Postoperative Nutrition Research Articles

Role of Nutrition in Prevention of Neonatal Spontaneous Intestinal Perforation and Its Complications: A Systematic Review.

Background: Spontaneous intestinal perforation (SIP) is a devastating complication of prematurity, and extremely low birthweight (ELBW < 1000 g) infants born prior to 28 weeks are at highest risk. The role of nutrition and feeding practices in prevention and complications of SIP is unclear. The purpose of this review is to compile evidence to support early nutrition initiation in infants at risk for and after surgery for SIP. Methods: A search of PubMed, EMBASE and Medline was performed using relevant search terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. s and full texts were reviewed by co-first authors. Studies with infants diagnosed with SIP that included information on nutrition/feeding practices prior to SIP and post-operatively were included. Primary outcome was time to first feed. Secondary outcomes were incidence of SIP, time to full enteral feeds, duration of parenteral nutrition, length of stay, neurodevelopmental outcomes and mortality. Results: Nineteen articles met inclusion criteria—nine studies included feeding/nutrition data prior to SIP and ten studies included data on post-operative nutrition. Two case series, one cohort study and sixteen historical control studies were included. Three studies showed reduced incidence of SIP with initiation of enteral nutrition in the first three days of life. Two studies showed reduced mortality and neurodevelopmental impairment in infants with early feeding. Conclusions: Available data suggest that early enteral nutrition in ELBW infants reduces incidence of SIP without increased mortality.

Analysis of post-operative efficacy and pharyngeal fistula healing in patients with laryngeal cancer treated with post-operative enteral nutrition support nursing combined with early oral feeding.

The present study aimed to analyze the effects of post-operative enteral nutrition support nursing combined with early oral feeding on post-operative efficacy and pharyngeal fistula (PF) healing in patients with laryngeal cancer (LC). A retrospective analysis of 133 patients with LC, who underwent laryngectomy between May 2014 and September 2016, was conducted. Of these patients, 61 patients (control group) were treated with enteral nutrition support nursing combined with nasogastric feeding, and 72 patients (observation group) were treated with enteral nutrition support nursing combined with early oral feeding. Levels of serum albumin (ALB), pre-albumin (PA), hemoglobin (Hb) and the lymphocyte count (LYM) were compared before and after surgery (7 and 14th post-operative days). The post-operative weight, upper arm muscle circumference (UAMC), triceps skinfold (TSF), post-operative infection, adverse reactions and PF healing were also measured. No differences were observed between the control and observation groups before surgery (all P>0.05). ALB, Hb, PA and LYM were significantly decreased in the control group on the 7 and 14th days post-operatively compared with those in the observation group (all P<0.05). Five patients in the control group presented with PF during treatment, and seven patients in the observation group suffered from PF after surgery. No difference in the average healing time of PF, number of patients with post-operative infection and adverse reactions were observed between the two groups (all P>0.05). The weight and UAMC in the observation group, 14 days post-operatively, were significantly higher than those before surgery in the same patients and in the control group (all P<0.05), whereas no difference in TSF (P>0.05) was observed. No differences in weight, UAMC and TSF were revealed in the control group before surgery and on the 14th day post-operatively (all P>0.05). Thus, post-operative enteral nutrition support nursing combined with early oral feeding resulted in significant improvement in the post-operative efficacy of patients with LC and had no effect on PF healing.

Impact of Nutrition Support Team on Postoperative Nutritional Status and Outcome of Patients with Congenital Gastrointestinal Anomalies.

BACKGROUND The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome. METHODS A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs. RESULTS Median weight gain and the amount of calorie delivered during NICU stay in subjects of NSTsupported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant. CONCLUSION NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.

Functional and nutritional outcomes after gastric cancer surgery.

