Resumption Of Oral Intake Research Articles

Effect of inferior alveolar plus buccal nerve block on donor site morbidity at buccal mucosal graft harvest site: A double-blinded, randomized placebo-controlled trial

ABSTRACT Introduction: Pain at the buccal mucosal graft (BMG) harvest site in the immediate postoperative period is common and delays resumption of oral intake. This study compares the time for resumption of pain-free solid and liquid diets and postoperative pain scores at harvest site following the administration of inferior-alveolar nerve-block plus buccal-nerve block (IANB + BNB) versus placebo. We hypothesize that the intervention could decrease pain and aid in early food intake. Methods: A single-center, placebo-controlled, double-blinded randomized-control trial was conducted from September 2022 to August 2023 (CTRI). All individuals > 18 years undergoing BMG harvest were included. Patients with contraindications for BMG harvest and diabetes were excluded. Furthermore, patients requiring additional lingual/labial graft, bilateral BMG, or a history of prior BMG harvest were also excluded. IANB + BNB was performed with a 10 ml mixture comprising lignocaine, bupivacaine, and dexamethasone, while normal saline was administered in the control group. Both groups received submucosal local anesthetic infiltration. Results: After randomization (n = 28 in each group), patients who received IANB + BNB had an early return to pain-free liquid (median 1 vs. 2 days; P ≤ 0.001) and solid diet (median 2 vs. 3 days; P = 0.001) 1 day quicker than those who received placebo. In the intervention arm, Visual Analog Scale scores at harvest site were lower from 2 to 48 h postoperatively, had reduced paracetamol requirement (median 7 g vs. 9 g; P = 0.001), and fewer necessitated opioids for breakthrough pain (14.4% vs. 53.3%; P = 0.002). Conclusion: Patients who received IANB + BNB resumed a pain-free diet in the postoperative period quicker, reported lower pain scores, and there were lesser postoperative analgesic requirements.

Investigating the Effectiveness of Enhanced Recovery after Surgery (ERAS) Protocols in Improving Postoperative Outcomes and Reducing Hospital Readmission Rates in Patients Undergoing abdominal Surgery

ABSTRACT Objectives: The main objective of the study is to determine the effectiveness of enhanced recovery after surgery (ERAS) protocols in improving postoperative outcomes and reducing hospital readmission rates in patients undergoing abdominal surgery. Materials and Methods: This study involves a total of 650 patients who were divided into two groups: the intervention group, which received care according to ERAS protocols, and the control group, which received standard postoperative care. Patients aged >18 years and scheduled for elective abdominal surgery were included in the study. Results: The mean age of patients in ERAS group were 56.4 ± 12.3 years, while in the standard care group 57.1 ± 11.8 years. Out of 650 patients, there were 339 male and 311 female. Patients were selected from different surgery departments. The ERAS group had lower 30-day readmission rates (6.2% vs. 15.4%), quicker mobilization (12.5 vs. 24.8 hours), and faster resumption of oral intake (8.6 vs. 18.2 hours). Pain levels were lower (VAS 3.1 vs. 5.8), and patient satisfaction was higher (89% vs. 74%) in the ERAS group, with all differences being statistically significant. Conclusion: It is concluded that ERAS protocols significantly improve postoperative outcomes, including reducing complications, shortening hospital stays, and lowering readmission rates for patients undergoing elective abdominal surgery.

Outcome of Laparoscopic Appendectomy: A Retrospective Study From a Local Secondary Referral Hospital.

