Resumption Of Diet Research Articles

An analysis of the new "three tubes" method in the treatment of spontaneous esophageal rupture

To investigate the clinical efficacy, feasibility and safety of new "three tubes" method in the treatment of spontaneous esophageal rupture. A total of 22 patients with spontaneous esophageal rupture were retrospectively analyzed. Through the new "three tubes" method of treatment, patients achieved leak cured with reduced hospital stay, less medical expenses and early resumption of oral diet. The new "three tubes" method for spontaneous esophageal rupture has the advantages of easy handling, minimal invasion, few complication and exact curative effect.

High volume crystalloid resuscitation adversely affects pediatric trauma patients

BackgroundAggressive fluid resuscitative strategies have been the cornerstone of early trauma management for decades. However, recent prospective adult studies have challenged this practice, underlining the detrimental effect of positive fluid balance on cardiopulmonary function. Fluid overload has been associated with impaired oxygenation and morbidity in critically ill adults, but data is lacking in pediatric trauma patients. MethodsWe completed a retrospective chart review of all pediatric trauma patients 0–18 years old admitted to a level 1 trauma center from January 2013 to December 2015. Four patient cohorts were established based on volume of fluid administered: <20 ml/kg/day, 20–40 ml/kg/day, 40–60 ml/kg/day, and > 60 ml/kg/day. The primary outcome was death. Secondary outcomes included the number of days on the ventilator, intensive care unit length of stay (ICU LOS), overall length of stay (LOS), number of days nil per os (NPO) as an indicator of ileus, and incidence of bloodstream infection and/or surgical site infection. ResultsThe mean volume of fluid administered over the first 24 h was 41 ml/kg/day, and 28 ml/kg/day over the first 48 h. ICU length of stay and overall length of stay were increased in patients who received more than 60 ml/kg/day in the first 24 h of their hospitalization. Furthermore, ventilator use, ICU length of stay, overall length of stay, and time to resumption of a regular diet were all increased in patients who received >60 ml/kg/day over 48 h. ConclusionsEarly administration of high volumes of crystalloid fluid greater than 60 ml/kg/day significantly correlates with pulmonary complications, days NPO, and hospital length of stay. These results span the first 48 h of a patient's hospital stay and should encourage surgical care providers to exercise judicious use of crystalloid fluid administration in the trauma bay, ICU, and floor. Type of StudyTherapeutic. Level of EvidenceLevel III.

Infectious Complications After Laparoscopic Appendectomy in Pediatric Patients with Perforated Appendicitis: Is There a Difference in the Outcome Using Irrigation and Suction Versus Suction Only? Results of a Multicentric International Retrospective Study.

Analyzing the recent literature, it seems that the use of irrigation increases the incidence of intra-abdominal abscesses (IAAs) and infectious complications in perforated appendicitis. The aim of this study was to compare peritoneal irrigation and suction versus suction only during laparoscopic appendectomy (LA) for perforated appendicitis in children. We retrospectively reviewed the records of 699 patients (460 boys and 239 girls, average age 9.8 years) who underwent LA for complicated appendicitis in six international centers of pediatric surgery over a 5-year period. The appendix was perforated with localized peritonitis in 465 cases and diffuse peritonitis in 234 patients. Irrigation + suction was used in 488 cases (group 1 [G1]), whereas suction only was used in 211 cases (group 2 [G2]). No significant difference between the two groups was found in regard to average operative time (P = .23), average time of resumption of oral diet (P = .55), average reprise of gastrointestinal transit (P = .55), and average length of hospital stay (P = .41). As for postoperative complications, the incidence of IAAs was significantly higher in G2 (41/211; 19.4%) compared with G1 (38/488; 7.7%) (P = .0000), whereas no significant difference was found between the two groups in regard to wound infection (G1: n = 2 or 0.4%; G2: n = 4 or 1.8%; P = .05) and small bowel obstruction rates (G1: n = 8 or 1.6%; G2: n = 2 or 0.9%; P = .47). In contrast with the most recent literature on this topic, our results demonstrated that peritoneal irrigation and suction were associated with a lower rate of postoperative IAA formation compared with the suction-only approach in children with perforated appendicitis. In such cases, peritoneal irrigation and abdominal drainage should be the preferred methods for peritoneal toilette, with no increase in operative time and postoperative morbidity.

