Electro-acupuncture to prevent prolonged postoperative ileus:A randomized clinical trial

AIM:To examine whether acupuncture can prevent prolonged postoperative ileus(PPOI)after intraperitoneal surgery for colon cancer. METHODS:Ninety patients were recruited from the Fudan University Cancer Hospital,Shanghai,China. After surgery,patients were randomized to receive acupuncture(once daily,starting on postoperative day 1, for up to six consecutive days)or usual care.PPOI was defined as an inability to pass flatus or have a bowel movement by 96 h after surgery.The main outcomes were time to first fl...     

基于智能听诊系统采集肠鸣音对结直肠癌术后延迟性肠麻痹的研究

目的研究术后第一天肠鸣音对结直肠癌手术患者围术期术后延迟性肠麻痹（PPOI）的预测价值。 方法回顾性分析2019年2月~2021年2月陕西省人民医院普外二科124例确诊结直肠癌行手术治疗患者的临床资料,通过ROC曲线对患者术后第一天肠率、肠鸣音振幅、肠鸣音频率和肠鸣音持续时间与PPOI进行分析。采用单因素和多因素分析研究影响结直肠癌患者围术期PPOI发生的危险因素。 结果共纳入124例患者,男性70例,女性54例。其中PPOI组患者42例,非PPOI组患者82例;通过ROC曲线分析发现术后第一天肠率和肠鸣音频率对围术期PPOI发病的预测差异有统计学意义（Z=3.300,2.159;P＜0.05）。结直肠癌围术期PPOI发生的单因素分析发现,合并不全肠梗阻（OR=2.400,P=0.027）、氟尿嘧啶植入剂（OR=2.418,P=0.030）,术后第一天肠率≤2.407 cpm（OR=0.287,P=0.002）,术后第一天肠鸣音频率≤442.294 Hz（OR=2.805,P=0.012）是结直肠癌根治术患者围术期PPOI发生的影响因素。多因素分析结果显示,合并不全肠梗阻（OR=3.002,P=0.013）、术后第一天肠率≤2.407 cpm（OR=0.334,P=0.012）是结直肠癌根治术患者围术期PPOI的独立危险因素（P＜0.05）。 结论智能听诊系统监测肠鸣音对术后患者胃肠道功能恢复具有预测价值。术后第一天肠率≤2.407 cpm是结直肠癌患者围术期PPOI发生的独立危险因素。     

Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer

BACKGROUND Prolonged postoperative ileus(PPOI) is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI.We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.AIM To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.METHODS Between June 2016 and March 2017,the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database.Clinical data of patients who fulfilled the criteria were obtained.Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI.A nomogram for PPOI was developed and verified by bootstrap resampling.The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve.The clinical usefulness of our model was evaluated using the net benefit curve.RESULTS This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy.The incidence of PPOI was 19.75% in patients with gastrectomy.Age older than 60 years,open surgery,advanced stage(III-IV),and postoperative use of opioid analgesic were independent risk factors for PPOI.We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy.This nomogram had an excellent diagnostic performance [area under the curve(AUC)=0.836,sensitivity=84.4%,and specificity=75.4%].This nomogram was further validated by bootstrapping for 500 repetitions.The AUC of the bootstrap model was 0.832(95%CI:0.741-0.924).This model showed a good fitting and calibration and positive net benefits in decision curve analysis.CONCLUSION We have developed a prediction nomogram of PPOI for gastric cancer.This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.     