Introduction Laparoscopic appendectomy is currently considered the operation of choice for patients with suspected acute appendicitis. This study aimed to assess the safety and feasibility of laparoscopic appendectomy in the settingof a secondary referral hospital. Methods A retrospective cohort study was conducted from January 2021 to December 2023.Records of patients older than 14 years of age who underwent appendectomy were retrieved.Patients were divided according to the type of technique used into two groups: group I (G1) consisted of patients who underwent laparoscopic appendectomy and group II (G2) includedthose with an open appendectomy. Patients who underwent interval appendectomy or incidental to other procedures were excluded. The two groups were compared in terms of patient demographics, pathological findings, operative time, postoperative course, and outcome. Results Laparoscopic appendectomy was performed in 101 patients while open appendectomy was done in 121 patients. There were no statistical differences between both groups regarding operative time, blood loss, time for oral intake resumption, hospital stay, or postoperative complications. Despite being not statistically significant, surgical site infection was lower in G1 as compared to G2 (3% versus 8.3%, p=0.09). Narcotic use was significantly less following laparoscopic appendectomy. In the late settings cases of G1, there was a relatively improved mean operative time (32.7 ±18.3) when compared to early settings appendectomy (62.4±26.3), which was statistically significant (P=0.001). Conclusion Laparoscopic appendectomy is safe, feasible, and adoptable even by junior staff. Therefore, it could be applicable in settings of secondary referral hospitals as an initial line of management when performed by an expert surgeon or trainee under the supervision of seniors.

EGS SO27 - Removable covered stent as an alternative to traditional methods in management of Oesophageal Perforation in unfit surgical patients: A Tertiary Care Hospital Experience

Abstract Background Oesophageal perforation in elderly and frail patients carries a significantly higher mortality rate. Traditionally, management involves surgery for patients who are fit for surgery, or a conservative approach for those with minimal contamination. Endoscopy, with procedures such as endoscopic washout of mediastinal collections and placement of covered removable stents, sometimes in conjunction with chest drain insertion, is emerging as a minimally invasive option for a selected group of patients who are not suitable for traditional methods. This technique aims to seal perforations, promote healing, and facilitate early restoration of oral intake. Method This retrospective study was conducted at a tertiary care hospital. Data were collected over a 10-year period starting from 2012. The study enrolled all patients aged 18 and older, admitted with oesophageal perforation and underwent oesophageal stent insertion. SX-ELLA Danis-seal stents (30-25-30 × 135mm) were used for benign perforations, while permanent covered metal stents were used for patients with underlying malignancy. Variables analyzed included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, location and size of esophageal perforation, type and dimensions of stent used, length of hospital stay, and mortality rates. Data analysis was conducted using SPSS version 25. Results During study period, 11 out of 78 patients with esophageal perforation underwent stent insertion (M:F=7:4, median age-71 (range 48-85) years, median CCI -5). Causes included spontaneous perforation (n=3,27.3%), iatrogenic (n=4,36.4%), and malignancy (n=4,36.4%). Distal esophageal perforation was observed in 7 patients (63.6%). Oral intake was commenced within 72 hours post-insertion. A single procedure sufficed for 10(90%) patients. Stents used for non-malignant perforations were removed endoscopically after an average of 12 weeks. No major complications; minor complications included stent migration (n=1, 9.1%), failed placement (n=1, 9.1%), and loss to follow-up (n=1, 9.1%). The 90-day mortality rate was 45.5% (n=5/11). Conclusion Endoscopy with mediastinal cavity washout and insertion of a covered metal stent in unfit surgical patients provides an alternative and improves outcomes. It could also be considered in patients with non-healing perforations to facilitate early resumption of oral intake.

306. TREATMENT OF ANASTOMOTIC LEAKS AFTER ESOPHAGECTOMY AND GASTRECTOMY FOR CANCER BY MEANS OF ENDOSCOPIC VACUUM THERAPY

Abstract Background Esophagectomy and gastrectomy are the cornerstones of the curative treatment of oesophageal and gastric cancer. In both techniques the risk of anastomotic leak (AL) is high, with rates of up to 21% after esophagectomy and up to 12% after gastrectomy. Mortality and morbidity are high after an AL occurs. Several treatment strategies have been developed for treatment of AL, including surgery, endoscopic stent and endoscopic vacuum therapy (EVT). The aim of this study is to analyse the treatment patterns of the patients with AL treated with EVT. Methods All patients diagnosed of gastric or oesophageal cancer with AL from January 2021 to January 2024 were included in a retrospective study. Baseline data, localization of the tumour, type of resection, type of anastomosis, total time with EVT, number of EVTs used per patient, hospital stay, Clavien-Dindo score and CCI were recorded. A descriptive analysis of the data is performed. Results All 18 patients with AL during the study period were treated with EVT. The tumour was located on the distal third of the oesophagus in 7 patients (38.9%), and stomach (27.8%). The median duration from surgery to the identification of AL was 5 days (IQR 4 – 9). The median duration of the EVT treatment was 18 days (IQR 13 – 23) with a median EVT replacement of 5.5 (IQR 4 – 7). 8 patients (44.4%) did not require ICU stay. Median time to resumption of oral intake was 34 days (IQR 26 –54). Success rate of the EVT therapy was 88.9%. Conclusions EVT is a useful tool for the treatment of AL in esophagogastric surgery. Even though the treatment may be long, it’s success rate in this series is 88.9% and it may avoid ICU stay in some cases. A close monitoring of this patients and the prompt use of additional techniques to assure source control is mandatory.