Recent improvements in diagnostic techniques and national screening programs have resulted in increasing number of patients diagnosed with early gastric cancer (EGC). The low incidence rate of lymph node metastasis and excellent survival rates after surgical treatment for EGC enabled the reduction in the extent of lymphadenectomy and the range of gastric resection for function-preserving gastrectomy. Thus, the quality of life (QOL) of patients with gastric cancer (GC) in the curative stage can be maintained. Moreover, these function-preserving procedures have been widely performed by less invasive procedures, such as laparoscopic and robotic approaches. Pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG) represent the two main function-preserving surgical procedures for GC. PPG is an alternative to distal gastrectomy (DG) for cT1 N0 EGC located in the middle part of the stomach. Preservation of the pyloric function is expected to prevent post-gastrectomy syndromes such as dumping syndrome. PG is an alternative to total gastrectomy (TG) and can thus be performed for cT1 N0 EGC located in the upper part of the stomach. Preservation of the residual stomach is expected to work as a reservoir for ingested food. The optimal reconstruction method after PG among the three most commonly performed procedures (esophagogastrostomy, jejunal interposition, and double-tract reconstruction) remains controversial. In addition to these three reconstruction methods, the novel double-flap technique (DFT) of esophagogastrostomy has gained attention recently because of its potential usefulness to prevent postoperative esophageal reflux. In this review article, we summarize the current evidence of PPG and PG with esophagogastrostomy by the DFT, focusing on postoperative nutrition and QOL.

Comparative study between Traditional and Stapled Gastrointestinal Anastomosis

Background: Intestinal anastomosis is a surgical procedure performed to establish communication between two formerly distant portions of the intestine. This procedure restores intestinal continuity after removal of a pathologic condition affecting the bowel. Intestinal anastomosis is one of the most commonly performed surgical procedures, especially in the emergency setting, and is also commonly performed in the elective setting when resections are carried out for benign or malignant lesions of the gastrointestinal (GI) tract. Objective: The aim of this work was to compare single layer, double layers and stapler intestinal anastomosis (Stomach, Stomach to small, small to small, small to large, large to large) in abdominal procedures and to evaluate the effectiveness of these procedures as regards to its integrity and complications including leakage. Patients and Methods: Prospective study on 50 patients presented with symptoms and signs suggestive for gastric operations, intestinal surgeries, resection and anastomosis according to inclusion and exclusion criteria. Cases were selected from Al-AzharUniversityHospitals and PublicHealthHospitals from March 2018 till June 2019. Results: There were high statistically significance between two groups in intra-operative bleeding, time and cost of operation as 23 patients of stapled group suffered minimal to mild bleeding, high operation cost and less time of procedure while 27 patients suffered minimal to moderate intra-operative bleeding, lower operation cost and longer procedure time. The analysis showed high significance between two groups in post-operative oral nutrition and discharge from hospital as patients underwent stapled anastomosis were allowed for oral nutrition 8 to 24 hours postoperatively and were discharged after 1 to 3 days, while patients underwent traditional anastomosis were allowed for nutrition after 5 to 7 days postoperatively and were discharged after 5 to 10 days. Conclusion: Stapled gastrointestinal anastomosis consumes lesser time at operation room, less intraoperative bleeding, early recovery and oral nutrition of patients, but has higher cost. Traditional gastrointestinal anastomosis consumes longer time at operation room, relatively more intraoperative bleeding, late recovery and oral nutrition of patients, but has lower cost. Both types of gastrointestinal anastomosis has the same postoperative co-morbidities.

Wives as Key Persons Positively Impacting Prognosis for Male Patients Undergoing Esophagectomy for Esophageal Cancer: A Retrospective Study from a Single Japanese Institute.

Identification of a key person for supporting patients with activities of daily living after esophagectomy can contribute to patients' nutrition, rehabilitation, mental status, and determination of treatments for cancer. It may also affect the patients' prognostic outcomes. This retrospective study included 504 patients who underwent three-incisional esophagectomy for esophageal cancer between June 2005 and June 2018 at the Kumamoto University Hospital. The association between the type of key person identified and overall survival (OS) was investigated. The impact of the key person on postoperative nutrition and survival after recurrence was also examined. Clinical backgrounds in patients with and without wife as their key person were equivalent. OS among male patients who identified their wife as their key person was significantly better than that in those without their wife as key person (P = 0.0035). Cox regression analysis showed that absence of a wife was an independent risk factor for worse survival outcomes (hazard ratio, 0.62; 95% confidence interval, 0.393-0.987; P = 0.044) along with age, clinical stage, severe postoperative morbidity, and pathological curability. Presence of a wife did not affect postoperative nutritional status. Incidence of death due to other causes and OS after recurrence were better in male patients with a wife than in those without; however, this difference was not significant. Among males with esophageal cancer, their wives may be a significant contributor to extension of survival after surgery, via various support mechanisms.

