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Palomba G, Basile R, Capuano M, Pesce M, Rurgo S, Sarnelli G, De Palma GD, Aprea G. Nasogastric tube after laparoscopic Heller-Dor surgery: Do you really need it? Curr Probl Surg 2024; 61:101457. [PMID: 38548426 DOI: 10.1016/j.cpsurg.2024.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Giuseppe Palomba
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
| | - Raffaele Basile
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marianna Capuano
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marcella Pesce
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Sara Rurgo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Domenico De Palma
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Aprea
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Madyarov V, Kuzikeev M, Malgazhdarov M, Abzalbek Y, Ashimov G. A forecasting method of postoperative intestinal paralysis and its timely resolution. PRZEGLAD GASTROENTEROLOGICZNY 2023; 18:393-401. [PMID: 38572460 PMCID: PMC10985748 DOI: 10.5114/pg.2023.133063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/17/2022] [Indexed: 04/05/2024]
Abstract
Introduction The development of intestinal paresis after surgery in patients with acute surgical conditions complicated by peritonitis is an urgent problem of abdominal surgery. Aim To study the effectiveness of the developed methods, as well as to predict the risk of intestinal paresis, and establish the possibilities of correcting this condition in patients with acute surgical pathology complicated by peritonitis. Material and methods Twenty patients were examined, in whom the temperature parameters of the mucous membrane and skin of the cheek were measured, based on which the probability of developing paresis was predicted. Results The proposed method of thermometry of the mucous membrane and cheek skin made it possible to predict a high risk of intestinal paresis in 75% of patients and low risk in 25% of patients. It was shown that 80% of patients had a complete restoration of intestinal motility on the first day after the start of treatment. In 20% of cases, a partial improvement in the motor evacuation function of the intestine was observed on the first day, and full recovery was noted on the second day after the start of therapy. Conclusions The developed methods are highly effective and suitable for predicting and correcting intestinal paresis in patients with acute surgical conditions in the postoperative period.
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Affiliation(s)
- Valentin Madyarov
- Department of Surgeons with Anaesthesiology and Intensive Care, Kazakh-Russian Medical University, Almaty, Republic of Kazakhstan
| | - Marat Kuzikeev
- Department of Surgeons with Anaesthesiology and Intensive Care, Kazakh-Russian Medical University, Almaty, Republic of Kazakhstan
| | - Maulen Malgazhdarov
- Department of Surgeons with Anaesthesiology and Intensive Care, Kazakh-Russian Medical University, Almaty, Republic of Kazakhstan
| | - Yestay Abzalbek
- Department of Oncology, Central Clinical Hospital, Almaty, Republic of Kazakhstan
| | - Gulmamed Ashimov
- Surgical Department, Medical Centre Rahat, Almaty, Republic of Kazakhstan
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Paleczny S, Fatima R, Amador Y, El Diasty M. Should nasogastric tube be used routinely in patients undergoing cardiac surgery? A narrative review. J Card Surg 2022; 37:5300-5306. [PMID: 36251277 DOI: 10.1111/jocs.17040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/27/2022] [Accepted: 10/05/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Nasogastric tube (NGT) use has been common in the immediate postoperative period in surgical patients for decades. Potential advantages include the decompression of gastric contents and the early administration of time-sensitive medications. However, its routine use after cardiac surgery has not been established as a gold standard yet. The NGT use for prevention of postoperative nausea and vomiting has been a matter of debate in literature. Also, NGT use has also been associated with the incidence of some respiratory and gastrointestinal complications and it may be a source of significant pain and discomfort to patients. In this article, we review the current available literature regarding the use of NGT during and immediately after cardiac surgery, with particular emphasis on its potential role in enhanced postoperative recovery. METHODS We performed a database search in October 2021 using Embase, Cochrane Library, and Medline to identify studies that examined the use of NGT in patients that underwent cardiac surgery. Data and literature about NGT's impact on post-operative nausea and vomiting, early administration of medications, interference with imaging, post-operative complications, respiratory complications, gastrointestinal complications, pain and discomfort, and enhanced recovery after surgery were examined. RESULTS Three reports investigating the use of NGT to reduce post-operative nausea and vomiting were examined with sample sizes of 114, 104, and 202. The use of NGT did not significantly reduce the incidence of post-operative nausea and vomiting in 2/3 of the studies: a 2% nausea reduction with NGT (p < 0.05), a 7.7% nausea reduction with NGT (p = 0.6), and a 14% vomiting reduction with NGT (p = 0.007). The prevalence of pneumonia following NGT use has been shown to vary ranging from 4 to 95% with associated mortality rates of 17 to 62%. CONCLUSION Based on our findings, there is currently not sufficient evidence to support the routine use of NGT during cardiac surgery. Further research is needed to establish the role of NGT in this patient population.