Prediction of Prolonged Postoperative Ileus After Radical Gastrectomy for Gastric Cancer: A Scoring System Obtained From a Prospective Study

Currently, there is a paucity of study investigating postoperative ileus in gastric cancer surgery. This prospective study aims to identify the risk factors for prolonged postoperative ileus (PPOI) and to use these risk factors to generate a risk stratification scoring system for the occurrence of PPOI.Patients who underwent radical gastrectomy for gastric cancer were included in this study. A multivariate logistic analysis was applied to identify independent risk factors for PPOI and to generate the scoring system. A receiver operating characteristic curve was generated and the area under the curve was calculated to demonstrate the predictive power of the scoring system.Finally, 296 patients were included and analyzed, of whom 96 (32.4%) developed PPOI. The multivariate analysis showed that age ≥65 years, operative duration ≥4 hours, tumor–node–metastasis (TNM) stage = III, open/converted operative technique, and total postoperative opiates dose (TOD) ≥0.3 mg/kg were independent risk factors for PPOI. Based on these factors, a risk stratification scoring system was generated, classified by low-risk (score 0–2), moderate-risk (score 3–4), and high-risk (score 5–6) groups. The incidence of PPOI increased by 7.5-fold from low-risk to high-risk group. The area under the curve of the scoring system was 0.841 (95% CI, 0.793–0.890), indicating a good predictive capability for the occurrence of PPOI.We have identified independent risk factors for the occurrence of PPOI and used these factors to construct a risk stratification scoring system.     

Nicotine chewing gum for the prevention of postoperative ileus after colorectal surgery: a multicenter,double-blind,randomised, controlled pilot study

Purpose

When postoperative ileus is not resolved after 5 days or recurs after resolution, prolonged POI (PPOI) is diagnosed. PPOI increases discomfort, morbidity and hospitalisation length, and is mainly caused by an inflammatory response following intestinal manipulation. This response can be weakened by targeting the cholinergic anti-inflammatory pathway, with nicotine as essential regulator. Chewing gum, already known to stimulate gastrointestinal motility itself, combined with nicotine is hypothesised to improve gastrointestinal recovery and prevent PPOI. This pilot study is the first to assess efficacy and safety of nicotine gum in colorectal surgery.

Methods

Patients undergoing elective oncological colorectal surgery were enrolled in this double-blind, parallel-group, controlled trial and randomly assigned to a treatment protocol with normal or nicotine gum (2 mg). Patient reported outcomes (PROMS), clinical characteristics and blood samples were collected. Primary endpoint was defined as time to first passage of faeces and toleration of solid food for at least 24 h.

Results

In total, 40 patients were enrolled (20 vs. 20). In both groups, six patients developed PPOI. Time to primary endpoint (4.50 [3.00–7.25] vs. 3.50 days [3.00–4.25], p = 0.398) and length of stay (5.50 [4.00–8.50] vs. 4.50 days [4.00–6.00], p = 0.738) did not differ significantly between normal and nicotine gum. There were no differences in PROMS, inflammatory parameters and postoperative complications.

Conclusions

We proved nicotine gum to be safe but ineffective in improving gastrointestinal recovery and prevention of PPOI after colorectal surgery. Other dosages and administration routes of nicotine should be tested in future research.

     

Preoperative risk factors for prolonged postoperative ileus after colorectal resection

Purpose

Prolonged postoperative ileus (PPOI) after colorectal resection significantly impacts patients’ recovery and hospital stay. Because treatment options for PPOI are limited, it is necessary to focus on prevention strategies. The aim of this study is to investigate risk factors associated with PPOI in patients undergoing colorectal surgery.

Methods

Data from all consecutive patients who underwent colorectal resection in our department were retrospectively analyzed from a prospective database over a 9-month period. PPOI was defined as the necessity to insert a nasogastric tube in a patient who experienced nausea and two episodes of vomiting with absence of bowel function. Multivariable analysis was performed considering a prespecified list of 16 potential preoperative risk factors.

Results

A total of 523 patients (mean age 59 years; 52.2% males) were included, and 83 patients (15.9%) developed PPOI. Statistically significant independent predictors of PPOI were male sex (OR 2.07; P = 0.0034), open resection (OR 4.47; P < 0.0001), conversion to laparotomy (OR 4.83; P = 0.0015), splenic flexure mobilization (OR 1.72; P = 0.063), and rectal resection (OR 2.72; P = 0.0047). Discriminative ability of this prediction model was 0.72.