Does intensive multidisciplinary intervention for adults who elect bariatric surgery improve post-operative weight loss, co-morbidities, and quality of life? A systematic review and meta-analysis.

This systematic review and meta-analysis of intervention studies aims to evaluate the effect of preoperative and/or post-operative support for adults who elect bariatric surgery delivered by a multidisciplinary team (MDT) on post-operative body composition, mental health, co-morbidities, quality of life, and side effects. Six electronic databases were searched. Revman and GRADE were used to assess confidence in pooled effects. Included interventions (N = 1533 participants in total) focused on lifestyle counselling (n = 4 studies), psychology (n = 4 studies), or exercise (n = 10 studies); comparator groups were less intensive usual care. Intensive MDT interventions increased post-operative weight loss (SMD: -0.94; 95% CI: -1.27 to -0.61) if delivered post-operatively. Preoperative and post-operative intensive interventions improved symptoms of depression and anxiety, quality of life, diastolic blood pressure, and resting heart rate but not lipids or glycaemic measures. Whilst usual MDT care is important preoperatively, this review conditionally recommends intensive MDT interventions for enhanced post-operative weight loss if delivered in the post-operative period, led by any health professional, based on moderate evidence. This review also conditionally recommends preoperative and/or post-operative lifestyle, nutrition, or psychology counselling and/or physical activity for improved mental and physical health. Further randomized controlled trials are required, which aim to specifically evaluate the best use of MDT resources.

Tolerability of early oral nutrition and factors predicting early oral nutrition failure after gastrectomy.

Many studies have suggested the feasibility and safety of early oral nutrition after gastrectomy; however, the tolerability of early oral nutrition has rarely been investigated. This study aimed to investigate the tolerability of early oral nutrition and factors affecting early oral nutrition failure after gastrectomy. We retrospectively reviewed 565 patients with gastric cancer who had undergone gastrectomy and who had received oral nutrition on postoperative day 1. Failure of early oral nutrition was defined as cessation of at least one meal for any reason. Preoperative clinical information and operative factors were analyzed concerning an association with early oral nutrition failure. The tolerability of early oral nutrition after gastrectomy was 74.7%. Of 565 patients, 72 (12.7%) failed early oral nutrition due to adverse gastrointestinal symptoms, 52 (9.2%) failed due to gastric stasis or ileus, and 19 (3.4%) patients failed due to other postoperative complications. In the univariate analysis, age (≥70 years), male sex, preoperative tumor obstruction, remnant stomach cancer, open surgery, operating time (≥4h), and an advanced preoperative stage were associated with failed early oral nutrition. Multivariable analysis of these factors revealed that male sex, preoperative tumor obstruction, operating time, and advanced preoperative stage were independent predictive factors for early oral nutrition failure after gastrectomy. The tolerability of early oral nutrition after gastrectomy was comparable to that of other gastrointestinal surgeries. A tailored approach for postoperative oral nutrition is required based on identified risk factors for early oral nutrition failure.

Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review

BackgroundThe best evidence-enhanced recovery care pathway is yet to be defined for patients undergoing spinal surgery. Minimally invasive surgery, multimodal analgesia, early mobilization, and early postoperative nutrition have been considered as critical components of enhanced recovery in spinal surgery (ERSS). The objective of this study will be to synthesize the evidence underpinning individual components of a proposed multidisciplinary enhanced recovery pathway for patients undergoing spinal surgery.MethodsThis is the study protocol for a systematic review of complex interventions. Our team identified 22 individual care components of a proposed pathway based on clinical practice guidelines and published reviews. We will include systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled trials, and observational studies in adults or pediatric patients evaluating any one of the pre-determined care components. Our primary outcomes will be all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We will search the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The risk of bias for individual studies will be appraised using appropriate tools. A narrative synthesis will be provided with the information presented in the text and tables to summarize and explain the characteristics and findings of the included studies. Due to clinical and methodological heterogeneity, we do not anticipate to conduct meta-analyses. Confidence in cumulative evidence for each component of care will be classified according to the GRADE system.DiscussionThis systematic review will identify, evaluate, and integrate the evidence underpinning individual components of a pathway for patients undergoing spinal surgery. The formation of an evidence-based pathway will allow for the standardization of clinical care delivery within the context of enhanced recovery in spinal surgery.Systematic review registrationPROSPERO CRD42019135289

In Terms of Nutrition, the Most Suitable Method for Bariatric Surgery: Laparoscopic Sleeve Gastrectomy or Roux-en-Y Gastric Bypass? A Systematic Review and Meta-analysis.