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Affiliation(s)
- Sarah Paleczny
- Department of Surgery, Division of Cardiac Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Rubab Fatima
- Department of Surgery, Division of Cardiac Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Yannis Amador
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Mohammad El Diasty
- Department of Surgery, Division of Cardiac Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Nasogastric decompression after intestinal surgery in children: a systematic review and meta-analysis. Pediatr Surg Int 2021; 37:377-388. [PMID: 33564932 DOI: 10.1007/s00383-020-04818-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Postoperative nasogastric decompression has been routinely used after intestinal surgery. However, the role of nasogastric decompression in preventing postoperative complications and promoting the recovery of bowel function in children remains controversial. This systematic review aimed to assess whether routine nasogastric decompression is necessary after intestinal surgery in children. METHODS A systematic review was conducted following the PRISMA guideline. Literature search was performed in electronic databases including PubMed, Embase, CENTRAL, and Web of science. Studies comparing outcomes between children who underwent intestinal surgery with postoperative nasogastric tube (NGT) placement (NGT group) and without postoperative NGT placement (no NGT group) were included. RESULTS Six studies were eligible for inclusion criteria including two randomized controlled trials (RCT) and four comparative observational studies. The overall rate of postoperative anastomotic leak was 0.6% (1/179) in NGT group and 0.9% (2/223) in no NGT group. The overall rate of wound dehiscence was 2.4% (4/169) in NGT group and 1.6% (4/245) in no NGT group. Meta-analysis of two RCTs in children undergoing elective intestinal surgery showed significant increase of mild vomiting in no NGT group compared with NGT group (OR 3.54 95% CI 1.04, 11.99) but no significant difference in persistent vomiting requiring NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), abdominal distension (OR 2.36 95% CI 0.34, 16.59), NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), wound infection (OR 1.63 95% CI 0.49, 5.48) and time to return of bowel movement (MD - 0.14 95% CI - 0.45, 0.17). There was no incidence of anastomotic leak in these 2 RCTs. However, there was an incidence of NGT-related discomfort in NGT group, which ranged from 30 to 100% of children studied. CONCLUSION Routine postoperative nasogastric decompression can be omitted in children undergoing intestinal surgery due to no benefit in preventing postoperative complications while increasing patient discomfort.
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Budipramana VS. Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v55i1.24386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Reperforation after gastric perforation repair is a complication which increases the rate of morbidity and mortality in gastric perforation. The lack of ability of the tissue to use oxygen in septic condition causes anaerobic cellular metabolism and furthermore it will cause failure in closing the perforation. The production of anaerobic metabolism is lactic acid which can be measured from the blood. The aim of this study is to determine the cut-off point of blood lactate level as a predictor of reperforation after repairing gastric perforation. Forty-six patients diagnosed as gastric perforation, who were repaired in Dr Soetomo Hospital from October 2014 to October 2015 were recruited as samples. Serum lactate was taken one hour before repairing the perforation. After being repaired, the patients were observed until the 14th day to evaluate whether any reperforation would occur or not . The design of this research was cross-sectional, analytic observational. The data was analyzed using independent t-test and ROC for obtaining the cut-off point as a predictor of the reperforation after the gastric perforation was repaired. There was a significant difference in the mean of lactate level in the group with reperforation compared with that of the non-reperforation group, that is as big as 3.74±0.59 mmol/L and 2.60±0.76 mmol/L. Using ROC curve analysis, there was the cut-off point of lactate level for reperforation 3.35 mmol/L, with sensitivity 92.9%, specificity 84.4%, positive predictive value 72% and negative predictive Value 96.4%, accuracy 87.0% and in the AUC value 0.902.
