ABSTRACT
AIM: Hospital stays of 5 days or more are not uncommon following ileostomy closure, yet within an enhanced recovery programme (ERP) it is possible for patients to be discharged on the first postoperative day following anterior resection. The aim of this study was to evaluate whether the introduction of an ERP for ileostomy closure reduced hospital stay without affecting morbidity or readmission rates. METHOD: Consecutive patients undergoing elective ileostomy closure from October 2000 to March 2013 were included in this study. The data were collected prospectively into a database. Enhanced recovery was introduced for all elective ileostomy closures in June 2010. Demographic data, length of stay (LOS), readmission, morbidity and mortality were compared between the two groups using the Mann-Whitney U-test and Fisher's exact test. RESULTS: One hundred and forty-five patients underwent elective ileostomy closure during the study period (37 ERP and 108 pre-ERP). There were no differences between the two groups with respect to demographics, American Society of Anesthesiologists grade, prior radiotherapy or chemotherapy, operative time, body mass index, antibiotic use or closure method. Readmission rates (5% vs 6.5%, P = 1.0), morbidity (8% vs 10%, P = 1.0) and mortality (0% vs 0%) were not significantly different. Median (2 vs 4 days, P < 0.0001) and mean (3.4 vs 5.6 days, P = 0.033) LOS were significantly shorter in the ERP group compared with the pre-ERP group. CONCLUSION: An ERP for closure of ileostomy significantly reduces LOS without adverse effects for patients.
Subject(s)
Elective Surgical Procedures/methods , Ileostomy/methods , Patient Discharge/statistics & numerical data , Plastic Surgery Procedures/methods , Adult , Aged , Aged, 80 and over , Cohort Studies , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Databases, Factual , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Operative Time , Recovery of Function , Reoperation/methods , Retrospective Studies , Statistics, Nonparametric , Suture Techniques , Time Factors , Treatment OutcomeABSTRACT
Essential fatty acids, especially gamma-linolenic acid (GLA), have been shown to directly inhibit the growth of cancer cell lines in culture. The aim of this study was to see whether an aqueous formulation of GLA works as well as the lithium-based salt. We evaluated the effect of the 1-deoxy-1-methylamino-D-glucitol salt of GLA (MeGLA) on the growth of two human pancreatic cancer cell lines (Panc-1 and MIA PaCa-2) in vitro, and compared its effects with a previously studied formulation, lithium GLA (LiGLA). The effect of time exposure (2-7 days) and difference in concentration (0-1000 micromol/l) were studied using 96-well culture plates. Cell growth was assessed by MTT assay. Control experiments were performed with meglumine alone in similar concentrations. MeGLA had cytostatic and cytotoxic effects on pancreatic cancer cell lines with 50% growth inhibition at 30-100 micromol/l and cytotoxic effects at 60-250 micromol/l. The degree of growth inhibition increased with time of exposure to MeGLA. The anti-proliferative effects of MeGLA were similar to those previously observed with LiGLA. We conclude that MeGLA has equivalent anti-proliferative activity to LiGLA when tested in vitro against pancreatic cancer cell lines and is therefore a suitable alternative to LiGLA for investigation of the in vivo activity of GLA against pancreatic adenocarcinomas.
