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N F Shum, H K Choi, J C K Mak, D C C Foo, W C Li, W L Law
BACKGROUND: Chewing gum may enhance intestinal motility after surgery. This trial studied whether chewing gum could lead to a further reduction in ileus in patients who had a laparoscopic colorectal resection and followed an enhanced recovery programme. METHODS: Patients undergoing laparoscopic colorectal resection were randomized to a control or intervention group. Patients in the control group received a standardized recovery programme. Patients in the intervention group were, in addition, given chewing gum three times daily from day 1 until discharge...
October 2016: British Journal of Surgery
Jonathan Moran, Emer Guinan, Paul McCormick, John Larkin, David Mockler, Juliette Hussey, Jeanne Moriarty, Fiona Wilson
BACKGROUND: Preoperative physical fitness is predictive of postoperative outcome. Patients with lesser aerobic capacity are at greater risk of postoperative complications, longer hospital stays, and mortality. Prehabilitation may improve physical fitness, but it is unknown whether enhanced fitness translates to an improvement in postoperative outcome. METHODS: This systematic review and meta-analysis aimed to assess the ability of prehabilitation to influence postoperative outcome after intra-abdominal operations...
November 2016: Surgery
Daniel Delitto, Brian S Black, Holly B Cunningham, Sarunas Sliesoraitis, Xiaomin Lu, Chen Liu, George A Sarosi, Ryan M Thomas, Jose G Trevino, Steven J Hughes, Thomas J George, Kevin E Behrns
BACKGROUND: Durable clinical gains in surgical care are frequently reliant on well-developed standardization of practices. We hypothesized that the standardization of surgical management would result in improved long-term survival in pancreatic cancer. METHODS: Seventy-seven consecutive, eligible patients representing all patients who underwent pancreaticoduodenectomy and received comprehensive, long-term postoperative care at the University of Florida were analyzed...
August 2016: American Journal of Surgery
Sushanth Reddy, Carlo M Contreras, Brandon Singletary, T Miller Bradford, Mary G Waldrop, Andrew H Mims, W Andrew Smedley, Jacob A Swords, Thomas N Wang, Martin J Heslin
BACKGROUND: Current methods to predict patients' perioperative morbidity use complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the current study was to determine the value of a timed stair climb in predicting perioperative complications for patients undergoing abdominal surgery. STUDY DESIGN: From March 2014 to July 2015, three hundred and sixty-two patients attempted stair climbing while being timed before undergoing elective abdominal surgery...
April 2016: Journal of the American College of Surgeons
Kate F Willcutts, Mei C Chung, Cheryl L Erenberg, Kristen L Finn, Bruce D Schirmer, Laura D Byham-Gray
OBJECTIVE: To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes. BACKGROUND: Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery. METHODS: Comprehensive literature searches were conducted across 5 databases from January 1980 until June 2015 without language restriction...
July 2016: Annals of Surgery
Akiko Hanyuda, Sun A Kim, Alejandro Martinez-Fernandez, Zhi Rong Qian, Mai Yamauchi, Reiko Nishihara, Teppei Morikawa, Xiaoyun Liao, Kentaro Inamura, Kosuke Mima, Yin Cao, Xuehong Zhang, Kana Wu, Andrew T Chan, Edward L Giovannucci, Jeffrey A Meyerhardt, Charles S Fuchs, Ramesh A Shivdasani, Shuji Ogino
BACKGROUND: High-level physical activity is associated with lower colorectal cancer (CRC) mortality, likely through insulin sensitization. Insulin receptor substrate 1 (IRS1) is a mediator of insulin and insulin-like growth factor (IGF) signaling pathways, and its down-regulation is associated with insulin resistance. Therefore, we hypothesized that tumor IRS1 expression status might modify cellular sensitivity to insulin and IGF, and the prognostic association of physical activity. METHODS: We assessed IRS1 expression level in 371 stage I-III rectal and colon cancers in the Nurses' Health Study and the Health Professionals Follow-up Study by immunohistochemistry...
