Effects of Preoperative Oral Carbohydrates on Quality of Recovery in Laparoscopic Cholecystectomy: A Randomized, Double Blind, Placebo-Controlled Trial.

BACKGROUND: While carbohydrate loading is an important component of enhanced patient recovery after surgery, no study has evaluated the effects of preoperative carbohydrate loading after laparoscopic cholecystectomy (LC) on patient satisfaction and overall recovery. Thus, we aimed to investigate the impact of preoperative oral carbohydrates on scores from the quality of recovery 40-item (QoR-40) questionnaire after LC. METHODS: A total of 153 adults who underwent LC were randomized into three groups. Group MN-NPO was fasted from midnight until surgery. Group No-NPO received 400 mL of a carbohydrate beverage on the evening before surgery, and a morning dose of 400 mL was ingested at least 2 h before surgery. Group Placebo received the same quantity of flavored water as for group No-NPO. The quality of recovery after general anesthesia was evaluated using QoR-40 questionnaire. Intraoperative hemodynamics were also evaluated. RESULTS: There were no significant differences among the groups in terms of the pre- and postoperative global QoR-40 scores (P = 0.257). Group MN-NPO had an elevated heart rate compared to patients who ingested a preoperative beverage (groups No-NPO and Placebo; P = 0.0412). CONCLUSIONS: The preoperative carbohydrate beverage did not improve quality of recovery using the QoR-40 questionnaire after general anesthesia for laparoscopic cholecystectomy compared to placebo or conventional fasting. However, the preoperative fasting group had a consistently increased heart rate during changes in body position that induced hypotension, which is likely a result of depletion of effective intravascular volume caused by traditional fasting over 8 h. TRIAL REGISTRATION: Clinical trial.gov identifier: NCT02555020.

Treatment of gallbladder disease during operations Iraqi Freedom and Enduring Freedom.

BACKGROUND: We examined the outcome after treatment for gallbladder disease in deployed military service members and the impact of instituting a clinical pathway to expedite return to duty (RTD). METHODS: A retrospective chart review of 97 medically evacuated patients with gallbladder disease was carried out. These patients were evacuated from the field to Landstuhl Regional Medical Center (LRMC), Germany, between March 2003 and November 2004. In October 2003, a clinical pathway was established to facilitate returning these deployed patients back to their combat units. These service members were compared with 90 local patients who underwent the same surgery during the study period. RESULTS: Twenty-nine patients were treated before the implementation of the clinical pathway. Of those, five had complications, five were converted to open, and 52% returned to their deployed units. After the clinical pathway was established, there were no complications (p = 0.023), two were converted to open (p = 0.002), and 84% returned to duty (p = 0.002). The Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) service members had delayed presentations for definitive treatment. When compared with the local patient group, OIF/OEF surgical cases were more often male (78 vs. 32%, p < 0.001), younger (average 31 vs. 35 years, p < 0.001), and associated with longer operative times (89 vs. 52 min, p < 0.001), and had higher conversion rate to open (7.2 vs. 2.2%, p = 0.17) and higher major complication rate (5.1 vs. 0%, p = 0.06). Time to operation and final pathologic diagnosis were significantly different between the two groups. CONCLUSIONS: Gallbladder surgery can be performed in a delayed manner in the deployed service member, although with a significantly higher morbidity as compared with the local population. We suggest that changes in the immediate treatment and transportation of these service members should occur at the theater level. The use of a clinical pathway facilitates the rapid RTD of soldiers diagnosed with gallbladder disease.

[Efficacy of sulfate calcium mineral water in disorders of motor evacuatory function of the stomach and gallbladder]. / Effektivnost' sul'fatnoi kal'tsievoi mineral'noi vody pri narushenii motorno-évakuatornoi funktsii zheludka i zhelchnogo puzyria.

Patients with disorders of motor-evacuatory gastric function and those of the gallbladder received sanatorium spa treatment with Nizhneivkinskaya 2K mineral water. It was found that both course and single intake of the above mineral water induce clinical remission of the disease, normalization of the echoscopic picture of the stomach and gallbladder, their motor function, tesiocrystalloscopic characteristics of the saliva. Therefore, spa treatment with mineral water Nizhneivkinskaya is effective in rehabilitation of patients with gastric and gallbladder motor-evacuatory dysfunction.