250. CHANGES IN AND CLINICAL UTILITY OF MAXIMUM PHONATION TIME AND REPETITIVE SALIVA SWALLOWING TEST SCORES AFTER ESOPHAGECTOMY

Abstract Background Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, intervention by speech-language pathologists (STs) has reported to be important for the prevention of postoperative pneumonia. In this study, we report on the perioperative swallowing rehabilitation led by STs at our hospital. In addition, we focused maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy. Methods ST intervention was started at the induction of preoperative chemotherapy, and pre-surgical swallowing rehabilitation including oral care, incentive spirometry, abdominal breathing, and breath-hold swallowing was started and continued after surgery. MPT is the longest speech duration after maximal inspiration, and RSST is the number of empty swallowing that can be repeated in 30 seconds. In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between 2020 and 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia. Results The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4 s, respectively; postoperative MPTs were significantly lower than preoperative MPT. Meanwhile, there were no significant changes in perioperative RSST scores. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (OR: 12.6, 95%CI: 1.29–123, P = 0.03) in the multivariate analysis. Regarding the onset of postoperative pneumonia, the MPT on POD6 was significantly associated with late-onset pneumonia, but not with early pneumonia (P = 0.02 and P = 0.25, respectively). Conclusion The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia. Early resumption of oral intake after esophagectomy might be a risk factor of aspiration pneumonia since expectoration function is not restored, especially in patients with a low MPT on POD 6.

Parasacral ischial plane block for lower limb surgeries: A case series

The para-sacral ischial plane block (PIP block) is a novel fascial plane approach targeting the sacral plexus. This technique simplifies the process as direct visualization of the sacral plexus or sciatic nerve is unnecessary. This retrospective case series includes ten patients with American Society of Anesthesiologists (ASA) physical status II-IV, aged over 18 years, undergoing elective or emergency lower limb surgeries such as debridement and below-knee amputation between May 2023 and November 2023. The block was performed in ≤ 6 minutes for all patients. Onset of subjective analgesia was almost immediate in those presenting with pain. Sensory loss occurred within 9 to 12 minutes. Motor block in the sciatic nerve distribution did not reach Grade 2 in any patient. Hemodynamic stability was notably maintained in all high-risk cases. Intraoperative supplementation with ketamine was required for one patient. The PIP block is a quick, easy-to-perform technique that offers satisfactory surgical conditions and hemodynamic stability in high-risk patients undergoing lower limb surgeries. It also provides prolonged postoperative analgesia and early resumption of oral intake with minimal procedural discomfort.

Treatment Strategies for Gastric Cancer Patients with Gastric Outlet Obstruction

Gastric cancer frequently leads to gastric outlet obstruction (GOO), causing significant symptoms and complications. Surgical bypass and stenting are two representative palliative treatments for GOO by gastric cancer. This study reviews clinical guidelines for malignant GOO treatment, highlighting differences in recommendations based on patient survival expectations and systemic health. A meta-analysis of surgical bypass and stenting in gastric cancer patients revealed no significant difference in technical and clinical success rates between the two treatments. However, stenting allowed faster resumption of oral intake and shorter hospital stays but had higher rates of major complications and reobstruction. Despite these differences, overall survival did not significantly differ between the two groups. Emerging techniques like EUS-guided gastrojejunostomy show promise but require further research and experienced practitioners. Ultimately, treatment should be tailored to patient preferences and the specific benefits and drawbacks of each method to improve quality of life and outcomes.

