tumor location, neoadjuvant treatment, and use of minimally invasive technique. The patients in the jejunostomy group had more squamous cell carcinoma (20.3% vs. 17.8%, P=0.005), and more locally advanced tumors. There were no significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate. The risk of pneumonia was increased in the jejunostomy group (11.8% vs. 7.2%, P=0.001). For patients with postoperative anastomotic leaks the risk for postoperative Clavien-Dindo score of IIIb or more was reduced (79.7% vs. 94.7%, P=0.037, adjusted odds ratio 0.20, 95% CI 0.04-0.97). Conclusions Jejunostomy is a safe method to ensure postoperative nutrition after esophagectomy, and might reduce the risk for severe outcomes in patients who suffer an anastomotic leak.

Current state of esophageal cancer surgery in China: a national database analysis

BackgroundThe present standard of surgical treatment for esophageal cancer is country dependent. The aim of the present study was to investigate the basic aspects of surgical procedures performed for esophageal cancer, and provide information about the present state of esophageal cancer surgery in China.MethodsData were obtained from a database administered by the Chinese Ministry for Health. A total of 542 participating hospitals were divided into seven geographic areas, and 10% of hospitals in each area were randomly chosen for inclusion. All patients with esophageal cancer, who underwent esophagectomy in these participating hospitals from January 1 to December 31, 2015, were included in the present study. The clinical characteristics, stage of tumor at diagnosis, operation summary and outcomes, and histological findings of patients were extracted and analyzed.ResultsThe present study included 11,791 patients, and the average number of patients per hospital was 218. Squamous cell carcinoma was the most common pathological type, while the mid-esophagus was the most common location. Open procedures were performed in 63.8% of patients, while minimally invasive esophagectomy was performed in 36.2% of patients. Multiple approaches to transthoracic esophagectomy were utilized. Two-field lymphadenectomy was the most frequently performed (64.8%), followed by three-field lymphadenectomy (21.8%). Gastric tubes, thoracic duct ligation and postoperative enteral nutrition were implemented to minimize complications.ConclusionThe standard operative procedure and detailed technique for esophageal carcinoma surgery is presently being debated in China. This survey provides some basic information about the present state of esophageal cancer surgery countrywide.

Perioperative weight loss and its influencing factors in patients with colorectal cancer

Objective To investigate the perioperative weight loss and its influencing factors in patients with colorectal cancer, and to provide evidence for the development and management of perioperative nutritional support strategies. Methods Ninety-one patients with colorectal cancer were enrolled and divided into observation group (n=61) with the degree of weight loss less than 5% of preoperative weight and control group (n=30) with the degree of weight loss more than 5% of preoperative weight. Change of body composition and factors of weight loss in patients with colorectal cancer were compared between the two groups by single factor and multivariate analysis. Results Ninety-one patients with colorectal cancer had the average weight loss of 2.0 kg. Of perioperative changes in body composition, the degree of body fat, muscle mass and protein group decreased statistically (P<0.05). Univariate analysis showed that the age, intraoperative blood loss and postoperative oral nutrition intake compliance were the risk factors for the degree of weight loss in patients with colorectal cancer after the operation. Multivariate logistic regression analysis showed that the intraoperative blood loss was an independent influencing factor for the degree of postoperative weight loss in patients with colorectal cancer (P<0.05). Conclusion Age, intraoperative blood loss and postoperative oral nutritional intake compliance may affect the degree of weight loss during perioperative period. Intraoperative blood loss is an independent risk factor affecting the degree of weight loss during perioperative period. In future clinical research and practice, minimally invasive and accurate surgical treatment should be strengthened, the amount of intraoperative blood loss and surgical trauma should be reduced, and the postoperative oral nutrition intake of patients should be paid attention, especially for elderly patients. Personalized dietary guidance and management for different groups should be conducted, and perioperative nutritional status of patients should be improved. Key words: Colorectal cancer; Weight loss; Body composition; Enhanced recovery after surgery

Application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection: a prospective analysis