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Martos-Benítez FD, Gutiérrez-Noyola A, García AS, González-Martínez I, Betancour-Plaza I. PROGRAM OF INTESTINAL REHABILITATION AND EARLY POSTOPERATIVE ENTERAL NUTRITION: A PROSPECTIVE COHORT STUDY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 31:e1387. [PMID: 30133679 PMCID: PMC6097030 DOI: 10.1590/0102-672020180001e1387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/28/2018] [Indexed: 11/22/2022]
Abstract
Background: Some factors can act on nutritional status of patients operated for a
gastrointestinal cancer. A timely and appropriate nutritional intervention
could have a positive effect on postoperative outcomes. Aim: To determine the effect of a program of intestinal rehabilitation and early
postoperative enteral nutrition on complications and clinical outcomes of
patients underwent gastrointestinal surgery for cancer. Methods: This is a prospective study of 465 patients underwent gastrointestinal
surgery for cancer consecutively admitted in an oncological intensive care
unit. The program of intestinal rehabilitation and early postoperative
enteral nutrition consisted in: 1) general rules, and 2) gastrointestinal
rules. Results: The mean age of analysed patients was 63.7±9.1 years. The most frequent
operation sites were colon-rectum (44.9%), gynaecological with intestinal
suture (15.7%) and oesophagus-gastric (11.0%). Emergency intervention was
performed in 12.7% of patients. The program of intestinal rehabilitation and
early postoperative enteral nutrition reduced major complication (19.2% vs.
10.2%; p=0.030), respiratory complications (p=0.040), delirium (p=0.032),
infectious complications (p=0.047) and gastrointestinal complications
(p<0.001), mainly anastomotic leakage (p=0.033). The oncological
intensive care unit mortality (p=0.018), length of oncological intensive
care unit (p<0.001) and hospital (p<0.001) stay were reduced as well.
Conclusions: Implementing a program of intestinal rehabilitation and early postoperative
enteral nutrition is associated with reduction in postoperative
complications and improvement of clinical outcomes in patients undergoing
gastrointestinal surgery for cancer.
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Affiliation(s)
| | | | - Andrés Soto García
- Department of Intensive Care, Institute of Oncology and Radiobiology, Havana, Cuba
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Martos-Benítez FD, Gutiérrez-Noyola A, Soto-García A, González-Martínez I, Betancourt-Plaza I. Program of gastrointestinal rehabilitation and early postoperative enteral nutrition: a prospective study. Updates Surg 2018; 70:105-112. [PMID: 29429053 DOI: 10.1007/s13304-018-0514-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/01/2018] [Indexed: 01/01/2023]
Abstract
Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit. The program of gastrointestinal rehabilitation and early postoperative enteral nutrition consisted on: (1) general rules: pain relive, early mobilization, antibiotic prophylaxis, deep vein thrombosis prophylaxis and respiratory physiotherapy; and (2) gastrointestinal rules: gastric protection, control of postoperative nausea and vomiting, early nasogastric tube remove and early enteral nutrition. The most frequent surgical sites were colorectal (44.9%), gynecological with intestinal suturing (15.7%) and esophagus/stomach (11.0%). Emergency surgery was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complications (19.2 vs. 10.2%; p = 0.030), respiratory complications (p = 0.040), delirium (p = 0.032), infectious complications (p = 0.047) and gastrointestinal complications (p < 0.001). Intensive care unit mortality (p = 0.018), length of intensive care unit stay (p < 0.001) and length of hospitalization (p < 0.001) were reduced as well. A program of gastrointestinal rehabilitation and early postoperative enteral nutrition is associated with reduced postoperative complications and improved clinical outcomes in patients undergoing gastrointestinal surgery for cancer.
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Affiliation(s)
| | | | - Andrés Soto-García
- Oncological Intensive Care Unit, Institute of Oncology and Radiobiology, Havana, Cuba
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Podder AR, Jyothi GS. Burst Abdomen: A Preventable Complication in Gynecological Oncology. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vinay HG, Raza M, Siddesh G. Elective Bowel Surgery with or without Prophylactic Nasogastric Decompression: A Prospective, Randomized Trial. J Surg Tech Case Rep 2016; 7:37-41. [PMID: 27512551 PMCID: PMC4966203 DOI: 10.4103/2006-8808.185654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction: Routinely postoperative nasogastric decompression was done until the nasogastric drainage is minimal, reoccurrence of bowel sounds and passing flatus. But prolonged nasogastric intubation is associated with complications like basal atelectasis due to poor cough reflux, loss of electrolytes and increased patient morbidity. Aims and Objectives: To study the need for routine use of nasogastric tube post operatively in bowel surgeries with reference to (1) Return of bowel movements (2) Compare the incidence of complications (3) Duration of hospital stay. Methodology: 100 patients who underwent elective bowel surgery were randomized into two groups: Study group (50): Nasogastric tube was removed immediately after operation or in the recovery room. Control group (50): Underwent nasogastric tube removal postoperatively after the patient passed flatus and audible bowel sounds on auscultation. Results: Incidence of complications were less in the study group i.e., only three patients had vomiting, and two patients had abdominal distension which lead to postponement of oral feeds. Most of our control group patients complained of discomfort and difficulty in coughing and in bringing out sputum, which was the probable cause for high incidence of pulmonary complications. Conclusion: Routine use of the nasogastric tube adjunct to patient care following bowel surgery may be safely eliminated.
