ABSTRACT
BACKGROUND: Postoperative ileus is common after surgery. One non-pharmacological intervention that has shown promising results in reducing the duration of postoperative ileus is chewing gum after surgery. However, this has not been investigated in upper gastrointestinal surgery such as pancreatic surgery. Hence the aim of this study was to investigate the effects of chewing gum treatment on patients undergoing pancreaticoduodenectomy ad modum whipple due to pancreatic or periampullary cancer. METHODS: This study was conducted as a phase III trial that was terminated early. Patients diagnosed with pancreatic tumours scheduled for pancreaticoduodenectomy ad modum whipple were included. The treatment group received chewing gum postoperatively and standard care. Controls received glucose solution and standard care. Chewing gum and glucose were used four times a day during the whole hospital stay. Time to first flatus and stool was defined as the primary outcome. The secondary outcome was start with clear liquids, start with liquid diet and length of hospital stay. RESULTS: No statistically significant differences could be observed between the chewing gum intervention group and the control group. However, a numerical difference in mean time was observed in first flatus, first stool, start of clear fluids, and start of liquid diet and length of hospital stay in favour of the intervention group. CONCLUSIONS: Although this study did not find statistically significant differences favouring the use of chewing gum for postoperative ileus, a positive trend was observed of a reduction of the impact of postoperative ileus among patients after pancreatic surgery. It also contributes valuable methodological experience that is important for future studies of chewing gum interventions during recovery after pancreatic surgery. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02319512 , publication date 2014-12-17.
Subject(s)
Chewing Gum , Dietary Supplements , Ileus/diet therapy , Pancreaticoduodenectomy , Postoperative Complications , Aged , Ampulla of Vater/pathology , Ampulla of Vater/surgery , Common Bile Duct Neoplasms/pathology , Common Bile Duct Neoplasms/surgery , Defecation/physiology , Female , Humans , Ileus/etiology , Ileus/prevention & control , Length of Stay , Male , Middle Aged , Pancreas/pathology , Pancreas/surgery , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Postoperative PeriodABSTRACT
Introducción La nutrición parenteral (NP) es una parte integral del tratamiento médico de aquellos pacientes que no tienen un tracto gastrointestinal funcionante o accesible. En este trabajo se describen las características clínicas de los pacientes que han recibido NP en un hospital de 420 camas desde 2009 hasta 2011. Además, se evaluaron los parámetros nutricionales al inicio y fin de la NP, y se analizaron las complicaciones asociadas. Material y métodos Estudio observacional retrospectivo de los episodios de NP en mayores de 18 años seguidos por la Unidad de Nutrición del Hospital Universitario de Guadalajara. Se recogieron: datos epidemiológicos y clínicos, número y tipo de vías empleadas, datos antropométricos, datos analíticos, número de días con NP, causa de la retirada, aporte calórico, prevalencia de flebitis, complicaciones metabólicas (hipertrigliceridemia, alteraciones en las pruebas de función hepática, hiperglucemia y síndrome de realimentación) y prevalencia de bacteriemia asociada a catéter venoso central (BAC).Resultados Se registraron 312 episodios de NP. La indicación inmediata fue íleo posquirúrgico en el 53,8% de los episodios. Se produjo una mejoría estadísticamente significativa de todos los parámetros analíticos que se evaluaron (albúmina, prealbúmina, proteína transportadora de retinol, transferrina, colesterol y linfocitos). El aporte calórico (Kcal por kg de peso) fue de 25,1 ± 6,6. En el 16,3% de los episodios no se registró ninguna complicación (..) (AU)
Introduction Parenteral nutrition (PN) is an integral part of medical management of patients who do not have a functioning or accessible gastrointestinal tract. This paper discusses the clinical characteristics of patients receiving PN in a 420-bed hospital from 2009 to 2011. In addition, nutritional parameters were assessed at the start and end of PN and associated complications were analyzed. Material and methods retrospective, observational study of PN episodes in adults conducted at the Nutrition Unit of Hospital Universitario de Guadalajara. Variables collected included epidemiological and clinical data, number and type of routes used, anthropometric data, analytical data, number of days on PN, reason for withdrawal, caloric provision, prevalence of phlebitis, metabolic complications (hypertriglyceridemia, abnormal liver function tests, hyperglycemia, and refeeding syndrome), and prevalence of bacteremia associated with central venous catheter (BAC).Results There were 312 episodes of PN. The immediate indication was postoperative ileus in 53.8% of the episodes. There was a statistically significant improvement in all analytical parameters assessed (albumin, prealbumin, retinol binding protein, transferrin, cholesterol, and lymphocytes). Caloric provision (kcal per kg) was 25.1 ± 6.6. No metabolic complication occurred in 16.3% of the episodes, and hyperglycemia was the most common complication (79.8%). There were 10 cases of phlebitis (32.2%) and 30 episodes of BAC (8.7%). Bacteriemia rate was 8.1 per 1000 days of PN. Discussion Although PN is an effective nutritional support technique, it is associated with complications of varying severity. Use of PN should therefore comply with the instructions accepted in the main clinical practice guidelines and requires careful monitoring by experienced professionals (AU)
Subject(s)
Humans , Nutrition Assessment , Parenteral Nutrition, Total/methods , Nutrition Disorders/diet therapy , Bacteremia/complications , Ileus/diet therapy , Treatment Outcome , Postoperative Complications/diet therapyABSTRACT
BACKGROUND: Consensus guidelines have indicated that postoperative parenteral nutrition (PN) might provide benefit when patients are expected to be nil per os (NPO) ≥7 d and when PN is administered ≥5 d. We hypothesized that most children receiving PN after appendectomy do not satisfy these criteria. METHODS: The medical records of the patients who had undergone appendectomy for perforated appendicitis from 2006-2011 were analyzed, and the proportion meeting the criteria for beneficial PN was determined. The clinical parameters independently associated with the criteria for beneficial PN (PN therapy ≥5 d, ileus ≥5 d, NPO ≥7 d) were identified using multiple regression analysis. RESULTS: A total of 1612 patients were treated for appendicitis. Of these, 587 met the inclusion criteria (age <16 y, perforated appendicitis, appendectomy within 24 h, no previous indication for PN). Of the 587 patients, 12.1% received PN; 43.8% of these received PN for ≥5 d. The predictors of PN duration of ≥5 d included preoperative symptoms for ≥3 d (P < 0.01) and initiation of PN by postoperative day 3 (P = 0.047). Preoperative symptoms for ≥3 d, imaging showing a discrete abscess or bowel obstruction, and operative findings of diffuse peritonitis predicted ileus of ≥5 d and NPO of ≥7 d (P < 0.01 for all). Major complications were more common in patients with ileus lasting ≥5 d. CONCLUSIONS: Fewer than one-half of patients receiving PN in the present cohort met the consensus-based guidelines for postoperative PN. The preoperative symptom duration, preoperative imaging findings demonstrating abscess and/or bowel obstruction, and intraoperative findings of diffuse peritonitis might predict prolonged ileus and longer recovery periods for children undergoing surgery for perforated appendicitis.