Objective To explore the application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection. Methods The prospective study was conducted. The clinicopathological data of 62 patients with intra-abdominal infection who were admitted to the 940 Hospital of the People′s Liberation Army Joint Service Support Force from February 2018 to December 2018 were collected. All patients were randomly divided into two groups by the envelope method with double-blind technique, including patients who began being given enteral eco-immune nutrition preparation at postoperative 24-48 hours in eco-immune group and patients who began being given simple enteral nutrition preparation at 24-48 hours in control group. Observation indicators: (1) analysis of immune function indices before treatment and after 7 days of treatment in the two groups; (2) postoperative conditions in the two groups; (3) follow-up. Follow-up using telephone interview was performed to detect complications and recurrence of infection up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and intra-group comparison and comparison between groups were analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results Sixty-two patients were screened for eligibility, including 38 males and 24 females, aged (54±14)years, with the range of 22-81 years. There were 30 in the eco-immune group and 32 in the control group. (1) Analysis of immune function indices before treatment and after 7 days of treatment in the two groups: before treatment, the percentages of CD3+, CD4+, CD8+, ratio of CD4+ /CD8+, count of natural killer (NK) cells, levels of blood endotoxin and immunoglobulin A (IgA) for the eco-immune group were 61%±12%, 34%±5%, 28%±5%, 1.25±0.34, 17.26%±2.74%, (2.4±0.3)ng/L, and (1.7±0.5)g/L, versus 59%±11%, 33%±5%, 27%±4%, 1.27±0.36, 16.96%±2.99%, (2.5±0.5)ng/L, (1.8±0.5)g/L for the control group, respectively, there were no significant differences between the two groups (t=-0.563, -0.354, -0.987, 0.327, -0.462, 0.887, 0.991, P>0.05). After 7 days of treatment, the above indices for the eco-immune group were 62%±8%, 37%±6%, 27%±8%, 1.45±0.32, 22.63%±7.25%, (2.2±0.4)ng/L, and (2.3±0.4)g/L, versus 58%±8%, 32%±4%, 27%±6%, 1.26±0.22, 16.26%±2.10%, (2.7±0.6)ng/L, and (2.0±0.4)g/L for the control group, respectively, there were significant differences in the percentages of CD3+, CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA (t=-2.393, -4.336, -3.074, -5.338, 4.010, -3.155, P 0.05). In the eco-immune group, the percentage of CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA showed significant differences after 7 days of treatment (t=-2.899, -2.739, -4.385, 2.157, -5.788, P 0.05). In the control group, the percentage of CD8+ and level of IgA showed significant differences after 7 days of treatment (t=3.659, -2.258, P 0.05). (2) Postoperative conditions in the two groups: the time to first flatus and duration of postoperative hospital stay of the eco-immune group were (2.4±0.5)days and (8±4)days, respectively, versus (2.9±0.7)days and (11±7)days of the control group; there were significant differences in the above indices between the two groups (t=-3.017, -2.764, P<0.05). In the eco-immune group, the incidence of complication was 6.7%(2/30), including 1 case of wound infection, 1 case of pulmonary infection. In the control group, the incidence of complication was 31.2%(10/32), including 6 cases of wound infection, 2 cases of pulmonary infection, 1 case of intra-abdominal infection, and 1 case of systemic inflammatory response syndrome. There was a significant difference in the incidence of complication between the two groups (χ2=4.122, P<0.05). The patients with infection were recovered after corresponding systematic conservative treatments. (3) Follow-up: of the 62 patients, 46 were followed up for 3-9 months, with a median follow-up time of 6 months, including 26 in the eco-immune group and 20 in the control group. During the follow-up, no complication or infection recurred in the two groups. Conclusion Compared with simple enteral nutrition, early postoperative enteral eco-immune nutrition in the nutritional support treatment is safe and effective for patients with intra-abdominal infection, which can enhance the immune function of patients, shorten the recovery time of patients, and reduce the incidence of infection complications. Key words: Infection; Intra-abdominal infection; Nutritional support; Eco-immune nutrition; Enteral nutrition; Postoperative; Efficacy

Postoperative Recurrent Gout Flares: A Cross-sectional Study From China.

