ABSTRACT
【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.
ABSTRACT
INTRODUCTION@#This study aimed to compare early and on-demand maternal feeding after Caesarean delivery in terms of gastrointestinal complaints and patient satisfaction.@*METHODS@#A total of 262 women with uncomplicated singleton term pregnancies who underwent a Caesarean section under regional anaesthesia were randomised to a soft food diet served at Postoperative Hour 2 (early feeding group) or eating whenever they wanted to upon return to the ward (on-demand group). Patient satisfaction scores at the time of discharge and gastrointestinal complaints were compared.@*RESULTS@#The fed-early group comprised 133 (50.8%) women and the on-demand group comprised 129 (49.2%) women. Major characteristics and surgical procedures were comparable between the two groups. No significant between-group differences in demographic criteria or surgical procedures were evident (p > 0.05). The mean time to the first feeding was 120.00 ± 00.00 minutes for the early feeding group as compared to 236.59 ± 107.74 minutes for the on-demand feeding group (p = 0.001). Satisfaction levels did not differ significantly between the two groups (p = 0.366). Duration to first breastfeeding, analgesia on the ward, passage of flatus, defecation, mobilisation and urination after catheter removal did not differ significantly between the two groups (p > 0.05).@*CONCLUSION@#Early initiation of solid food in low-risk women after Caesarean delivery under regional anaesthesia was associated with high satisfaction and did not increase gastrointestinal complaints. We suggest having flexibility in terms of postoperative feeding time. This may shorten hospitalisation time and reduce hospitalisation costs.
ABSTRACT
RESUMEN La cirugía bariátrica (CB) ha demostrado ser una alternativa segura y eficaz para la resolución de la obesidad y sus comorbilidades. Parte del éxito de la CB, radica en el manejo nutricional del paciente, para lo que se requiere de un equipo médico-nutricional, entrenado en nutrición bariátrica, con el objetivo de evitar déficit nutricional y modificar hábitos a largo plazo. En la actualidad, no existe en Chile un consenso sobre el protocolo de manejo nutricional pre y post CB. El objetivo del 1er Consenso Chileno de Nutricionistas en Cirugía Bariátrica, es ser una guía para los nutricionistas que asisten a pacientes bariátricos. Este documento resume el trabajo realizado por los Nutricionistas de Sociedad Chilena de Cirugía Bariátrica y Metabólica (SCCBM), quienes durante 5 años trabajaron en reuniones presenciales y comisiones de estudio, revisando evidencias científicas, guías de tratamiento y recomendaciones de expertos, que fundamentarán las recomendaciones alimentario nutricional para cada tema. El resultado es un documento que homologa criterios para el manejo nutricional de pacientes bariátricos y genera los tópicos mínimos para asegurar la atención nutricional de calidad en los equipos bariátricos chilenos.
ABSTRACT Bariatric surgery (BS) has proven to be a safe and effective alternative for the resolution of obesity and its comorbidities. Part of the success of BS lies in the nutritional management of the patient, for which a medical-nutritional team, trained in bariatric nutrition, is required with the aim of modifying long-term habits and avoiding nutritional deficit. At present, there is no consensus in Chile on the pre-and post-BS nutritional management protocol. The objective of the 1st Consensus of Chilean Nutritionists on Bariatric Surgery is to be a guide for nutritionists who assist bariatric patients. This document summarizes the work done by Nutritionists of the Chilean Society of Bariatric and Metabolic Surgery (SCCBM), who, during 5 years, worked in face-to-face meetings and study commissions, reviewing scientific evidence, treatment guides and expert recommendations, which will support nutritional nutrition recommendations for each topic. The result is a document that standardizes criteria for the nutritional management of bariatric patients and generates the minimum topics to ensure quality nutritional care for Chilean bariatric teams.
Subject(s)
Humans , Postoperative Period , Diet , Micronutrients , Nutrients , Bariatric Surgery/rehabilitation , Guidelines as TopicABSTRACT
BACKGROUND: Resolution of postoperative ileus has traditionally been the moment at which bowel function returns. The re-start of postoperative oral feeding usually occurs after that. Recently, many reports have been published on early postoperative feeding in patients operated on laparoscopically and even in patients receiving a laparotomy. The aim of this study was to scrutinize the validity of early postoperative feeding. METHODS: Fiftyfour colorectal cancer patients who had undergone radical resective surgery for cure were included in this study and were divided into two group. Group 1 included 32 patients who were fed in a traditional manner. Group 2 consisted of 22 patients who received a regular diet on the first postoperative day. The mean age was 62, the male-to-female ratio was 1.2:1. Thirteen tumor were located on the right side colon, 4 on the left side colon, 10 on the rectosigmoid, 27 on the rectum. Operative methods were 13 right hemicolectomies, 4 left hemicolectomies, 19 low anterior resections, and 18 abdominoperineal resections. The possible problems associated with early oral feeding were well understood by the patients and consents were obtained. Immediately after the operation, the nasogastric tube was removed in the operation room, and The time of complete recovery from anesthesia was 3 to 5 hours later. At that time, liquid drink was given; then, liquid food or blended food was allowed. RESULT: Early oral intake was tolerable in 14 patients out of 21 (67%); in 8 patients a nasogastric tube was reinserted due to severe nausea, vomiting, and/or abdominal distension. All those minor problems were resolved after reinsertion of the nasogastric tube and returning to the traditional method. In one patient, who had a received a low anterior resection, a serious complication, anastomatic leakage, developed. Early oral intake was not thought to be the exact cause of the leakage, but it made the problem more complicated. A huge amount of feces soiled the peritoneal cavity and the already dissected retroperitoneum. CONCLUSIONS: The tolerability of early postoperative oral intake was 67%. In the remainder of patients, all the minor problems except one, were relieved by simply returning to the traditional method. However, early postoperative oral intake should be used with caution for patients who experience difficulty with anastomosis or have an intraoperative technical breakdown and in whom the possibility of leakage exists.