Development of a postoperative care pathway for children with renal tumors

To identify the factors associated with a shorter postoperative stay, as an initial step to develop a care pathway for children undergoing extirpative kidney surgery. This study retrospectively reviewed patients managed with upfront open radical nephrectomy for renal tumors between 2005 and 2016 at a pediatric tertiary care facility. Univariate and multivariate logistic regression were performed to identify factors associated with early discharge (by postoperative day 4). A total of 84 patients met inclusion criteria. Median age was 28.1 months (range 1.8-193.1). Thirty-four (40.5%) patients had a nasogastric tube postoperatively. The patients were advanced to a clear liquid diet on a median postoperative day 2 (range 0-7) and regular diet on a median postoperative day 3 (range 1-8). Median time from surgery to discharge was 5 days (range 2-12), with 38 (45.2%) discharged early. Univariate and multivariate logistic regression analyses showed that earlier resumption of regular diet (OR 0.523, P=0.028) was positively associated with early discharge. Other analyzed factors were not significant (see Table). Timely initiation of adjuvant therapy is a specific requirement of Children's Oncology Group (COG) protocols. Chemotherapy and radiation therapy are ideally initiated simultaneously, as early as possible, within 2 weeks of surgery. Thus, factors that can facilitate early discharge from the hospital can maximize protocol adherence with respect to timing of adjuvant therapy initiation and optimize patient outcome. This study shed light on several postoperative factors and how these relate to postoperative stay and recovery. Specifically, tumor size, pre-operative bowel preparation, extent of lymph node sampling, stage, operative time, estimated blood loss, surgical service, postoperative nasogastric tube use, transfusion, and chemotherapy prior to discharge were not associated with discharge timing. Early re-feeding was associated with early discharge. Thus, it seems reasonable that, when developing a postoperative care pathway for these patients, these factors be considered and specifically encourage early re-feeding. In pediatrics, data on early recovery after surgery protocols are limited, and high-quality studies are unavailable. Within pediatric urology, early recovery after surgery protocols in children undergoing major urologic reconstruction have been shown to reduce hospital stay and can decrease complication rates. It seems reasonable that a similar pathway can be applied to children undergoing radical nephrectomy for suspected malignancy. For children with renal tumors who underwent radical nephrectomy, early re-feeding was associated with a shorter time to discharge. Use of bowel preparation and nasogastric tube did not appear to shorten time to discharge. These data are important for developing postoperative care pathways for these patients.

Reducing the exposure of the tonsillar fossa does not impact postoperative pain levels in children undergoing tonsillectomy: A double-blind randomized controlled trial

BackgroundIt is not established whether reducing the exposure of the tonsillar fossa would be an effective strategy for postoperative pain relief among the pediatric population submitted to tonsillectomy. We assessed the impact of closing this region using absorbable sutures on pain, on the resumption of normal diet and on the healing process until seven days after surgery. MethodsRandomized, double-blind, controlled trial comparing postoperative pain in 132 children between the ages of 5 and 12 years undergoing tonsillectomy having bilateral closure, unilateral closure or non-closure of the tonsillar fossa. ResultsNo differences in pain levels were reported both at discharge and on postoperative day 7. The day of resumption of normal diet was similar in all patients. Less granuloma and edema of the uvula were noted in patients with non-closure of the tonsillar fossa. ConclusionThese results showed that reducing the exposure of the tonsillar fossa after the removal of the palatine tonsils was not an effective method for postoperative pain relief in children. Moreover, its closure was associated with slower healing.