To investigate the morbidity, clinical characteristics, and risk factors for postoperative recurrent gout flares (PRGFs). This cross-sectional study included all surgical patients at 2 academic institutions between 2010 and 2018. Data including demographics, prior history of gout, clinical variables, medications, and the occurrence of PRGFs were abstracted from medical records. Forward stepwise multivariable logistic regression analysis was used in the statistical analyses. Among the 518 (0.5% [518/114,760]) surgical patients with a prior diagnosis of gout, 474 had sufficient documentation for analysis. Of these, 191 (40.3%) had experienced a PRGF. Most PRGFs (54.4%) were polyarticular gout; 79.6% had a pretreatment pain score of PRGFs ≥7, and 59.2% required combination pharmacologic therapy. The mean (SD) serum urate (SU) level decreased postoperatively (500.33 [122.77] vs. 380.15 [118.35] μmol/L; p = 0.000), with an average decrease of 125.86 μmol/L. The decrease in the postsurgical SU level was greater in patients who received postoperative total parenteral nutrition (PTPN) than in those who did not (p = 0.009), and it was correlated with the duration of PTPN (r = 0.156, p = 0.031). Factors independently associated with PRGFs were decrease in the postsurgical SU level by ≥126 μmol/L, previous flares involving the ankle, failure to take prophylactic colchicine therapy, and abdominal surgery. Recurrent gout flares often occur postoperatively and are severe. For high-risk patients, especially those undergoing abdominal surgeries, timely monitoring of postsurgical SU level, colchicine prophylaxis, and avoiding the overuse of PTPN may help prevent PRGFs.

Impact of Post-Operative Nutrition Status and Inadequate Caloric Delivery on Hospital Readmission in Patients Status Post Whipple Procedure

Impact of Post-Operative Nutrition Status and Inadequate Caloric Delivery on Hospital Readmission in Patients Status Post Whipple Procedure

Effect of early enteral nutrition combined with rapid rehabilitation on recovery of gastrointestinal function after gastric cancer operation

Objective To study the effect of early enteral nutrition combined with rapid rehabilitation on the recovery of gastrointestinal function after gastric cancer operation. Methods A total of 104 gastric cancer patients who received surgical treatment in the hospital from January 2017 to May 2018 were selected as research objects.According to the random number table method, they were divided into the control group and the research group, 52 cases of each group.Patients in the control group received routine nutritional intervention and rehabilitation management, while patients in the research group received early enteral nutritional intervention and rapid rehabilitation nursing after surgery.The postoperative gastrointestinal function recovery effect, postoperative hospitalization time, nutrition level and complication rate were compared between the two groups. Results The recovery time of anus exhaust, defecation, bowel sound and hospital stay in the research group were all lower than those in the control group, and the differences were statistically significant(P<0.05). Serum Hb, TP and ALB levels of the two groups were higher than those of the control group, on the 7th day after the operation.The research group was higher than the control group, and the difference was statistically significant(P<0.05). The total incidence of postoperative complications in the research group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion Early enteral nutrition combined with rapid rehabilitation management can promote the postoperative gastrointestinal function recovery of gastric cancer patients, shorten the postoperative hospitalization time, improve the nutritional level of the body, and reduce the occurrence of postoperative complications, which is worthy of clinical promotion. Key words: Early enteral nutrition; Rapid recovery; Gastric cancer; Gastrointestinal function

A Prospective Randomized Trial Comparing Jejunostomy and Nasogastric Feeding in Minimally Invasive McKeown Esophagectomy