Laparoscopic Gastrojejunostomy Versus Endoscopic Stenting as a Palliative Treatment for Gastric Outlet Obstruction.

Introduction: Gastric outlet obstruction (GOO) is a common complication in advanced stage upper gastrointestinal malignancies. The symptoms of severe nausea and protracted vomiting can lead to a decline in quality of life and cachexia. Symptoms of GOO can be effectively managed with either operative or nonoperative palliative interventions. In our article, we aim to compare laparoscopic gastrojejunostomy (GJ) to endoscopic stenting as palliative interventions for GOO. Methods: We retrospectively evaluated the charts of patients who underwent palliative procedure for gastric outlet obstruction. Group I included patients who underwent endoscopic stenting, and group II patients underwent Laparoscopic GJ. The groups' demographics (age, gender), length of procedure, length of stay, days to oral intake, overall survival, complications rate, and 30-day mortality rates were compared. Results: Overall, 38 patients were included in the study. Nineteen patients underwent endoscopic stenting and 19 underwent laparoscopic GJ. Comparing the groups, no significant differences were noted. Surgical time was significantly longer than the endoscopic procedures (83 minutes versus 25 minutes, P = .001). No significant differences were noted in days of oral intake initiation, overall survival and 30-day mortality rates. Five patients in the stenting group had complications (26.3%) versus none in the surgical group (P = .046). No postoperative complications were noted. Conclusion: Laparoscopic GJ is a safe and feasible treatment for GOO, demonstrating early resumption of oral intake. The relative short hospital stay, combined with an encouraging postoperative complications profile and low reintervention rate, should be kept in mind especially among patients with longer life expectancy.

Incidence and predictive factors of bleeding following tonsillectomy among pediatrics: A retrospective cohort study.

To estimate the incidence of post tonsillectomy bleeding and to identify its predisposing factors among the pediatric population. A retrospective cohort study included 1280 pediatric patients (18 years or younger) who underwent tonsillectomy at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia between 2019 and 2020. The study sample was divided into 2 groups based on the development of postoperative bleeding and were compared using Chi-square test and independent t-test. Significant variables (p-value ≤0.05) were included in the logistic regression model to determine the predictors of bleeding following tonsillectomy. The bleeding rate following tonsillectomy was 3.4% in 43 (95% confidence interval [CI] 2.4-4.5) patients. In the multivariable logistic regression model, the significant predictors of post tonsillectomy bleeding were age ≥12 years (odds ratio [OR]: 2.685, p=0.027), decreased postoperative oral intake (OR: 4.244, p=0.042), and single use of postoperative analgesia (OR: 53.124, p<0.001). Out of the 43 patients, 39 (90.7%) patients experienced secondary bleeding, and more than half of the patients who developed bleeding required surgical intervention 27 (62.8%). Tonsillectomy is a safe and common surgical procedure but carries risks for postoperative bleeding. Age ≥12 years, poor postoperative oral intake, and the use of a single postoperative analgesic increase the risk of bleeding. We encourage healthcare providers to ascertain early resumption of oral intake and ensure effective pain management. We recommend a dual alternating analgesic regimen with weight-based dosing for optimal pain control. Furthermore, educating caregivers about the importance of adequate oral intake following tonsillectomy may improve patient outcomes.

Esophageal perforation after anterior cervical spine surgery

ObjectiveTo report our updated experience in the management of esophageal perforation resulting from anterior cervical spine surgery, and to compare two wound management approaches. MethodsThis is a retrospective review of patients managed for esophageal perforations resulting from anterior cervical spine surgery (2007-2020). We examine outcomes based on 2 wound management approaches: closed (closed incision over a drain) versus open (left open to heal by secondary intention). We collected data on demographics, operative management, resolution (resumption of oral intake), time to resolution, number of procedures needed for resolution, microbiology, length of stay, and neck morbidity. ResultsA total of 13 patients were included (10 men). Median age was 52 years (range, 24-74 years). All patients underwent surgical drainage, repair, or attempted repair of perforation, hardware removal, and establishment of enteral access. Wounds were managed closed versus open (6 closed, 7 open). There were 2 early postoperative deaths due to acute respiratory distress syndrome and aspiration (open group), and 1 patient was lost to follow-up (closed group). Among the remaining 10 patients: resolution rate was 80% versus 100%, resolution in 30 days was 20% versus 100%, median number of procedures needed for resolution was 3 versus 1, and median hospital stay was 23 versus 14 days, for the closed and open groups, respectively. ConclusionsEsophageal perforation following anterior cervical spine surgery should be managed in a multidisciplinary fashion with surgical neck drainage, primary repair when feasible, hardware removal, and establishment of enteral access. We advocate open neck wound management to decrease the time-to-resolution, number of procedures, and length of stay.