Overcoming barriers and improving adherence to nutritional protocols in enhanced recovery after surgery (ERAS) for colorectal surgery

Objectives: Nutrition is an essential component of Enhanced Recovery After Surgery (ERAS) programs. ERAS programs advocate resumption of diet within a few hours post surgery with supplementation of high-calorie drinks. In March 2016, Tan Tock Seng Hospital started to adopt ERAS protocols for elective colorectal surgery. However, internal audits and retrospective review of our data indicated poor compliance with ERAS nutritional protocols. Our aim was to identify barriers and develop strategies to improve adherence to ERAS nutritional protocols, so as to facilitate the integration of nutritional protocols within ERAS. Methods: In July 2016, a multidisciplinary project team was formed. Root cause analysis was carried out with different stakeholders. Four actionable barriers were identified in the implementation of nutritional aspect of ERAS: 1) unfamiliarity with new ERAS protocols; 2) confusion caused by an outdated existing Colorectal Clinical Pathway; 3) reluctance to adopt new practice; and 4) resource limitation and logistic issues. Strategies implemented included: educational talks to staff and patients on ERAS nutritional protocols to disseminate the practice changes; revising the existing Colorectal Clinical Pathway to align with new ERAS nutritional protocols; sharing favourable results to convince staff and overcome resistance; conducting frequent meetings to reflect on practice, build teamwork and align different ward cultures; identifying and training ERAS champions in different wards as ERAS advocates; collaborating with pharmacy to store nutritional supplements at the ward level to promote early oral nutrition. A comparison of pre and post-implementation of strategies on ERAS nutritional compliance and clinical outcomes were carried out during the period of March to October 2016 (n=135) and Nov 2016 to July 2017(n=157). Results: Overall, adherence to ERAS nutritional measures improved by 25% with an overall increasing trend. Patients recovered faster with decreased median length of stay from 7 to 6 days, complication rate dropped from 47.4% to 39.5% and 30 days readmission rate from 7.2% to 5.2%. Conclusion: Implementation of strategies addressing actionable barriers successfully improved adherence to nutritional standardisation of ERAS protocols and clinical outcomes following colorectal surgery. Disclosure of Interest: None declared.

Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic adenocarcinoma: analysis of 12 cases

Objective: To evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS) for left-sided pancreatic adenocarcinoma. Methods: Clinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old(47-68 years old). Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017. Results: All patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes(180-445 minutes), and the blood loss was 150 ml(50-500 ml). The medium first flatus time and diet resumption time were 3.0 days(1-5 days) and 3.5 days(1-7 days) respectively.The medium postoperative hospital stay was 9 days(4-18 days). Morbidity occurred in 8 patients with gastric empty delay(n=1), bleeding(n=1), fluid collection(n=3). There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis. Conclusion: Lap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.

Effect of Early Surgery on Outcome In Perforation Peritonitis

BACKGROUND: Early diagnosis and emergent surgical management of perforation peritonitis remain the mainstay of treatment. The aim of study was to find the effect of early surgery on postoperative outcome in patients with perforation peritonitis.MATERIALS &amp; METHODS: A retrospective medical report of 200 patients who underwent exploratory laparotomy and proceed for perforation peritonitis from July 2015 to December 2016 was studied. Patients were divided into two groups based on the time of surgery i.e: Early (&lt;6 hours) and late (≥6 hours) intervention groups. All perioperative outcome of surgery were analyzed.RESULTS: Late intervention patients were more likely to develop complications (34.3 and 17.8%, P &lt; 0.05) and mortality (14 and 6%, P&lt;0.05) in comparison to early intervention patients and had significantly higher median time to resumption of normal diet (5and 2.8 days, length of hospital stay (15 and 9 days) and length of ICU stay (8 and 4 days) (P &lt; 0.05). The time to operation (≥ 6 hours) and preoperative hypotension were independent risk factors for postoperative complications in multivariate analysis.CONCLUSION: Early surgical intervention within six hours along with broad spectrum antibiotics preceded by adequate aggressive resuscitation improves postoperative outcomes in perforation peritonitis.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, page: 12-16

Knowledge and Practice on Selected Aspects of Postnatal Care Among Postnatal Mothers

