Fluid administration in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: neither too much nor too little

Abstract Introduction Intraoperative fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy plays an important role in postoperative morbidity. Studies have found an association between overload fluid therapy and increased postoperative complications, advising restrictive intraoperative fluid therapy. Our objective in this study was to compare the morbidity associated with restrictive versus non-restrictive intraoperative fluid therapy. Methods Retrospective analysis of a database collected prospectively in the Anesthesiology Service of Virgen del Rocío Hospital, from December 2016 to April 2019. One hundred and six patients who underwent complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were divided into two cohorts according to Fluid Therapy received 1. Restrictive ≤ 9 mL.kg-1.h-1 (34 patients), 2. Non-restrictive ≥ 9 mL.kg-1.h-1 (72 patients). Percentage of major complications (Clavien-Dindo grade III-IV) and length hospital stay were the main outcomes variables. Results Of the 106 enrolled patients, 68.9% were women; 46.2% had ovarian cancer, 35.84% colorectal cancer, and 7.5% peritoneal cancer. The average fluid administration rate was 11 ± 3.58 mL.kg-1.h-1. The restrictive group suffered a significantly higher percentage of Clavien-Dindo grade III-IV complications (35.29%) compared with the non-restrictive group (15.27%) (p= 0.02). The relative risk associated with restrictive therapy was 1.968 (95% confidence interval: 1.158-3.346). We also found a significant difference for hospital length of stay, 20.91 days in the restrictive group vs 16.19 days in the non-restrictive group (p= 0.038). Conclusions Intraoperative fluid therapy restriction below 9 mL.kg-1.h-1 in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was associated with a higher percentage of major postoperative complications.

Operación de Nissen por vía laparoscópica: Una modificación a la técnica / Nissen Surgery through laparoscopy. A modification to the technique

Objetivo. Describir una modificación técnica en la operación de Nissen por vía laparoscópica. Sede. Hospital regional. Diseño. Estudio prospectivo, longitudinal, sin grupo control. Pacientes y método. Se estudiaron trece pacientes, ochos mujeres y cinco hombres, cuyas edades fluctuaron entre 21 y 65 años, con promedio de 46. A todos se les hizo estudio clínico, radiológico y endoscópico, confirmándose la presencia de reflujo gastroesofágico. La modificación técnica consiste en sustituir la sonda de Levin por una sonda Sengestaken-Blakemore, ésta se "ancla" en la unión cardioesofágica al insuflar el balón gástrico a una presión de 60 mm de Hg, acto seguido se insufla el balón esofágico a una presión de 35 mm de Hg, que equivale a utilizar una sonda de calibre 80 Fr, y se procede a realizar la calibración del Nissen. Resultados. El tiempo de hospitalización flutuó entre 24 y 72 h, promedio de 48, todos los enfermos retornaron a sus actividades cotidianas en un promedio de 15 días, sólo un enfermo presentó disfagia post-Nissen, que desapareció a los 6 meses, los 12 restantes han evolucionado asintomáticos. Conclusión. El calibrar el esófago a una presión de 35 mm de Hg impidió la disfagia post-Nissen por vía laparoscópica