BackgroundEarly postoperative enteral nutrition is recommended for patients undergoing esophagectomy; however, the optimum method of tube feeding remains controversial. Thus, the aim of this study is to assess two common enteral nutrition methods after minimally invasive McKeown esophagectomy. MethodsA randomized controlled trial was performed with 120 patients who underwent minimally invasive McKeown esophagectomy from January 2017 to December 2018. The patients were randomly divided so that 58 patients were in the jejunostomy feeding (JF) group and 62 patients were in the nasogastric feeding (NF) group. The postoperative outcomes, including complications, nutritional status, quality of life, and survival rate, were studied and used as the main parameters to compare the abovementioned tube feeding methods. ResultsThe incidence of overall complications was equivalent between the two groups (P = 0.625), except for bowel obstruction (which occurred 4 times in the JF group but did not occur in the NF group). In the first month after surgery (postoperative month 1, POM1), a significantly higher body mass index (BMI) was observed in the JF group (23.6 ± 3.2) than in the NF group (20.9 ± 3.5, P = 0.032). The global quality-of-life scores were better in the JF group than in the NF group (P < 0.001). In addition, there were no significant differences between the two groups in terms of disease-free survival (DFS) (P = 0.816) and overall survival (OS) (P = 0.564). ConclusionsCompared with NF, JF provides more safety, efficacy, and utility as nutritional support for minimally invasive McKeown esophagectomy patients who have a high incidence of anastomotic leakage. However, the higher risk of intestinal obstruction after JF requires attention.

SUN-PO304: Effects of Preoperative and Postoperative Enteral Nutrition on Postoperative Nutritional Status and Immune Function of abdominal Surgery Pediatric Patients

SUN-PO304: Effects of Preoperative and Postoperative Enteral Nutrition on Postoperative Nutritional Status and Immune Function of abdominal Surgery Pediatric Patients

Enhanced recovery after surgery in pediatric gastrointestinal surgery.

ObjectiveEnhanced recovery after surgery (ERAS) protocols help optimize inpatient care and minimize discomfort. This study was performed to explore the safety, feasibility, and clinical and social value of ERAS in pediatric gastrointestinal surgery.MethodsThis study included all children (n = 125) who underwent appendectomy, pyloromyotomy, transabdominal Soave’s procedure, Meckel’s diverticulum resection, or reduction of intussusception in our institution from January to September 2018. We compared surgical outcomes between children who underwent surgery under conventional perioperative regimens (control group, n = 57) and those who were treated with ERAS protocols (ERAS group, n = 68).ResultsThere were no significant intergroup differences in demographic or surgical data. However, the bowel function recovery time, postoperative intravenous nutrition time, duration of postoperative hospital stay, and hospital costs were significantly lower in the ERAS group than control group. There was no significant intergroup difference in the complication rate.ConclusionsOur results indicate that implementation of ERAS protocols is safe and feasible in pediatric gastrointestinal surgery. They can improve patient comfort, shorten the duration of the postoperative hospital stay, reduce hospital costs, and accelerate postoperative rehabilitation without increasing the risk of postoperative complications. Therefore, ERAS protocols deserve wider implementation and promotion.

Періопераційне харчування як важлива ланка імплементації принципів Fast Track хірургії

ABSTRACT. Relevance. Fast Track surgery concept provides for a significant reduction of patient’s stress response to surgical intervention. The main task is a quick rehabilitation, quick return to a normal quality of life and significant reduction for an in-patient stay, thereby reducing medical costs. Objective: To assess the efficacy of the lack of pre- and postoperative fasting in accelerating postoperative recovery of patients and the reduction of patient’s stress response to operative injury. Materials and methods. We performed 564 surgical interventions under Fast Track approach. In particular, we used adapted, high-caloric sipping (drinking as small sips through a straw) feed manufactured at a medical enterprise and does not include dietary fibre — Nutricomp Drink Plus (BBraun). Results. Early oral feeding within the first hours after surgery accelerates recovery of productive intestinal motility. In 73.5 % of patients, the passage of flatus (spontaneous) is reported to the end of the first postoperative day that is about 8-fold higher than in patients who were not on such diet. General weakness, hunger and thirst reduced 2.5, 3 and 2.5-fold, respectively, in patients on Fast Track approach compared with the conventional perioperative management. Conclusion. The lack of pre- and postoperative fasting is one of the cornerstones of this program that proved the efficacy in terms of reduced stress response to surgical injury. Key Words: Fast Track approach, surgical intervention, pre- and postoperative nutrition.

Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications.

Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications.

Transüretral Rezeksiyon- Prostat (TUR-P) Ameliyatlarında ERAS Protokolü İle Ameliyat Öncesi ve Sonrası Yapılması Gereken Beslenme, Ağrı ve Erken Mobilizasyon Uygulamalarının Karşılaştırılması

Amaç: Yapılan bu çalışmada TUR-P ameliyatları sonrası Avrupa'nın 5 ülkesinin bir araya gelerek oluşturdukları ameliyat sonrası hızlı iyileşme (ASHİ) protokolünü Gaziantep’teki hastanelerde bulunan sağlık personelinin duyup duymadığını; ağrı, erken mobilizasyon ve beslenme konularının bakım ve tedavilerinde bu protokolün gerekliliklerini uygulayıp uygulamadığını tespit etmek istedik.Gereç ve Yöntem: Gaziantep'te bulunan beş hastanesinin üroloji klinik hemşireleri, üroloji uzmanları ve anestezi uzmanlarına yönelik demografik özellikler bulunduran soru formlarıyla, üroloji servisinde TUR-P ameliyatı olan hastaların ASHİ protokolü ile ameliyat öncesi ve sonrası yapılması gereken beslenme, ağrı ve erken mobilizasyon uygulamalarının karşılaştırılması hakkındaki bilgiler belirlendi. Cerrahlara, hemşirelere ve anestezi uzmanlarına bu konuları içeren anket soruları uygulandı ve çalışmanın örneklemini 95 kişi oluşturdu. Araştırmacılar tarafından hazırlanan ankette 25 soru bulunmaktaydı. Araştırma öncesi etik kuruldan, tüm hastane ve katılımcılardan gerekli yasal izin alındı. Bu veriler 1 Nisan 2018 -10 Haziran 2018 tarihleri arasında yüz yüze görüşülerek toplandı. Cerrahların, hemşirelerin ve anestezi uzmanlarının ASHİ protokolüne göre bakım ve tedavilerindeki tutumları analiz edildi; değerlendirmede sayı yüzde kullanıldı. Bulgular: Sağlık personelinin yaş ortalaması 34.73+ 9.11 idi, sağlık personelinin % 26,3’ü cerrah, % 17,9’u anestezi uzmanı ve % 55,8’i hemşireydi. Hastalara ameliyatları öncesi, oral olarak karbonhidrattan zengin sıvı verme durumu % 29,5 idi. “Ameliyat öncesi açlık süresi ASHİ Protokolüne uygundur” diyenlerin oranı % 4,2 idi. Ameliyat sonrası sıvı ve katı gıda alımı da ASHİ Protokolüne uygun değildi. Hastaların bulantı ve kusmasını önlemek amacıyla profilaksi uygulanma durumu % 65,3’dü. “TUR-P ameliyatı sonrası antiembolik çorap uyguluyoruz” diyenlerin oranı % 62.1 idi. Hastaları mobilize etme durumunda da ASHİ protokolüne uygun hareket edilmiyordu. “Ameliyat sonrası ağrı için analjezik yapılmalı” diyenlerin oranı % 62,1 iken antienflamatuar ilaç seçimi oranı ise % 44,2 idi. ASHİ protokolünü duyanların oranı % 7,4’dü. ASHİ Protokolünü uygulayanların oranı ise %37,9’du. Sonuç: Yapılan bu çalışma sonucu ASHİ Protokolüne uygun bir bakım ve tedavi prosedürünün TUR-P ameliyatlarından sonra uygulanmadığı söylenebilir. Kanıta dayalı ASHİ protokolüne göre hemşirelik bakım paketlerinin ve tedavi prosedürlerinin üroloji kliniklerinde uygulanmaya başlatılması için hizmet içi eğitimlerin planlanması, tüm personelin ASHİ protokolüne benzeyen prosedürler oluşturması ve araştırmalar yapması için komitelerin kurulması sağlanmalıdır.