INTRODUCTION: Maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women. Skilled care before, during and after childbirth can save the lives of women and newborn babies. Only a small proportion of women in developing countries- less than 30% receive adequate postpartum care. In very poor countries and regions as few as 5% of who receive such care. A large proportion of maternal deaths occur during the first 6 weeks after delivery, and postpartum care might help to prevent many of these deaths. In developed countries, 90% of new mothers receive postpartum care.MATERIALS &amp; METHODS: A descriptive approach with descriptive correlation research design was used to assess the knowledge and practice on selected aspects of postnatal care among postnatal mothers. The study was carried out in Banashankari Referral Hospital, Bangalore. The purposive sampling technique was used to select the 60 samples of postnatal mothers. The collected data were analyzed by using descriptive and inferential statistics.RESULTS: Thirty Three (55%) respondents were having moderately adequate knowledge regarding selected aspects of postnatal care, 24(40%) were having inadequate knowledge and only 03(05%) of respondents had adequate knowledge out of 60 samples . The level of practice was out of 60 respondents, 29(48.33%) respondents were having inadequate practices, 26(43.33%) were having moderately adequate practices and only 05(08.34%) of them had adequate practices on selected aspects of postnatal care.CONCLUSION: The findings of the study conclude that the postnatal mothers had moderately adequate knowledge and practices on selected aspects of postnatal care. The study suggests that the postnatal mothers require educational instructions for improving the knowledge and practice.BACKGROUND: Early diagnosis and emergent surgical management of perforation peritonitis remain the mainstay of treatment. The aim of study was to find the effect of early surgery on postoperative outcome in patients with perforation peritonitis.MATERIALS &amp; METHODS: A retrospective medical report of 200 patients who underwent exploratory laparotomy and proceed for perforation peritonitis from July 2015 to December 2016 was studied. Patients were divided into two groups based on the time of surgery i.e: Early (&lt;6 hours) and late (≥6 hours) intervention groups. All perioperative outcome of surgery were analyzed.RESULTS: Late intervention patients were more likely to develop complications (34.3 and 17.8%, P &lt; 0.05) and mortality (14 and 6%, P&lt;0.05) in comparison to early intervention patients and had significantly higher median time to resumption of normal diet (5and 2.8 days, length of hospital stay (15 and 9 days) and length of ICU stay (8 and 4 days) (P &lt; 0.05). The time to operation (≥ 6 hours) and preoperative hypotension were independent risk factors for postoperative complications in multivariate analysis.CONCLUSION: Early surgical intervention within six hours along with broad spectrum antibiotics preceded by adequate aggressive resuscitation improves postoperative outcomes in perforation peritonitis.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, page: 37-41

Single-incision laparoscopic hepaticojejunostomy for children with perforated choledochal cysts.

Conventionally, perforated choledochal cyst (CDC) is a contraindication of laparoscopic treatment. The current study is to evaluate efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) in children with perforated CDCs. One hundred and thirty-three children with perforated CDCs who underwent SILHs in our hospital between August 2011 and August 2017 were reviewed. Fifteen (11.3%) patients were converted to open procedures due to severe adhesions and oozing. The mean age at SILH was 2.09years (range 2days-12.37years). The average operative time was 3.23h (range 2-5h). The mean postoperative hospital stay was 6.25days (range 4-16days). The mean time to full diet resumption was 2.18days (range 2-6days). The mean duration of drainage was 3.71days (range 3-10days). The median follow-up period was 24months. Postoperative liver function tests and serum amylase levels returned to normal within 1year. Three (2.5%) patients required blood transfusions because of extensive oozing from intramural micro-vessels of CDCs. Two (1.7%) patients encountered duodenal injuries because of severe adhesions. The duodenum was repaired with double-layer 5-0 PDS running sutures. One (0.8%) patient with giant CDC had abdominal fluids because of extensive dissection of intrapancreatic segment of CDC. He recovered after 10days of drainage. None of patients had bile leak, anastomotic stenosis, cholangitis, intrahepatic reflux, pancreatic leak, pancreatic calculi formation, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction. Single-incision laparoscopic hepaticojejunostomy is safe and effective for selected patients with perforated CDCs in experienced hands.