This study assesses the differences in postoperative nutritional status between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). We searched the literature from PubMed, Web of Science, Embase, and the Cochrane Library database. Twenty-nine articles were included, with a total of 5437 obese patients. After bariatric surgery, the LSG group had less anemia and iron deficiency anemia than the LRYGB group. The serum iron, ferritin deficiency, and vitamin B12 rates after LSG were lower than patients receiving LRYGB. And PTH and serum phosphorus concentration of patients after LSG were both lower than those after LRYGB. The postoperative results of LSG were better than that of LRYGB. Therefore, we recommend LSG for a better postoperative nutrition, but only for reference.

Early implementation of a postoperative nutrition support pathway for patients undergoing esophagectomy.

344 Background: A significant risk of malnutrition burdens patients with esophageal cancer undergoing esophagectomy as tumor-related dysphagia and side effects of chemoradiation impair the patients’ ability to maintain adequate nutrition. Moreover, patients lose 10% or more of their preoperative body weight in the first year following surgery. Implementation of nutrition protocols may reduce postoperative weight loss and enhance recovery in these patients. Methods: This is a retrospective study examining a postoperative nutrition protocol initiated in August of 2017. Patients with esophagogastric cancer who underwent Ivor Lewis esophagectomy from July 2016 to July 2019 were identified from a prospectively collected database. Patients that underwent surgery after implementation of this protocol were compared to those operated prior to it. Results: Patients’ and tumor characteristics were similar between the two groups. The protocol included preoperative evaluation by a dietician, postoperative feeding pathway, and regular post-discharge follow up by phone with a dietician. In the post protocol group, we observed a reduction in time to initiation of diet and decreased weight loss at patient follow up (Table). There was no difference in incidence of postoperative complication, length of stay, 30-day readmission, or in hospital mortality. Conclusions: In conclusion, postoperative nutrition support programs may help reduce postoperative weight loss and may have a role in the prevention of malnutrition in these patients. Initial results suggest that more aggressive nutritional supplement program is feasible and may lead to improved postoperative outcomes in patients undergoing esophagectomy. [Table: see text]

Can the preoperative nutritional risk score be a predictor of the outcomes in critically ill patients of lung transplantation: a retrospective study.

Nutritional Risk Screening 2002 (NRS2002) and prognostic nutrition index (PNI) are nutritional risk screening instruments that are also used to predict the complications and morbidity after surgery. Our study aims to evaluate whether preoperative nutrition status at admission or postoperative nutrition treatment during admission for lung transplantation (LTX) was linked to clinical outcomes. This study is a retrospective observational cohort study of 42 patients undergoing LTX. Using PNI and NRS-2002 screening instruments, patients were tested for dietary danger upon admission. Univariate and multivariate analyzes were performed to investigate the independent nutritional risk predictive value for post-operative complications, hospital length or intensive care unit (ICU) stay, and mortality. Age, the average calorie intake, parenteral nutrition within 7 days, furosemide, the time of postoperative mechanical ventilation (MV), postoperative extracorporeal membrane oxygenation (ECMO) between survivor and non-survivor had a significant difference. Univariate analyses of death in LTX, age [HR 1.06 (1.00-1.13), P=0.04], the average calorie intake first 3 days [HR 0.99 (0.99-1.00), P=0.02], parenteral nutrition within 7 days [HR 0.20 (0.05-0.77), P=0.02], furosemide [HR 0.08 (0.01-0.76), P=0.02] and postoperative ECMO [HR 6.40 (1.65-24.77), P=0.00] were independent predictors for increased mortality. And multivariate analyses found that only postoperative ECMO [HR 9.59 (1.07-86.13), P=0.04] was independent predictors for increased mortality, whereas PNI and NRS2002 were not. PNI and NRS2002 was not an independent predictor for post-operative mortality, and postoperative ECMO was only independent predictors for increased mortality in this study.