Conclusions

Therapeutic strategies aimed to prevent PPOI after colorectal resection should focus on patients with increased risk. Patients and medical staff can be informed of the higher PPOI risk, so that early treatment can be started.

     

降气和胃通腑法对肠癌患者术后胃肠功能及免疫功能的影响

目的:观察针灸和中药恢复肠癌术后患者胃肠功能和免疫功能的临床疗效.方法:将肠癌根治性手术后的105例患者随机分成对照组、中药组和针灸组,各35例.对照组给予术后常规处理;中药组给予术后常规处理和术后第1天营养管推入四磨汤口服液20mL,每日3次,治疗10 d;针灸组给予术后常规处理和术后第1天针灸治疗,每日1次,治疗1...     

Compression anastomosis clip for gastrointestinal anastomosis

AIM： To investigate the feasibility of compression anastomosis clip （CAC） for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS： Sixty-six patients undergoing gastrointestinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. RESULTS： The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CONCLUSION： CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further confirmed with a larger patient sample.     

Acupuncture against chronic postsurgical pain in non-small cell lung cancer patients: A protocol of randomized controlled trial

Introduction:Video-assisted thoracoscopic lobectomy is the prior recommended treatment for non-small cell lung cancer (NSCLC), with the advantages of small trauma, less postoperative pain, and quick recovery. However, a large number of patients may suffer chronic postsurgical pain (CPSP), which makes the patients unwilling to practice pulmonary exercises, and it would directly affect patient''s cough, sputum expectoration, and mobility. Opioids could greatly improve the quality of postoperative analgesia and the quality of life after surgery, but it is accompanied with obvious side effects. A number of clinical studies have proved that acupuncture could improve postoperative pain and reduce opioid use. In this study, we try to conduct a randomized controlled study to evaluate the efficacy and safety of plum-blossom needle acupuncture combined with Tramadol in improving CPSP after lobectomy in NSCLC patients.Methods:Patients will be randomly divided into treatment group (acupuncture plus Tramadol) and control group (sham acupuncture plus Tramadol) with a random number table in 1:1 ratio. The patients, outcome assessor, and statistician will be blinded. The outcomes are changes of numerical rating scale, Karnofsky performance score, brief pain inventory, blood routine, liver and kidney function. The data will be analyzed by SPSS 22.0.Conclusions:The results will help to evaluate the efficacy and safety of plum-blossom needle acupuncture in improving CPSP after lobectomy in NSCLC patients.     

Effects of 7.5% hypertonic saline on fluid balance after radical surgery for gastrointestinal carcinoma

AIM: To investigate the effects of 7.5% hypertonic saline on positive fluid balance and negative fluid balance, after radical surgery for gastrointestinal carcinoma. METHODS: Fifty-two patients with gastrointestinal carcinoma undergoing radical surgery were studied. The patients were assigned to receive either Ringer lactate solution following 4 mL/kg of 7.5% hypertonic saline (the experimental group, n = 26) or Ringer lactate solution (the control group, n = 26) during the early postoperative period in SICU. Fluid infusion volumes, urine outputs, fluid balance, body weight change, PaO2/FiO2 ratio, anal exhaust time as well as the incidence of complication and mortality were compared between the two groups. RESULTS: Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than in control group (P<0.000001, P=0.000114). Fluid infusion volumes on the operative day and the first postoperative day were significantly less in experimental group than in control group (P= 0.000042, P= 0.000415). The volumes of the positive fluid balance on the operative day and during the first 48 h after surgery, in experimental group, were significantly less than in control group (P<0.000001). Body weight gain post-surgery was significantly lower in experimental group than in control group (P<0.000001). The body weight fall in experimental group occurred earlier than in control group (P<0.000001). PaO2/FiO2 ratio after surgery was higher in experimental group than in control group (P= 0.000111). The postoperative anal exhaust time in experimental group was earlier than in control group (P= 0.000006). The overall incidence of complications and the incidence of pulmonary infection were lower in experimental group than in control group (P= 0.0175, P= 0.0374). CONCLUSION: 7.5% hypertonic saline has an intense diuretic effect and causes mobilization of the retained fluid, which could reduce fluid infusion volumes and positive fluid balance after radical surgery for gastrointestinal carcinoma, as well as, accelerate the early appearance of negative fluid balance after the surgery, improve the oxygen diffusing capacity of the patients' alveoli, and lower the overall incidence of complications and pulmonary infection after the surgery.     