March 2016: Annals of Surgical Oncology
R Gupta, T J Gan
'Enhanced recovery after surgery' protocols implement a series of peri-operative interventions intended to improve recovery after major operations, one aspect of which is fluid management. The pre-operative goal is to prepare a hydrated, euvolaemic patient by avoiding routine mechanical bowel preparation and by encouraging patients to drink clear liquids up to two hours before induction of anaesthesia. The intra-operative goal is to achieve a 'zero' fluid balance at the end of uncomplicated surgery: goal-directed fluid therapy is recommended for poorly prepared or sick patients or those undergoing more complex surgery...
January 2016: Anaesthesia
Nathalie Bakker, Jort D Deelder, Milan C Richir, Hamit Cakir, Hiëronymus J Doodeman, Wilhelmina H Schreurs, Alexander P J Houdijk
INTRODUCTION: Anastomotic leakage is a serious complication after colorectal resection. Recent studies suggest that nonsteroidal anti-inflammatory drugs may increase the risk of anastomotic leakage. We investigated this association in our enhanced recovery population. MATERIAL AND METHODS: Patients undergoing an elective colon or rectal resection with primary anastomosis because of malignancy and treated within our enhanced recovery program were included. Univariable and multivariable logistic regression analyses were used to study risk factors for anastomotic leakage...
April 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Sweyn S Garrioch, Michael A Gillies
PURPOSE OF REVIEW: This review appraises recent evidence and provides clinical guidance on optimal perioperative fluid therapy. RECENT FINDINGS: Choice of perioperative intravenous fluid continues to be the source of much debate. Not all crystalloids are equivalent, and there is growing evidence that balanced solutions are superior to 0.9% saline in many situations. Recent evidence from the critical care population has highlighted risks associated with synthetic colloids; this and the absence of demonstrable benefit in the surgical population make it difficult to recommend their use in the perioperative period...
August 2015: Current Opinion in Critical Care
Neda Amini, Yuhree Kim, Omar Hyder, Gaya Spolverato, Christopher L Wu, Andrew J Page, Timothy M Pawlik
BACKGROUND: We sought to define trends in the use of epidural analgesia (EA) for hepatopancreatic procedures, as well as to characterize inpatient outcomes relative to the use of EA. METHODS: The Nationwide Inpatient Sample database was queried to identify all elective hepatopancreatic surgeries between 2000 and 2012. In-hospital outcomes were compared among patients receiving EA vs conventional analgesia using propensity matching. RESULTS: EA utilization was 7...
September 2015: American Journal of Surgery
Simon Ulyett, Matthew G Wiggans, Matthew J Bowles, Somaiah Aroori, Christopher D Briggs, Paul Erasmus, Gary Minto, David A Stell
BACKGROUND: Liver resection is associated with significant morbidity, and assessment of risk is an important part of preoperative consultations. Objective methods exist to assess operative risk, including cardiopulmonary exercise testing (CPX). Subjective assessment is also made in clinic, and patients perceived to be high-risk are referred for CPX at our institution. This article addresses clinicians' ability to identify patients with a higher risk of surgical complications after hepatectomy, using selection for CPX as a surrogate marker for increased operative risk...
September 2015: Journal of Surgical Research
Zhenhua Zeng, Zhongqing Chen, Tao Li, Junli Zhang, Youguang Gao, Siqi Xu, Shumin Cai, Ke-seng Zhao
BACKGROUND: Polydatin (PD), a monocrystalline and polyphenolic drug isolated from a traditional Chinese herb (Polygonum cuspidatum), is protective against mitochondrial dysfunction and has been approved for clinical trials in the treatment of shock. However, whether the administration of PD has a therapeutic effect on multiple-organ dysfunction syndrome (MODS) requires investigation. MATERIAL AND METHODS: MODS was induced in Sprague-Dawley rats via hemorrhage and ligation and puncture of cecum-induced sepsis...
