Enteral versus parenteral nutrition support following laparotomy in seriously traumatized patients

Polytraumatized patients are characterized by hypercatabolic states with great need for full nutrition for energy supply, host defence, and wound healing. This is a prospective randomized study including 30 seriously injured patients admitted to our hospitals between March 1996 and April 1998. We are comparing the efficacy of total parenteral nutrition [TPN] versus tube feeding jejunostomy. We started nutritional support immediately postoperatively. There were no significant differences between the two groups as regards age, sex, injury severity score [ISS], and mechanism of injury. Daily caloric intake, nitrogen intake, and nitrogen balance were statistically comparable in both groups. The results showed that pre-and post-nutrition weight, biochemical investigations and body parameters were comparable in both groups. Septic complications were lower in tube feeding jejunostomy patients, while abdominal complications were higher in them than TPN group. We suggest that early post-operative feeding jejunostomy is a reliable, safe, simple and cost effective method of nutrition for polytraumatized patients undergoing laparotomy

Comparison of laparoscopic cholecystectomy with the open technique

This paper presents the results of laparoscopic cholecystectomy [LC] performed in 69 patients having gall bladder disease. Their results were compared with the data obtained from 53 open [classic] cholecystectomy LC patients included cases with chronic calcular cholecystitis, symptomatic cholelithiasis, acute cholecystitis and common bile duct stones. The average operative time was significantly longer in operation. LC [P < 0.0001]. The procedure was successfuly completed in 66 of 69 patients. The remaining 3 cases were converted to open operations with conversion rate of 4.3%. The mean postoperative hospital stay was significantly shorter for LC [P < 0.0001]. No deaths and no major complications were recorded in either type of cholecystectomies. Only minor complications were observed with lower rate for LC. These data have shown that LC could be considered as the best choice for treatment of gallstones since it is a safe, effective technique. Moreover, the patients benefit from a short hospital stay with lower hospital costs