Early removing gastrointestinal decompression and early oral feeding improve patients＇ rehabilitation after colorectostomy

AIM: To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS: Three hundred and sixteen patients submitted to operations associated with colorectostomy from January 2004 to September 2005 were randomized to two groups: In experimental group (n=161), the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group (n=155), the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastomotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS: The median and average days to the first passage of flatus (3.0±0.9 vs 3.6±1.2, P<0.001), the first passage of stool (4.1±1.1 vs 4.8±1.4 P<0.001) and the length of postoperative stay (8.4±3.4 vs 9.6±5.0, P<0.05) were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage (1.24% vs 2.58%), acute dilation of stomach (1.86% vs 0.06%) and wound complications (2.48% vs 1.94%) were similar in the groups, but fever (3.73% vs 9.68%, P<0.05), pulmonary infection (0.62% vs 4.52%, P<0.05) and pharyngolaryngitis (3.11% vs 23.23%, P<0.001) were much more in the control group than in the experimental group. CONCLUSION: The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.     

Quality of life following laparoscopic Nissen fundoplication: Assessing short-term and long-term outcomes

AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplication. Short-term outcome data including symptom response, side effects of surgery, endoscopy, and patient’s perception of over-all success were collected prospectively. Long-term out-comes were investigated retrospectively in patients witha median follow-up of 10 years by assessment of reflux symptoms, side effects of surgery, durability of antire-flux surgery, need for additional treatment, patient’s perception of success, and quality of life. Antireflux sur-gery was considered a failure based on the following criteria: moderate to severe heartburn or regurgitation; moderate to severe dysphagia reported in combination with heartburn or regurgitation; regular proton pump inhibitor medication use; endoscopic evidence of erosive esophagitis Savary-Miller grade 1-4; pathological 24-h pH monitoring; or necessity to undergo an additional surgery. The main outcome measures were short-and long-term cure rates and quality of life, with patient sat-isfaction as a secondary outcome measure. RESULTS: Conversion from laparoscopy to open sur-gery was necessary in 2.4% of patients. Mortality was zero and the 30-d morbidity was 7.6% (95%CI: 4.7%-11.7%). The median postoperative hospital stay was 2 d [interquartile range (IQR) 2-3 d]. Two hundred and forty-seven patients were interviewed for short-term analysis following endoscopy. Gastro-esophageal reflux disease was cured in 98.4% (95%CI: 95.9%-99.6%) of patients three months after surgery. New-onset dysphagia was encountered postoperatively in 13 patients (6.7%); 95% reported that the outcome was better after antireflux surgery than with preopera-tive medical treatment. One hundred and thirty-nine patients with a median follow-up of 10.2 years (IQR 7.2-11.6 years) were available for a long-term evalu-ation. Cumulative long-term cure rates were 87.7% (81.0%-92     

Multivariate analysis of the risk for pulmonary complication after gastrointestinal surgery