September 2015: Journal of Surgical Research
C Williamsson, N Karlsson, C Sturesson, G Lindell, R Andersson, B Tingstedt
BACKGROUND: Fast-track (FT) programmes are multimodal, evidence-based approaches to optimize patient outcome after surgery. The aim of this study was to evaluate the safety, clinical outcome and patients' experience of a FT programme after pancreaticoduodenectomy (PD) in a high-volume institution in Sweden. METHODS: Consecutive patients undergoing PD were studied before and after implementation of the FT programme. FT changes included earlier mobilization, standardized removal of the nasogastric tube and drain, and earlier start of oral intake...
August 2015: British Journal of Surgery
Jessica Lovich-Sapola, Charles E Smith, Christopher P Brandt
Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction...
April 2015: Surgical Clinics of North America
Charity H Evans, Jane Lee, Melissa K Ruhlman
Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality...
April 2015: Surgical Clinics of North America
Ronald F Martin
No abstract text is available yet for this article.
April 2015: Surgical Clinics of North America
Oliver S Eng, Laleh G Melstrom, Darren R Carpizo
Optimal perioperative fluid administration in major gastrointestinal surgery remains a challenging clinical problem. Traditional dogma of a liberal approach to fluid administration in order to counteract potential hypovolemia and decreased end-organ perfusion can often result in fluid overload, perhaps negatively impacting perioperative outcomes. This hypothesis has been investigated in several types of gastrointestinal surgery. We discuss the current literature on perioperative fluid administration in colorectal and pancreatic surgery and highlight the controversies that still exist...
March 15, 2015: Journal of Surgical Oncology
P Kambakamba, K Slankamenac, C Tschuor, P Kron, A Wirsching, K Maurer, H Petrowsky, P A Clavien, M Lesurtel
BACKGROUND: Epidural analgesia (EDA) is a common analgesia regimen in liver resection, and is accompanied by sympathicolysis, peripheral vasodilatation and hypotension in the context of deliberate intraoperative low central venous pressure. This associated fall in mean arterial pressure may compromise renal blood pressure autoregulation and lead to acute kidney injury (AKI). This study investigated whether EDA is a risk factor for postoperative AKI after liver surgery. METHODS: The incidence of AKI was investigated retrospectively in patients who underwent liver resection with or without EDA between 2002 and 2012...
June 2015: British Journal of Surgery
Malcolm H Squires, Neha L Lad, Sarah B Fisher, David A Kooby, Sharon M Weber, Adam Brinkman, Juan M Sarmiento, Charles R Scoggins, Michael E Egger, Kenneth Cardona, Clifford S Cho, Robert C G Martin, Maria C Russell, Emily Winslow, Charles A Staley, Shishir K Maithel
BACKGROUND: The value of routine primary (intraoperative) drain placement after major hepatectomy remains unclear. We sought to determine if primary drainage led to decreased rates of complications, specifically, intra-abdominal biloma or infection requiring a secondary (postoperative) drainage procedure. STUDY DESIGN: All patients who underwent major hepatectomy (≥3 hepatic segments) at 3 institutions, from 2000 to 2012, were identified. Patients with biliary anastomoses were excluded...
April 2015: Journal of the American College of Surgeons
M Adamina, T Steffen, I Tarantino, U Beutner, B M Schmied, R Warschkow
BACKGROUND: The aim of this analysis was to assess the predictive value of C-reactive protein (CRP) for the early detection of postoperative infectious complications after a variety of abdominal operations. METHODS: A meta-analysis of seven cohort studies from a single institution was performed. Laparoscopic gastric bypass and colectomies, as well as open resections of cancer of the colon, rectum, pancreas, stomach and oesophagus, were included. The predictive value of CRP was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve...
May 2015: British Journal of Surgery
2015-04-23 08:52:35
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