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Henrik Iversen, Madelene Ahlberg, Marja Lindqvist, Christian Buchli
BACKGROUND: Anastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resections. METHODS: Retrospective cohort study based on prospectively collected data. All 894 patients with primary anastomosis after colorectal resection at a tertiary referral center between 2006 and 2013 were analyzed...
December 28, 2017: World Journal of Surgery
Ashok R Jethwa, Samir S Khariwala
No abstract text is available yet for this article.
November 8, 2017: Laryngoscope
B Feike Kingma, Elles Steenhagen, Jelle P Ruurda, Richard van Hillegersberg
Enhanced Recovery After Surgery (ERAS) aims to accelerate recovery by a set of multimodality management strategies. For esophagectomy, several nutritional elements of ERAS can be safely introduced and are advised in routine practice, including preadmission counseling to screen and treat for potential malnutrition, shortened preoperative fasting, and carbohydrate loading. However, the timing of oral intake and the use of routine nasogastric decompression remain matter of debate after esophagectomy. Furthermore, more research is needed on future developments such as perioperative immunonutrition...
October 2017: Journal of Surgical Oncology
Michael W Manning, William Jonathan Dunkman, Timothy E Miller
Goal-directed fluid therapy (GDFT) seeks to improve outcomes through individualized optimization of oxygen delivery using IV fluid and vasoactive infusions. Trials of GDFT show clinical benefits over traditional liberal fluid administration, but fail to demonstrate benefits when compared to a restrictive strategy within an optimized enhanced recovery protocol. The ideal monitors, hemodynamic goals, and fluid administration strategy are not well established but may be less important than rational application of thoughtful fluid management strategies...
October 2017: Journal of Surgical Oncology
Guniz M Koksal, Emre Erbabacan, Antonio M Esquinas
No abstract text is available yet for this article.
August 29, 2017: Annals of Surgery
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, Hiƫronymus 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
2015-05-07 11:06:47
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