AIM: To identify the risk factors for postoperative pulmonary complications (PPC) after gastrointestinal surgery. METHODS: A total of 1 002 patients undergoing gastrointestinal surgery in the Second Affiliated Hospital, Sun Yat-Sen University, during December 1999 and December 2003, were retrospectively studied. RESULTS: The overall incidence of PPC was 22.8% (228/ 1 002). Multivariate logistic analysis identified nine risk factors associated with PPC, including age odds ratio (OR = 1.040) history of respiratory diseases (OR = 2.976), serum albumin (OR = 0.954), chemotherapy 2 wk before operation (OR = 3.214), volume of preoperative erythrocyte transfusion (OR = 1.002), length of preoperative antibiotic therapy (OR = 1.072), intraoperative intratracheal intubation (OR = 1.002), nasogastric intubation (OR = 1.050) and postoperative mechanical ventilation (OR = 1.878). Logistic regression equation for predicting the risk of PPC was P(1) =q/[1+e-(-3.488+0.039×+1.090×Rd+0.001×Rbc-0.0047×Alb+0.002×Lii+ 0.049×Lni+0.630×Lmv+0.070×Dat+1.168×a)].     

What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery

OBJECTIVE: To compare baseline preoperative and 6-month postoperative functional health status and quality of life in patients undergoing lung cancer resection. METHODS: Lung cancer surgery patients from three hospitals were administered the Short-Form 36 Health Survey (SF-36) and the Ferrans and Powers' quality-of-life index (QLI) before surgery and 6 months after surgery. Preoperative, intraoperative, hospital stay, and 6-month postoperative clinical data were collected. All p values 相似文献   

Follow-up after surgical treatment for cancer of the gastrointestinal tract

BACKGROUND: Presently, no evidence-based guidelines for the follow-up of patients after surgery for gastrointestinal cancer are available. As a consequence, follow-up strategies may differ between hospitals depending on preference of physicians. We investigated which follow-up procedures are currently employed after surgery for gastrointestinal cancer in the Netherlands. METHOD: A questionnaire was sent to all surgical departments in the Netherlands. The questionnaire focused on frequency of follow-up visits and diagnostic procedures after surgical treatment for oesophageal, gastric, pancreatic and colorectal cancer and psychosocial issues during follow-up. RESULTS: The response rate was 90% (83/92). In the majority of hospitals, surgeons treated patients with colorectal (100%) and gastric (96%) cancer in their own centre, whereas patients with pancreatic (64%) and oesophageal (61%) cancer were more often referred to a tertiary centre. For all patients treated for gastrointestinal cancer, three to four follow-up visits were made in the first year, followed by at least two annual visits thereafter. After colorectal surgery, blood tests (78%), colonoscopy (75%) and abdominal ultrasound (57%) were frequently performed. In other gastrointestinal malignancies, procedures were in most cases only performed if symptoms occurred. In almost three-quarters of patients, psychosocial problems were observed, which were dealt with by surgeons in two-thirds of patients. The majority of patients treated for gastrointestinal cancer were pre- and postoperatively discussed in a multidisciplinary setting. Oncologists, gastroenterologists and dieticians were the most frequently consulted specialists after surgery for gastrointestinal cancer. CONCLUSION: Patients frequently visit the outpatient clinic after surgery for gastrointestinal cancer in the Netherlands. Whereas follow-up after colorectal cancer surgery focuses on finding recurrent disease and metachronous lesions in the colorectum, this is less clear after oesophageal, gastric and pancreatic cancer surgery. Further studies are needed to establish what is the most effective follow-up protocol after different types of gastrointestinal cancer surgery.     