Inpatient Management of Hyperemesis Gravidarum.

Hyperemesis gravidarum has a reported incidence of approximately 0.3-3% of pregnancies. Without treatment, refractory hyperemesis gravidarum can result in dehydration, electrolyte deficiencies, and severe nutritional deficiencies, resulting in significant maternal morbidity. The overall goals of inpatient management of refractory hyperemesis gravidarum are the resumption of oral intake to an adequate level to maintain hydration and nutrition, including the ability to tolerate oral pharmacotherapy. Patients initially are stabilized with rehydration and electrolyte repletion. There are numerous pharmacotherapeutics available that can be administered intravenously to control symptoms when oral intake is not an option. However, despite maximizing typical antiemetics, there will be cases refractory to these medications, and alternative pharmacotherapeutics and nutrition-support modalities must be considered. Mirtazapine, olanzapine, corticosteroids, and gabapentin are examples of alternative pharmacotherapeutics, and enteral and parenteral nutrition are alternative therapies that can be used when oral intake is not tolerated for prolonged time periods with ongoing weight loss. In refractory cases of hyperemesis gravidarum, the risks and benefits of these alternative forms of management must be considered, along with the risks of undertreated hyperemesis gravidarum and the overall effect of hyperemesis gravidarum on patients' quality of life.

Videofluoroscopic swallowing study to detect pharyngeal leak after total (pharyngo-) laryngectomy: Retrospective assessment of a single-institution protocol.

We aimed to assess the effectiveness of a single-institution protocol of videofluoroscopic swallowing study (VFSS) for the detection of pharyngeal leak (PL) and its usefulness to mitigate evolution into subsequent pharyngocutaneous fistula (PCF) after total (pharyngo-) laryngectomy (TL). This retrospective single-center study was conducted between February 2014 and December 2022. We included all patients who underwent TL and performed a VFSS between Day 7 and Day 14 postoperatively to detect a subclinical PL. Two-hundred and forty-eight patients met the inclusion criteria. Among the 186 patients (75%) with a negative VFSS, 11 patients (5.9%) developed a secondary PCF after oral intake resumption (false negative of VFSS). Among the 62 patients (25%) with a positive VFSS, the occurrence of a PCF was avoided in 59.7% of cases. This study showed a good effectiveness of VFSS in the detection of PL after TL, alongside a usefulness to mitigate evolution into subsequent PCF.

Effect of modified endotracheal intubation protocol combined with early oral intake on postoperative recovery quality in thyroid and parathyroid surgery at a tertiary hospital in China: a 2x2 factorial randomised controlled trial protocol

IntroductionEarly oral intake (EOI) is supposed to be safe and beneficial to patients’ recovery. However, the optimal timing of resuming oral intake has not been validated in thyroid and parathyroid...

Laparoscopic Adrenalectomy: Tailoring Approaches for the Optimal Resection of Adrenal Tumors.

In this study, we investigated the outcomes of laparoscopic approaches for adrenal tumor resection in 67 patients from a single center with a median age of 51 (range 40-79). Predominantly comprising women, the majority of patients were overweight or obese. Adrenal tumors larger than 6 cm were mostly treated using the laparoscopic transperitoneal method (p < 0.001). Our results revealed that patients subjected to the retroperitoneal approach exhibited quicker recovery, as evidenced by faster resumption of oral intake and ambulation, along with reduced intraoperative blood loss and shorter hospitalization (p-value < 0.05). In contrast, patients subjected to the transperitoneal approach experienced minimal complications, though not statistically significant, despite the technique's intricacy and slower recovery. These findings emphasize the significance of tailoring the surgical approach to individual patient characteristics, with particular emphasis on the tumor size. The choice between the retroperitoneal and transperitoneal methods should be informed by patient-specific attributes to optimize surgical outcomes. This study underscores the need for a comprehensive evaluation of factors such as tumor characteristics and postoperative recovery when determining the most suitable laparoscopic approach for adrenal tumor resection. Ultimately, the pursuit of individualized treatment strategies will contribute to improved patient outcomes in adrenal tumor surgery.