Short- and long-term outcomes of laparoscopic-assisted surgery, mini-laparotomy and conventional laparotomy in patients with Stage I-III colorectal cancer.

Background:Three operative techniques have been used for colorectal cancer (CRC) resection: Conventional laparotomy (CL) and the mini-invasive techniques (MITs)– laparoscopic-assisted surgery (LAS) and mini-laparotomy (ML). The aim of the study was to compare the short- and long-term outcomes of patients undergoing the three surgical approaches for Stage I–III CRC resection.Patients and Methods:This study enrolled 688 patients with Stage I–III CRC undergoing curative resection. The primary endpoints were perioperative quality and outcomes. The secondary endpoints were oncological outcomes including disease-free survival (DFS), overall survival (OS) and local recurrence (LR).Results:Patients undergoing LAS had significantly less blood loss (P < 0.001), earlier first flatus (P = 0.002) and earlier resumption of normal diet (P = 0.025). Although post-operative complication rates were remarkably higher in patients undergoing CL than in those undergoing MITs (P = 0.002), no difference was observed in the post-operative mortality rate (P = 0.099) or 60-day re-intervention rate (P = 0.062). The quality of operation as assessed by the number of lymph nodes harvested and rates of R0 resection did not differ among the groups (all P > 0.05). During a median follow-up of 5.42 years, no significant difference was observed among the treatment groups in the rates of 3-year late morbidity, 3-year LR, 5-year LR, 5-year OS or 5-year DFS (all P > 0.05).Conclusions:Patients undergoing CL had higher post-operative morbidities. Moreover, the study findings confirm the favourable short-term and comparable long-term outcomes of LAS and ML for curative CRC resection. Therefore, both MITs may be feasible and safe alternatives to CL for Stage I-III CRC resection.

Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures

ObjectiveTo describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. MethodsA retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56). ResultsThe most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001). ConclusionNon-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease.

A comparative study of open cholecystectomy and laparoscopic cholecystectomy in patients with cholelithiasis

Background: Cholelithiasis is a major cause of morbidity among Indians with a female preponderance. Most of the cases of gallstones are asymptomatic. For a long time, open cholecystectomy (OC) used to be the surgical treatment for cholelithiasis. But with the advent of laparoscopic cholecystectomy (LC) there has been a gradual shift in the treatment with most surgeons preferring LC over OC. Apart from the benefits of decreased hospital stay, lesser postoperative pain and earlier return to normal activity LC are also cosmetically better as compared to OC. Longer operative time and increased incidence of biliary leakage are some pitfalls of LC in initial phase of surgical practice.Methods: A prospective study of 100 patients was carried out in the department of surgery in IQ city medical college and Durgapur city hospital, Durgapur between January 2017 and August 2017 with the aim of comparing open cholecystectomy with laparoscopic cholecystectomy. The patients were randomly assigned into two groups. Group A consisted of patients who underwent laparoscopic surgery while Group B patients underwent open surgery for cholelithiasis.Results: Duration of surgery was longer in OC than LC (72.4min versus 44.7min.). Mean duration of post-operative pain was 18.3hrs in group A as compared to mean duration of 30.7hrs in group B patients. The mean period of post-operative hospital stay was 1.8 days in group A and 4.8 days in group B. Post-operative resumption of normal diet was possible in 2.1 days in OC while it took lesser time (1.2 days) in LC. The rate of surgical site infection was higher in OC as compared to LC.Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, lesser post-operative hospital stay and fewer incidence of surgical site infection.

Normal Diet within Two Postoperative Days—Realistic or Too Ambitious?