Single centre experience of post-operative parenteral nutrition provision in patients undergoing cytoreductive surgery & heated intraperitoneal chemotherapy

Single centre experience of post-operative parenteral nutrition provision in patients undergoing cytoreductive surgery & heated intraperitoneal chemotherapy

Optimizing Outcomes in Urological Surgery: Postoperative Care.

Understanding best practices in perioperative care is critical for quality of care for our urology patients. We compiled a single, concise resource that provides recommendations for optimizing postoperative outcomes in patients undergoing urological surgery. Optimal postoperative care includes minimizing complications, optimizing recovery and improving patient outcomes. The assembled White Paper multidisciplinary writing team included experts in a number of different areas (urologists, nurses, anesthesiologists) to address a comprehensive set of topics that urological providers face when caring for postoperative patients. This article provides a summary of key elements to optimize postoperative care in adult urological surgery, including in-hospital considerations, transition/discharge, and followup and surveillance. In-hospital postoperative considerations include checklists, handoffs for safe transitions from the anesthesia to surgical team, level of care planning and enhanced recovery after surgery (ERAS®). Embedded in ERAS are postoperative nutrition, mobilization, wound care, judicious use of catheters and drains, and postoperative medications and transfusions. As the patient transitions to the outpatient setting, the urologist must provide clear and readable postoperative education, which includes medication management and coordinated followup with primary care providers and home health as needed. Finally, followup visits should be carefully considered using innovative methods such as telehealth and patient reported outcomes to elevate postoperative and long-term care. This article summarizes postoperative factors that may impact surgical outcomes in urology. By understanding and applying best practices for postoperative care, urologists can optimize the quality of care for their patients.

Preoperative skeletal muscle index predicts postoperative supplemental nutrition needs in patients undergoing pancreatoduodenectomy

Presenter: Andrew DeAtkine | University of Alabama - Birmingham Background: Significant loss of skeletal muscle mass, or sarcopenia, is a common sequela of pancreatic cancer. Sarcopenic patients often exhibit decreased overall survival and major postoperative complications following pancreatoduodenectomy (PD). Few studies have investigated postoperative nutritional requirements for sarcopenic patients compared to non-sarcopenic patients following PD. We hypothesized that preoperative skeletal muscle index (SMI) may predict postoperative supplemental nutrition needs in patients undergoing PD. Methods: A retrospective review of all patients with preoperative CT imaging within 3 weeks of an elective PD from 2013 to March 2019 were identified by billing codes. The skeletal muscle area was measured at the third lumbar vertebra (L3) on CT imaging and indexed to patient height to calculate SMI. Sarcopenia was based on gender-specific cutoffs of SMI (≤52.4 cm2 /m2 in men and ≤38.5 cm2 /m2 in women). Results: We identified 159 patients in the study period undergoing PD with appropriate imaging for analysis. Median SMI of males (n=71) was 49.6 cm2 /m2 and females (n=88) was 37.2 cm2 /m2. The median SMI of female patients who required tube feeds at discharge (dTF) compared to females who did not was lower (32.0 [IQR 28.4-36.8] vs. 38.2 [IQR 34.7-45.7] cm2 /m2; p= 0.019). The median SMI of male patients who required dTF compared to patients who did not was also lower (42.9 [IQR 38.5-50.0] vs. 51.0 [IQR 45.3-56.4] cm2 /m2; p= 0.023). Receiver operating characteristic (ROC) curve analysis suggested SMI may be used to predict dTF for both females (AUC = 0.748) and males (AUC = 0.702). Youden’s index analysis of these curves suggested a SMI cut-off of ≤32.5 cm2/m2 for females and ≤42.9 cm2/m2 for males as prognostic of dTF. Standard cutoffs for sarcopenia did not show a significant association with dTF by univariate logistic regression; however, the above proposed SMI cutoffs did correlate with dTF for both female (OR: 6.76, 95%CI 1.08-42.88) and male (OR: 4.54, 95%CI 1.01-20.45) patient populations. Conclusion: A significant association exists between very low SMI and postoperative enteral nutrition requirements, suggesting that the patients with severe sarcopenia undergoing PD may benefit from the placement of a feeding tube at the time of resection.