Benefits of EUS-guided gastroenterostomy over surgical gastrojejunostomy in the palliation of malignant gastric outlet obstruction: a large multicenter experience.

Palliation of malignant gastric outlet obstruction (mGOO) allows resumption of peroral intake. Although surgical gastrojejunostomy (SGJ) provides durable relief, it may be associated with a higher morbidity, interfere with chemotherapy, and require an optimum nutritional status. EUS-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative. We aimed to conduct the largest comparative series to date between EUS-GE and SGJ for mGOO. This multicenter retrospective study included consecutive patients undergoing SGJ or EUS-GE at 6 centers. Primary outcomes included time to resumption of oral intake, length of stay (LOS), and mortality. Secondary outcomes included technical and clinical success, reintervention rates, adverse events (AEs), and resumption of chemotherapy. A total of 310 patients were included (EUS-GE, n= 187; SGJ, n= 123). EUS-GE exhibited significantly lower time to resumption of oral intake (1.40 vs 4.06 days, P< .001), at lower albumin levels (2.95 vs 3.33 g/dL, P< .001), and a shorter LOS (5.31 vs 8.54 days, P< .001) compared with SGJ; there was no difference in mortality (48.1% vs 50.4%, P= .78). Technical (97.9% and 100%) and clinical (94.1% vs 94.3%) success was similar in the EUS-GE and SGJ groups, respectively. EUS-GE had lower rates of AEs (13.4% vs 33.3%, P< .001) but higher reintervention rates (15.5% vs 1.63%, P< .001). EUS-GE patients exhibited significantly lower interval time to resumption of chemotherapy (16.6 vs 37.8 days, P< .001). Outcomes between the EUS-GE and laparoscopic (n= 46) surgical approach showed that EUS-GE had shorter interval time to initiation/resumption of oral intake (3.49 vs 1.46 days, P< .001), decreased LOS (9 vs 5.31 days, P< .001), and a lower rate of AEs (11.9% vs 17.9%, P= .003). This is the largest study to date showing that EUS-GE can be performed among nutritionally deficient patients without affecting the technical and clinical success compared with SGJ. EUS-GE is associated with fewer AEs while allowing earlier resumption of diet and chemotherapy.

Esophageal reconstruction as the first step for treating secondary aortoesophageal fistula due to thoracic endovascular aortic stent infection

BackgroundThe surgical strategy for aortoesophageal fistula (AEF) depends on the experience of each surgeon, and there is no consensus on the strategy to be adopted. We propose our two-stage operation compromising esophagectomy and reconstruction as the first step and in situ aortic graft replacement as the second step after 7 days for treating AEF secondary to thoracic aortic stent graft infection.Case presentationA diagnosis of AEF was made in a 70-year-old man with a history of multiple aortic interventions. The patient underwent esophageal resection and reconstruction with a pedicled stomach roll endoscopically in the right thoracic cavity. Postoperatively, enteral feeding was resumed via a feeding tube placed in the jejunum to maintain adequate nutritional status. There was no evidence of either anastomotic leakage or necrosis. Seven days later, the patient underwent removal of the infected stent graft and in situ graft replacement via a redo left thoracotomy. After the surgery, the patient was able to start oral intake relatively early. Although more than 6 months has passed since the patient was discharged, no recurrence of infection has been observed.ConclusionsThe benefit of our strategy is the radical treatment for secondary AEF and the early resumption of oral intake.