Postoperative complications and nutritional status between uncut Roux-en-Y anastomosis and Billroth II anastomosis after D2 distal gastrectomy: a study protocol for a multicenter randomized controlled trial

BackgroundGastric cancer is the fourth most common malignant disease worldwide, with lower one-third gastric cancer the most common type. Distal gastrectomy with D2 lymph node dissection was recommended as a standard surgery for distal gastric cancer patients. However, some controversy remains about the anastomosis of the residual stomach and the intestine. The objectives of this trial are to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more effectively than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy.Methods/designThis multi-center, prospective, phase III, randomized controlled trial will compare the efficacy of uncut Roux-en-Y anastomosis versus Billroth II anastomosis in phase I–III patients with initial treatment of radical distal gastrectomy. Patients will be randomized to undergo either the intervention (uncut Roux-en-Y anastomosis) or the control (Billroth II anastomosis). We will recruit 832 patients who meet the trial eligibility criteria and will follow the patients after surgery to observe postoperative complications and nutrition status for 5 years. The primary assessment indices of the study are reflux gastritis, esophagitis, bile regurgitation, and anastomotic ulcer. The secondary assessment indices are nutritional status, quality of life, perioperative complications, overall survival rate, and others. When the number of cases reaches 400, an interim analysis will be performed to identify any evidence of definite superiority of the experimental intervention.DiscussionWe aim to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy. The results of the trial will contribute to the best evidence on which to base the reconstruction of distal gastrectomy.Trial registrationChinese Southern Gastric Cancer Conference CSGC002 Trial. ClinicalTrials.gov, NCT02763878. Registered on 5 May 2016.

Peri- and postoperative nutrition in colorectal cancer patients

Peri- and postoperative nutrition in colorectal cancer patients Abstract. The long multimodal therapy regimens for colorectal cancer require a sufficient nutritional status of the patient. The "Enhanced Recovery After Surgery" concept aims for minimization of the interruption of nutrient intake and has been validated prospectively. Preoperative malnutrition as a strong risk factor for complications should be detected and treated early after cancer diagnosis by screening tools as the "Nutritional Risk Screening" (NRS-2002) or the "Malnutrition Universal Screening Tool" (MUST). High-caloric oral supplementation, enteral nutrition and parenteral nutrition are possible measures, which should be escalated stepwise. The recent concept of "prehabilitation" additionally includes short‑term optimization of the physical and psychological status. Postoperative attention should be paid to possible deficiency syndromes of single nutrients due to reduced resorption after bowel segment resection or stoma creation. Risk- and preventive factors in primary prevention of colorectal carcinoma are well-known, in secondary prevention knowledge is less clear. There is only low evidence for a positive effect of omega-3 fatty acids, coffee, high-fiber diet and vitamin D in secondary prevention of colorectal carcinoma, requiring further studies.

P3B.12: Spiral intestinal lengthening and tailoring (SILT) as a rescue procedure for SBS patients with difficult clinical situations.

Introduction: Autologous gastrointestinal reconstructive (AGIR) procedures are essential component of intestinal rehabilitation program for patient with short bowel syndrome (SBS). Unfortunately, several patients develop postoperative bowel re-dilatation with loss of bowel adaptation. Spiral intestinal lengthening and tailoring (SILT) technique promises to regain intestinal physiology by tailoring the bowel even if there is no massive bowel dilatation. The aim of this study was to report our experience using SILT in SBS with difficult clinical situation. Methods: Retrospective review of the single AGIR surgeon was performed from 2012 to date. Patients’ demographics, pre- and post-procedure bowel length, surgical complications, and postoperative parenteral nutrition (PN) requirements were analyzed. Data were compared using independent samples, Mann-Whitney’s U-test. Data were expressed in mean (IQR) Results: 9 children with SBS underwent SILT between 2012 and 2017. Rescue SILT was performed in 4 patients with age at procedure of 58.5 months (45–143.3). 3 patients had previous STEP in history of SBS post gastroschisis while one had mild dilatation after AGIR due to long segment Hirschsprung. Preoperative small bowel length measured 66 cm (49.5–75.7) with a diameter of 7 cm (6–8). SILT allowed a median increase in length of 68.5% (p = 0.34) and a significant tailoring of the dilated segment providing a reduction in diameter of 63% (p = 0.02). No major complications related to SILT were encountered and none of the children required further surgical intervention following a follow-up of 6.5 months (4.5–39.6). Interestingly, a significant reduction of PN requirement at 4 months (p = 0.02) associated with improve of liver function was reported. Conclusion: In this study SILT was reported to have no peri-operative complication and to have good results in complex SBS patients. This procedure offers a safe alternative for SBS children after the failure of conventional AGIR procedures.