Assessment of postoperative nutritional status and physical function between open surgical aortic valve replacement and transcatheter aortic valve implantation in elderly patients.

Background and aims : Severe aortic stenosis (AS) has been normally treated with surgical aortic valve replacement (AVR) whereas recently, transcatheter aortic valve implantation (TAVI) has been introduced as a minimally invasive operation for patients with high surgical risk and frailty. In this study, we have evaluated postoperative physical function and nutrition intake in the patients following AVR and TAVI. Methods : This prospective observational study involved 9 patients with surgical aortic valve replacement (AVR) and 7 patients with transcatheter aortic valve implantation (TAVI). Body composition was measured one day prior surgery, postoperative day (POD) 1, POD 3, POD 5 and POD 7. Hand grip strength, calf circumference and gait speed were measured one day before surgery and on the day of discharge. Results : Skeletal muscle was significantly decreased in AVR patients at postoperative day 3 and 7, while there was no change in TAVI patients. Patients with TAVI showed higher dietary intake after surgery compared to patients with AVR, and they maintained hand grip strength and calf circumference at discharge. Conclusions : In elderly patients with AS, TAVI can improve post-operative recovery maintaining nutritional status and physical function even. J. Med. Invest. 67 : 139-144, February, 2020.

The effect of hypocaloric nutrition on surgical complications in patients undergoing major surgery

Introduction: The response to the stress of injury has been divided into "ebb” and "flow” phases. The magnitude of injury influences both the degree and duration of each phases. High provisions of glucose-derived calories tend to accentuate these reactions and increase the degree of hyperglycaemia. Objectives/Aims: It was aimed that to evaluate hypocaloric-hyperproteinic regimen during the first days after elective surgery for morbidity, mortality and length of stay. Methods: Sixty patients undergoing elective major surgery were enrolled in this prospective, randomised, controlled study. These patients were divided three groups, designed Group I conventional therapy, Group II hypocaloric-hyperproteinic parenteral nutrition, Group III total parenteral nutrition. Postoperative morbidity, mortality and length of stay data were recorded. Results: Hypocaloric-hyperproteinic parenteral nutrition in major surgery patients did not increased or reduced on mortality, morbidity, infective complications, and postoperative stay in hospital. Hypocaloric- hyperproteinic parenteral nutrition declines of nutritional expenditure 60% accordance to TPN. Conclusion: In this study, postoperative hypocaloric-hyperproteinic parenteral nutrition did not affect mortality and morbidity. Larger randomised clinical trials are required especially about hyperproteinic parenteral nutrition

Clinical Features and Advantages of a Novel Percutaneous Endoscopic Gastrostomy Method.

BackgroundTo study the clinical characteristics of novel percutaneous endoscopic gastrostomy.Material/MethodsWe retrospectively analyzed the hospital records of 173 patients undergoing various methods of gastrostomy (a novel PEG, traditional PEG, and surgical gastrostomy). Clinical characteristics were analyzed. For the novel PEG, the operation was as same as the traditional method for initial steps until the annular guide wire was inserted. The following steps were different: water was injected through an injection port to expand the capsule, then the water sac was confirmed to be close to the gastric wall under endoscope, and, finally, the incision was sutured and covered.ResultsPatient ages ranged from 42 to 93 years (60.8±9.2 years, 91 males and 82 females). Among all patients, there were 27 cases of brain trauma, 42 cases of cerebral infarction, 74 cases of esophageal or cardiac carcinoma, 21 cases of laryngocarcinoma, and 9 cases of Alzheimer disease. Clinical features were significantly better for novel PEG compared to traditional PEG: duration of operation (19.75±3.14 min vs. 37.86±5.33 min and 54.12±9.48 min, P<0.001), intraoperative blood loss (27.14±3.63 ml vs. 43.53±6.24 ml and 75.78±12.41 ml, P<0.001), postoperative pain score (1.12±0.19 pts vs. 3.85±0.44 pts and 6.22±1.06 pts; P<0.001), infection rate (1.35% vs. 3.77% and 2.17%, P<0.001), length of hospital stay (3.16±0.42 d vs. 5.68±0.78 d and 8.29±1.31 d, P<0.001), and time to free activity (2.24±0.26h vs. 3.74±0.48 h and 14.85±2.38 d, P<0.001). The incidence of complications such as wound infection (1.35% vs. 3.77% and 4.76%), vomiting (1.35% vs. 5.66% and 6.52%), and nausea (2.70% vs. 1.88% and 6.52%) in the novel PEG group was lower than in the other groups (P<0.0001). Improved outcomes were obtained without increased medical costs in the novel PEG group.ConclusionsFor patients with difficult postoperative oral nutrition, the novel PEG treatment resulted in overall better clinical outcomes than traditional PEG.