Enhanced Recovery After Surgery (ERAS) protocols advocate early postoperative resumption of normal diet to decrease surgical stress and prevent excessive catabolism. The aim of the present study was to identify reasons for delayed tolerance of normal postoperative diet. This was a retrospective analysis including all consecutive colorectal surgical procedures since May 2011 until May 2017. Data was prospectively recorded by an institutional data manager in a dedicated database. Uni- and multivariate risk factors associated with delayed diet (beyond POD 2) were identified by multiple logistic regression among demographic, surgery- and modifiable pre- and intraoperative ERAS-related items. In a second step, univariate analysis was performed to compare surgical outcomes for patients with early vs. delayed oral intake. The study cohort consisted of 1301 consecutive colorectal ERAS patients. Herein, 691 patients (53%) were able to resume normal diet within two days of surgery according to ERAS protocol, while in 610 patients (47%), a delay in tolerance of normal diet was observed. Male gender was independently correlated to early tolerance (Odds Ratio (OR) 0.66; 95% Confidence Interval (CI) 0.46–0.84, p = 0.002), while ASA score ≥ 3 (OR 1.60; 95% CI 1.12–2.28, p = 0.010), abdominal drains (OR 1.80; 95% CI 1.10–2.49, p = 0.020), right colectomy (OR 1.64; 95% CI 1.08–2.49, p = 0.020) and Hartmann reversal (OR 2.61; 95% CI 1.32–5.18, p = 0.006) constituted risk factors for delayed tolerance of normal diet. Patients with delayed resumption of normal diet experienced more overall (Clavien grade I–V) (47% vs. 21%, p < 0.001) and major (Clavien grade IIIb–V) (11% vs. 4%, p < 0.001) complications and had a longer length of stay (9 ± 5 vs. 5 ± 4 days, p < 0.001). Over half of patients could not tolerate early enteral realimentation and were at higher risk for postoperative complications. Prophylactic drain placement was the only independent modifiable risk factor for delayed oral intake.

A Pilot Study of Enhance Recovery after Surgery (ERAS) for Liver Resection

Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for liver resection was initiated. Objective: The aim of this study was to achieve discharge by postoperative day 3 for minor resection and day 5 for major resection. Design and Setting: This is a prospective study conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015. Material and Methods: All patients undergoing open liver resection were included in the study. They were then managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s demographics data, intra operative parameters, postoperative complications and adherence to postoperative recovery protocol were recorded. Results: Seventeen patients (7 major and 10 minor resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%) in the major group were discharged on time. 9 patients had postoperative complications with no mortality recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in 15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients - 35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14 patients). Conclusion: From these overall achievement, most of our targets have been met and this shows that our ERAS protocol is safe to be applied to patient undergoing hepatectomy. Limitations: Some patients had achieved their target but not discharged for unknown reason.

The safety and efficacy of powered intracapsular tonsillectomy in children: A meta-analysis.

We performed a systemic review and meta-analysis regarding the postoperative pain, perioperative, and postoperative morbidity of powered intracapsular tonsillectomy and adenoidectomy (PITA) using a microdebrider as a method of tonsillectomy. Five databases (PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials) in their entirety through March 2017. We included studies in which there was a comparison between groups of patients who underwent PITA (PITA group) and those who had extracapsular tonsillectomy (control group). Articles assessing effects of PITA in the pediatric patient were systemically and independently reviewed by two researchers. The outcomes of interest were intraoperative morbidity (operative time and bleeding), postoperative morbidity (postoperative pain, recovery time, tonsil regrowth, and postoperative bleeding rate), and improvement of sleep breath disorder (apnea-hypopnea index [AHI] and symptomatic scores). PITA did not significantly increase operative time or intraoperative blood loss. With PITA, there was significantly decreased postoperative pain, amount of analgesia, time to resumption of normal diet and activity, and incidence of postoperative admissions (due to dehydration or postoperative bleeding control) compared to those of the control group. In contrast, the incidence of postoperative tonsil regrowth was statistically higher in the PITA group than in the control group. The PITA improved AHI and obstructive sleep apnea 18-item questionnaire scores significantly, which were similar with the control group. With regard to intraoperative morbidity and postoperative morbidity, PITA is a safe procedure. However, there are high levels of heterogeneity with regard to several measured parameters. Therefore, further large, well-designed trials are required to substantiate our findings. Laryngoscope, 128:732-744, 2018.