Diagnosis and surgical treatment of esophageal gastrointestinal stromal tumors

AIM: To retrospectively evaluate our experience with the diagnosis and surgical resection of esophageal gastrointestinal stromal tumors(GISTs).METHODS: Between January 2003 and August 2014, five esophageal GIST cases were admitted to our hospital. In this study, the hospital records, surgery outcomes, tumor recurrence and survival of these patients were retrospectively reviewed.RESULTS: The median age of the patients was 45.6 years(range: 12-62 years). Three patients presented with dysphagia, and one patient presented with chest discomfort. The remaining patient was asymptomatic. Four patients were diagnosed with esophageal GISTs by a preoperative endoscopic biopsy. Three patients underwent esophagectomy, and two patients underwent video-assisted thoracoscopic surgery. The mean operating time was 116 min(range: 95-148 min), and the mean blood loss was 176 m L(range: 30-300 m L). All tumors were completely resected. The mean length of postoperative hospital stay was 8.4 d(range: 6-12 d). All patients recovered and were discharged successfully. The median postoperative follow-up duration was 48 mo(range: 29-72 mo). One patient was diagnosed with recurrence, one patient was lost to follow-up, and three patients were asymptomatic and are currently being managed with close radiologic and clinical follow-up.CONCLUSION:Surgery is the standard,effective and successful treatment for esophageal GISTs.Longterm follow-up is required to monitor recurrence and metastasis.     

Risk factors for the development of prolonged post-operative ileus following elective colorectal surgery

Purpose

Prolonged post-operative ileus (PPOI) increases post-operative morbidity and prolongs hospital stay. An improved understanding of the elements which contribute to the genesis of PPOI is needed in the first instance to facilitate accurate risk stratification and institute effective preventive measures. The aim of this retrospective cohort study was to therefore determine the perioperative risk factors associated with development of PPOI.

Methods

All elective intra-abdominal operations undertaken by the Colorectal Unit at Auckland District Health Board from 1 January to 31 December 2011 were accessed. Data were extracted for an assortment of patient characteristics and perioperative variables. Cases were stratified by the occurrence of clinician-diagnosed PPOI. Univariate and regression analyses were performed to identify correlates and independent risk factors, respectively.

Results

Two hundred and fifty-five patients were identified of whom 50 (19.6 %) developed PPOI. The median duration for PPOI was 4 days with 98 % resolving spontaneously with conservative measures. Univariate analysis identified increasing age; procedure type; increasing opiate consumption; elevated preoperative creatinine; post-operative haemoglobin drop, highest white cell count and lowest sodium; and increasing complication grade as significant correlates. Logistic regression found increasing age (OR 1.032, 95 % CI 1.004–1.061; p?=?0.026) and increasing drop in pre- to post-operative haemoglobin (OR 1.043, 95 % CI 1.002–1.085; p?=?0.037) as the only independent predictors for developing PPOI. An important limitation of this study was its retrospective nature.

Conclusions

Increasing age and increasing drop in haemoglobin are independent predictors for developing PPOI. Prospective assessment is required to facilitate more accurate risk factor analysis.     

Evolution of the postoperative pericardial effusion after day 15: the problem of the late tamponade

STUDY OBJECTIVES: To evaluate, through clinical and transthoracic echocardiography (TTE) follow-up, the natural history of persistent pericardial effusion (PE) after postoperative day 15 in patients who were given and were not given anticoagulant therapy. DESIGN AND PATIENTS: We retrospectively studied a cohort of 1,277 patients who were hospitalized between May 1997 and May 1999 in our center a mean (+/- SD) time period of 15 +/- 3 days after undergoing coronary artery bypass graft (CABG) surgery (856 patients) or valve replacement (VR) surgery (421 patients). MEASUREMENTS: TTE was performed on mean (+/- SD) postoperative day 20 +/- 1 (TTE(1)) and postoperative day 30 +/- 2 (TTE(2)). PE severity was classified on a scale from grade 1 to grade 4. RESULTS: On postoperative day 20 +/- 1, PE was present in 22% of the 1,277 patients and was more frequent after patients underwent CABG surgery than after undergoing VR surgery (25% vs 17%, respectively; p < 0.01). On postoperative day 30 +/- 2, the overall incidence of late tamponade in patients with PE was 4%. The incidence increased with the severity grade of PE at TTE(1) (p < 0.001). The negative predictive value of a severity grade < 2 at TTE(1) for late tamponade was 100%. Late tamponade incidence was higher after VR surgery than after CABG surgery (11% vs 2%, respectively; p < 0.01), and was higher in patients who had received anticoagulation therapy than in those who had not (8% vs 2%, respectively; p < 0.05). CONCLUSION: Persisting PE is common after postoperative day 15 and is more frequent after undergoing CABG surgery than after undergoing VR surgery. The incidence of late tamponade is usually underestimated, and it increases with the presence of VR, anticoagulation therapy, and/or higher postoperative TTE severity grade. Our data suggest that only patients with a PE severity grade of >/= 2 (< 10% of patients) require TTE follow-up after postoperative day 20.     