Outcome of laparoscopic versus open repair of perforated peptic ulcers in low-risk patients

Background Peptic ulcer perforation (PPU) represents the main indication for emergent surgical intervention for peptic ulcer disease. The study aimed to assess the efficacy and safety of laparoscopic repair (PPU) in comparison with open repair in low-risk patients. Methods A retrospective study was conducted in a tertiary medical institution that included 98 patients diagnosed with PPU in line with the inclusion criteria. An analysis was performed to compare patients who underwent laparoscopic surgery (LS) (n=31) and patients submitted to open surgery (OS) of PPU (n=67). Characterization of LS and OS was achieved in terms of patients’ demographics, Bœy’s score, PULP score, and intraoperative and postoperative data. Results The patient’s mean age in the LS and OS groups were 48.8 and 51.1 years, respectively. Most patients in both groups were men (87.1% and 86.5%, respectively). The mean time for resumption of oral intake after surgery was 2.93 ±1.06 (1–7) days in the laparoscopy group compared with 3.79±0.8 (2–7) days in the laparotomy group (P&lt;0.0001). The average length of hospital stay was 5.77± 1.8 (4–13) days in the LS group and 7.22±1.6 (5–12) days in the OS group (P=0.0001). Early complications (&lt;30 days) were found in 12 patients (12.2%); 3 (9.6%) in the LS group and 9 (13.4%) in the OS group (P=0.5). Conclusion Repair of PPU by laparoscopy is a better alternative to the open approach regarding reduction of postoperative hospital stay and fast return to daily activity with less postoperative ileus and wound complications.

Comparison of Bizact™ Low Temperature Dissecting Device with Bipolar Diathermic Scissors for Tonsillectomy in Adult Patients

Tonsillectomy is one of the most frequent surgical procedures done worldwide. While the surgical procedure may take less than 10 minutes, there is a significant related morbidity due to per- and post-operative bleeding, post-operative pain and delayed return to normal activity and diet [1]. There is no consensus on the optimal method and device for surgery; use of cold dissection or coblation or diathermia scissors, with electro-cautery as needed; are advocated by different authors. The BIZact ™ vessel seal instrument (Medtronic, Mansfield, MA, USA) is a new technology with continuous measurements of tissue impedance, in order to deliver minimally bipolar energy for dissection and vessel sealing, with minimal thermal damage of remaining tissue [2]. The purpose of the present prospective, partly double-blinded study, was to evaluate the usefulness of BIZact for surgery in a population of adult tonsillectomy patients, in terms of: safety, bleeding, perioperative easiness and time consume, as well as postoperative parameters such as pain, resumption of oral intake, bleeding and overall satisfaction.

Flexible endoscopic Zenker's diverticulotomy - A retrospective review of outcomes in 75 patients

ObjectiveFlexible endoscopic Zenker's diverticulotomy (FEZD) is a procedure performed primarily by gastroenterologists for treatment of symptomatic Zenker's diverticulum (ZD). Given the lack of prior investigations with large sample sizes, we report on one of the largest series of patients who underwent FEZD. MethodsA review of patients who underwent FEZD at our institution from 2006 to 2021 was performed. Data were abstracted for patient demographics, clinical features, procedural characteristics, adverse events, and outcomes. ResultsA total of 75 patients (37 women) with mean age of 77.9 (33–102) years and mean (range) follow-up of 1.1 (0–13.2) years were identified. 67.9 % of FEZD cases were performed under general anesthesia. The mean procedure time was 37.1 min. Same day discharge and resumption of oral intake was seen in 56.4 % and 57.1 % of cases, respectively. Adverse events included intraprocedural bleeding (15.7 %) controlled with endoscopic means, infection (4.8 %) exclusively managed with antibiotics in all but one case, subcutaneous emphysema (2.4 %), and perforation (10.7 %) conservatively managed in all but one case. 97.6 % of patients had sustained subjective improvement in symptoms following their procedure. Fifteen patients (20 %) experienced recurrence after undergoing initial FEZD—26.7 % percent of whom were sufficiently treated with repeat FEZDs. Younger age was associated with recurrence (p < 0.01). ConclusionFEZD is an effective, safe procedure for the management of symptomatic ZD. It is a viable alternative for patients in whom otorhinolaryngological procedures via rigid endoscopy are not an option.