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Affiliation(s)
- H G Vinay
- Department of General Surgery, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| | - Mohammed Raza
- Department of General Surgery, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| | - G Siddesh
- Department of General Surgery, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
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Matulewicz RS, Brennan J, Pruthi RS, Kundu SD, Gonzalez CM, Meeks JJ. Radical Cystectomy Perioperative Care Redesign. Urology 2015; 86:1076-86. [PMID: 26383615 DOI: 10.1016/j.urology.2015.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/19/2015] [Accepted: 09/01/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative. METHODS A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search. Specific topics were reviewed within the scope of the three major phases of perioperative management: preoperative, intraoperative, and postoperative. Preference was given to evidence from prospective randomized trials, meta-analyses, and systematic reviews. RESULTS Preoperative considerations to improve care in the RC patient should include multi-disciplinary medical optimization, patient education, and formal coordination of care. Efforts to mitigate the risk of malnutrition and reduce postoperative gastrointestinal complications may include carbohydrate loading, protein nutrition supplementation, and avoiding bowel preparation. Intraoperatively, a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus. Finally, enhanced recovery protocols including novel medications, early feeding, and multi-modal analgesia approaches are associated with earlier postoperative convalescence. CONCLUSION RC is a complex and morbid procedure that may benefit from care redesign. Evidence based quality improvement is integral to this process. We hope that this review will help guide further improvement initiatives for RC.
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Affiliation(s)
- Richard S Matulewicz
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Jeffrey Brennan
- Department of Anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Raj S Pruthi
- Department of Urology, UNC School of Medicine, Chapel Hill, NC
| | - Shilajit D Kundu
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Chris M Gonzalez
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Joshua J Meeks
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Song W, Chen JH, Zhang XH, Xu JB, He YL, Cai SR, Han FH, Chen CQ. Effect of somatostatin in advanced gastric cancer after D2 radical gastrectomy. World J Gastroenterol 2014; 20:14927-14933. [PMID: 25356053 PMCID: PMC4209556 DOI: 10.3748/wjg.v20.i40.14927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/15/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the effect of somatostatin in patients with advanced gastric cancer who received D2 lymphadenectomy and vagina vasorum dissection.
METHODS: Using a prospective, single-blind, placebo-controlled design, patients with advanced gastric cancer were randomized into a study group (n = 61) and a control group (n = 59). Patients in the study group were given somatostatin for 5-7 d starting 6 h after the operation, and patients in the control group were given normal saline. Preoperative and nonoperative complications in the perioperative period, as well as different types of postoperative drainage in the two groups were compared.
RESULTS: There was no significant difference between the study group and the control group for preoperative clinicopathological indicators. We found no significant difference between the two groups for the overall incidence of complications, but a lower percentage of peritoneal effusion was observed in the treatment group (1.6% vs 10.2%, P < 0.05). There were no significant differences between the two groups in the incidence of postoperative pancreatic dysfunction and chylous fistula. However, there were significant differences in the amylase concentration in drainage fluid, volume and duration of drainage, volume and duration of chylous fistula and peritoneal drainage, and volume and duration of gastric tube drainage. The study group did not show any increase in mean hospitalization cost and the cost reduced when the postoperative complications occurred.
CONCLUSION: Postoperative somatostatin reduces volume and duration of surgical drainage and related complications. Somatostatin may improve safety of gastric cancer surgery, reducing postoperative complications and promoting recovery.