Hospital Staffs' Perceptions of Postoperative Nutrition Among Colorectal Patients: A Qualitative Study.

After lower gastrointestinal surgery, few patients start eating within timeframes outlined by evidence-based guidelines or meet their nutrition requirements in hospital. The present study explored hospital staffs' perceptions of factors influencing timely and adequate feeding after colorectal surgery to inform future interventions for improving postoperative nutrition practices and intakes. This qualitative exploratory study was conducted at an Australian hospital where Enhanced Recovery After Surgery guidelines had not been formally implemented. One-on-one semistructured interviews were conducted with hospital staff who provided care to patients undergoing colorectal surgery. Interviews lasted from 21 to 47minutes and were audio recorded and transcribed verbatim. Data were analyzed using inductive thematic analysis. Emergent themes and subthemes were discussed by all investigators to ensure consensus of interpretation. Eighteen staff participated in interviews, including 9 doctors, 5 nurses, 2 dietitians, and 2 foodservice staff. Staffs' responses formed 3 themes: (1) variability in perceived acceptability of postoperative feeding; (2) improving dynamics and communication within the treating team; and (3) optimizing dietary intakes with available resources. Staff and organizational factors need to be considered when attempting to improve postoperative nutrition among patients who undergo colorectal surgery. Introducing a feeding protocol, enhancing intraprofessional and interdisciplinary communication, and ensuring the availability of appropriate, nutrient-dense foods are pivotal to improve nutrition practices and intakes.

Preoperative Nutrition Status and Postoperative Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex surgery to treat peritoneal surface malignancy (PSM). PSM and gastrointestinal (GI) resection from CRS can lead to significant GI symptoms and malnutrition. There is limited research into the nutrition status of this patient group and the impact of malnutrition on morbidity. This study aims to determine if preoperative malnutrition, assessed using the Subjective Global Assessment (SGA), is associated with postoperative morbidity and increased length of stay (LOS) in patients undergoing CRS/HIPEC for PSM. This study prospectively assessed the nutritional status of patients undergoing CRS/HIPEC using a validated nutrition assessment tool. Preoperative clinical symptoms, Peritoneal Cancer Index (PCI), intraoperative blood transfusions, operative time, GI resections, postoperative morbidity, and LOS, as well as pre- and postoperative nutritional interventions, were recorded. The impact of preoperative nutritional status was assessed in relation to postoperative complications and hospital LOS. The study included 102 participants; 34 patients (33%) were classified as malnourished (SGA = B or C). Preoperative weight loss (15% vs. 74%; p ≤ 0.001) and the presence of clinical symptoms (18% vs. 47%; p = 0.002) were significantly higher in malnourished patients. While PCI, intraoperative blood transfusions, and GI resections were independent predictors of morbidity, malnutrition was significantly associated with infectious complications and LOS. For each grade of worsening malnutrition, LOS increased by an average of 7.65 days. Preoperative malnutrition is prevalent in patients undergoing CRS/HIPEC and postoperative morbidity is common. Malnutrition is linked to LOS and plays a role in postoperative outcomes such as infection. Clear pre- and postoperative nutrition pathways are needed to optimize nutrition support and postoperative recovery.