Effects of a new perioperative enhanced recovery after surgery protocol in hepatectomy for hepatocellular carcinoma.

Enhanced recovery after surgery (ERAS) protocols are becoming the standard of care in many surgical procedures, although data on their use following hepatectomy for hepatocellular carcinoma (HCC) are scarce. This study aimed to evaluate the effects of a new ERAS pathway in terms of the patient nutrition status after hepatectomy for HCC. This is a retrospective analysis of 97 consecutive patients treated with open or laparoscopic hepatectomy for HCC between January 2011 and August 2014. We compared the perioperative outcomes between patients whose treatment incorporated the ERAS pathway and control patients. The nutritional status was evaluated using the controlling nutritional status score. The length of hospital stay (LOS) after both open and laparoscopic hepatectomy was shorter for the ERAS group than the control group. The days of ambulation and cessation of intravenous infusion were earlier and the postoperative nutrition status was statistically better in the ERAS group than in the control group. A multivariate analysis showed that being in the non-ERAS group was a risk factor of delayed discharge. There were no marked differences in the rate of severe complications between the two groups. The ERAS pathway seems feasible and safe and results in a faster recovery, reduced LOS, improved nutrition status, and fewer severe complications.

Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study

BackgroundThe incidence of adenocarcinoma of esophagogastric junction (AEG) has recently risen worldwide, including in Eastern Asia. The aim of the study was to explore the short-term and long-term clinical efficacy of piggyback jejunal interposition reconstruction single-tract reconstruction (PJIRSTR), piggyback jejunal interposition reconstruction double-tract reconstruction (PJIRDTR), and total gastrectomy esophageal jejunal Roux-en-Y anastomosis (TGRY) for the treatment of Siewert II and III AEG patients.MethodsA total of 300 Siewert II and III AEG patients admitted to Shanxi Tumor Hospital from June 2015 to December 2017 were prospectively selected. Patients were randomly divided into PJIRSTR group (n = 98), PJIRDTR group (n = 103), and TGRY group (n = 99) using the random number table method.ResultsThere were no statistically significant differences in total operation time, intraoperative blood loss, time of first anal exhaust, and postoperative hospital stay among the three groups (F = 2.526, 0.457, 0.234, 0.453; P > 0.05). The reconstruction time of PJIRSTR group and PJIRDTR group was longer than that of TGRY group (P < 0.01). There were no significant differences in cases of anastomotic leakage, anastomotic bleeding, abdominal infection, incision infection, ileus, and dumping syndrome in three groups (P > 0.05). The incidence of reflux esophagitis at 3, 6, 12, and 18 months after surgery in the PJIRSTR group and the PJIRDTR group were significantly lower than TGRY group in the same period (P < 0.05). Compared with PJIRDTR group and TGRY group, PJIRSTR group had a small fluctuation range of postoperative nutrition indexes and had basically recovered to the preoperative level at 18 months. Four patients of Visick grade IV presented in TGRY group 18 months postoperatively, which was significantly higher compared with the other two groups.ConclusionCompared with PJIRDTR and TGRY, PJIRSTR can significantly reduce the incidence of postoperative reflux esophagitis and improve the long-term nutritional status of patients.Trial registrationChinese Clinical Trial Registry, ChiCTR-IIR-16007733. Registered 07 November 2015 – Retrospectively registered, http://www.chictr.org.cn/searchproj.aspx.