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Han Y, Qu XL, Fu H. Gastric cancer surgery without nasogastric decompression. Shijie Huaren Xiaohua Zazhi 2014; 22:4075-4080. [DOI: 10.11569/wcjd.v22.i27.4075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nasogastric decompression (ND) has been used worldwide in gastric cancer surgery as a traditional way since Hunter pioneered. Most surgeons believe that using ND in abdominal surgery could relieve the internal pressure of anastomosis and reduce the incidence of anastomotic leakage. However, there has no strict scientific evidence for this obtained from medical studies, especially prospective studies. In recent years, several studies have shown that routine use of ND after surgery could not prevent anastomotic leakage or accelerate the recovery of bowel function, and surgery without ND did not increase the risk of anastomotic leakage. All kinds of gastric cancer surgery could be performed safely without ND, which greatly reduces the suffering of the patients, accelerates postoperative recovery, and reduces the workload significantly. If patients with pyloric obstruction or bleeding receive ND before surgery, nasogastric tube could be removed after they waked up. Gastric cancer surgery without ND is safe and deserves clinical popularization. This review summarizes the safety and significance of gastric cancer surgery without ND.
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Rossetti G, Fei L, Docimo L, Del Genio G, Micanti F, Belfiore A, Brusciano L, Moccia F, Cimmino M, Marra T. Is nasogastric decompression useful in prevention of leaks after laparoscopic sleeve gastrectomy? A randomized trial. J INVEST SURG 2014; 27:234-9. [PMID: 24476003 DOI: 10.3109/08941939.2013.875606] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although its excellent results, laparoscopic sleeve gastrectomy (LSG) presents major complications ranging from 0% to 29%. Among them, the staple line leak presents an incidence varying from 0% to 7%. Many trials debated about different solutions in order to reduce leaks' incidence. No author has investigated the role of gastric decompression in the prevention of this complication. Aim of our work is to evaluate if this procedure can play a role in avoiding the occurrence of staple line leaks after LSG. MATERIALS AND METHODS Between January 2008 and November 2012, 145 patients were prospectively and randomly included in the study. Seventy patients composed the group A, whose operations were completed with placement of nasogastric tube; the other 75 patients were included in the group B, in which no nasogastric tube was placed. RESULTS No statistical differences were observed between group A and group B regarding gender distribution, age, weight, and BMI. No intraoperative complications and no conversion occurred in both groups. Intraoperative blood loss (50.1 ± 42.3 vs. 52.5 ± 37.6 ml, respectively) and operative time (65.4 ± 25.5 vs. 62.6 ± 27.8 min, respectively) were comparable between the two groups (p: NS). One staple line leak (1.4%) occurred on 6th postoperative day in group A patients. No leak was observed in group B patients. Postoperative hospital stay was significantly longer in group A vs. group B patients (7.6 ± 3.4 vs. 6.2 ± 3.1 days, respectively, p: 0.04). CONCLUSIONS Routine placement of nasogastric tube in patients operated of LSG seems not useful in reducing leaks' incidence.
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Affiliation(s)
- Gianluca Rossetti
- Digestive Surgery Unit, Second University of Naples , via Pansini 5, Naples , Italy
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Effects of psychological nursing intervention on personality characteristics and quality of life of patients with esophageal cancer. Clin Res Hepatol Gastroenterol 2013; 37:283-8. [PMID: 23117050 DOI: 10.1016/j.clinre.2012.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 08/14/2012] [Accepted: 08/29/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study examined the effects of a psychological nursing intervention on personality characteristics and quality of life of esophageal cancer patients. METHODOLOGY Esophageal cancer patients (n=86) were randomized into either an intervention group (n=45) or a control group (n=41). Patients in the control group were given routine nursing care, and those in the intervention group were provided with psychological nursing interventions in addition to routine nursing care. Personality characteristics, assessed through Eysenck Personality Questionnaire, and quality of life, assessed through EORTC QLQ-C30, were compared between the two groups. RESULTS The results showed that personality characteristics were closely related to quality of life. After the psychological nursing intervention, the main factors were neurosis, psychosis or mood instability, and personality stability. However, introverted and extroverted personality characteristics were not associated with quality of life. The psychological nursing intervention was associated with decreased P-scale and E-scale scores of personality characteristics and improved quality of life in each dimension scored. CONCLUSIONS A psychological nursing intervention can affect the personality characteristics of esophageal cancer patients and improve their quality of life; this approach is worthy of further study and clinical application.
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Affiliation(s)
- Benjamin M Whittam
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lavi R, Katznelson R, Cheng D, Minkovich L, Klein A, Carroll J, Karski J, Djaiani G. The Effect of Nasogastric Tube Application During Cardiac Surgery on Postoperative Nausea and Vomiting—A Randomized Trial. J Cardiothorac Vasc Anesth 2011; 25:105-9. [DOI: 10.1053/j.jvca.2010.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Indexed: 11/11/2022]
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