Bioelectrical impedance analysis to assess changes in body water compartments after digestive surgery

BACKGROUND/AIMS: Accurate monitoring of fluid balance in patients after surgery is a difficult task. Bioelectrical impedance analysis (BIA) is a safe and noninvasive method to measure extracellular water (ECW) and intracellular water (ICW) by passing a weak alternating current through the body. The purpose of the present study was to evaluate changes in body water compartments after gastroenterological surgery by BIA in relation to patient age, type of operation, postoperative complications and systemic inflammatory response syndrome (SIRS). METHODOLOGY: Ninety-four patients undergoing digestive surgery in our department [laparoscopic cholecystectomy (n=9), gastrectomy (n= 23), colectomy (n=26), hepatectomy (n=29), pancreatoduodenectomy (n=4) and esophagectomy (n=3)] were enrolled in the study. Body fluids were measured by bioelectrical impedance analysis before and after surgery (one hour after operation and on postoperative days 1, 3, 7 and 14). RESULTS: Total body water (TBW) and ICW in all groups were significantly lower than preoperative values on day 14. Day 14 ECW in patients less than 70 years or age without postoperative SIRS or complications was significantly lower than the preoperative value. In contrast, ECW was not significantly different from the preoperative value in patients older than age 70 with postoperative SIRS. Additionally, ECW on day 14 was significantly higher than the preoperative value in patients with postoperative complications. When types of surgery were taken into consideration, day 14 TBW was significantly lower than preoperative value only in patients with gastrectomy and hepatectomy. CONCLUSIONS: Development of postoperative SIRS and complications resulted in an increase of ECW above its preoperative value. BIA is useful for detecting small changes in body composition following gastroenterological surgery, and provides a means for monitoring perioperative water balance.     

Effect of cholecystectomy on gastroesophageal and duodenogastric reflux

OBJECTIVE: The majority of patients experience resolution of their symptoms after cholecystectomy, but a minority either find their symptoms unchanged or complain of new upper GI symptoms. It has been suggested that the effect of cholecystectomy on upper GI motility, sphincter function, or bile delivery may account for these postoperative symptoms. We aimed to determine whether cholecystectomy affects gastroesophageal reflux or duodenogastric reflux by using 24-h ambulatory pH and gastric bilirubin monitoring before and after surgery. METHODS: Seventeen symptomatic patients with gallstones underwent 24-h ambulatory esophageal and gastric pH-metry and gastric bilirubin monitoring. Helicobacter pylori status was ascertained in all patients by 14C urea breath test and serology. Combined pH and bilirubin monitoring was repeated 3 months after cholecystectomy. Eleven healthy subjects served as a control group. RESULTS: Three (17%) patients complained of persistent or new symptoms after surgery, whereas 14 (83%) patients were asymptomatic. Two patients (12%) underwent open cholecystectomy, and (88%) had the operation performed laparoscopically. No significant differences were detected in esophageal acid exposure (pH < 4), gastric alkaline shift (pH > 4), or gastric bilirubin exposure (absorbance > 0.14) after surgery. Three (17%) patients tested positive for Helicobacter pylori; the presence of infection did not appear to affect pre- or postoperative values. CONCLUSIONS: Cholecystectomy does not result in increased bile reflux into the stomach or increased gastroesophageal acid reflux. Those patients who had increased postoperative duodenogastric reflux were entirely asymptomatic. The symptoms of postcholecystectomy syndrome are unlikely to be related to increased duodenogastric reflux after surgery.