Outcomes of robotic versus laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiation therapy and the effect of learning curve

Randomized controlled trials have demonstrated that laparoscopic surgery for rectal cancer is safe and can accelerate recovery without compromising oncological outcomes. However, such a surgery is technically demanding, limiting its application in nonspecialized centers. The operational features of a robotic system may facilitate overcoming this limitation. Studies have reported the potential advantages of robotic surgery. However, only a few of them have featured the application of this surgery in patients with advanced rectal cancer undergoing neoadjuvant chemoradiation therapy (nCRT).From January 2012 to April 2015, after undergoing nCRT, 40 patients with mid or low rectal cancer were operated using the robotic approach at our institution. Another 38 patients who were operated using the conventional laparoscopic approach were matched to patients in the robotic group by sex, age, the body mass index, and procedure. All operations were performed by a single surgical team. The clinicopathological characteristics and short-term outcomes of these patients were compared. To assess the effect of the learning curve on the outcomes, patients in the robotic group were further subdivided into 2 groups according to the sequential order of their procedures, with an equal number of patients in each group. Their outcome measures were compared.The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, rectal resection type, and pathological examination result. After undergoing nCRT, more patients in the robotic group exhibited clinically advanced diseases. The complication rate was similar between the 2 groups. The operation time and the time to the resumption of a soft diet were significantly prolonged in the robotic group. Further analysis revealed that the difference was mainly observed in the first robotic group. No significant difference was observed between the second robotic and laparoscopic groups.Although the robotic approach may offer potential advantages for rectal surgery, comparable short-term outcomes may be achieved when laparoscopic surgery is performed by experienced surgeons. However, our results suggested a shorter learning curve for robotic surgery for rectal cancer, even in patients who exhibited more advanced disease after undergoing nCRT.

Open Appendectomy versus Laparoscopic Appendectomy in Adults

As of late, the occurrence of appendicitis has notably diminished. However, appendicitis stays one of the more common surgical emergencies, and appendectomy stays the treatment of non-complicated appendicitis. Acute appendicitis (AA), a typical intra-abdominal surgical pathology, obliges a comprehensive understanding of its presentation, assessment, diagnosis, and overall operative administration. There are two types of surgery to remove the appendix. The standard technique is an open appendectomy and laparoscopic appendectomy. As with other laparoscopic surgical procedures, the literature defines decreased pain, earlier resumption of diet, and decreased length of hospital stay for laparoscopic appendectomy versus the equivalent open procedure. Nevertheless, this should be accurately considered in the light of the present condition of the open procedure, which already causes minimal risk and is related with an extremely short hospital stay and a low complication rate. Further disadvantages of laparoscopy incorporate increased cost and longer operating times. We conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from January 1, 1988, through July 28, 2017.

Coblation versus other surgical techniques for tonsillectomy.

Coblation versus other surgical techniques for tonsillectomy.

High-fat diet-induced acceleration of osteoarthritis is associated with a distinct and sustained plasma metabolite signature

Metabolic changes induced by high fat diet (HFD) that contribute to osteoarthritis (OA) are poorly understood. We investigated longitudinal changes to metabolites and their contribution to OA pathogenesis in response to HFD. HFD-fed mice exhibited acceleration of spontaneous age-related and surgically-induced OA compared to lean diet (LD)-fed mice. Using metabolomics, we identified that HFD-fed mice exhibited a distinct and sustained plasma metabolite signature rich in phosphatidylcholines (PC) and lysophosphatidylcholines (lysoPCs), even after resumption of normal chow diet. Using receiver operator curve analysis and prediction modelling, we showed that the concentration of these identified metabolites could efficiently predict the type of diet and OA risk with an accuracy of 93%. Further, longitudinal evaluation of knee joints of HFD- compared to LD- fed mice showed a greater percentage of leptin-positive chondrocytes. Mechanistic data showed that leptin-treated human OA chondrocytes exhibited enhanced production of lysoPCs and expression of autotaxin and catabolic MMP-13. Leptin-induced increased MMP13 expression was reversed by autotaxin inhibition. Together, this study is the first to describe a distinct and sustained HFD-induced metabolite signature. This study suggests that in addition to increased weight, identified metabolites and local leptin-signaling may also contribute in part, towards the accelerated OA-phenotype observed in HFD mice.