Routine Gastric Decompression after Pancreatoduodenectomy: Treating the Surgeon?

2021 ◽  
Author(s):  
K. F. Flick ◽  
M. Soufi ◽  
M. T. Yip-Schneider ◽  
R. E. Simpson ◽  
C. L. Colgate ◽  
...  
Keyword(s):  
Gastric Decompression

The Efficacy and Safety of Methylnaltrexone for the Treatment of Postoperative Ileus

2021 ◽  
pp. 000313482110488
Author(s):  
Jennifer Beavers ◽  
Lindsay Orton ◽  
Leanne Atchison ◽  
Andrew Medvecz ◽  
Bradley Dennis ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Postoperative Ileus ◽  
Primary Outcome ◽  
Surgical Complication ◽  
Opioid Antagonist ◽  
Control Group ◽  
Efficacy And Safety ◽  
Gastrointestinal Malignancy ◽  
Gastric Decompression ◽  
Bowel Rest

Background Postoperative ileus (POI) is a surgical complication resulting in increased morbidity and length of stay (LOS). Usual care for POI includes bowel rest and gastric decompression. It has been questioned if methylnaltrexone (MNTX), a peripheral opioid antagonist, could be used as treatment for POI. The purpose of this study was to determine if MNTX is effective and safe for POI treatment. Methods This single-center, retrospective cohort study included patients ⩾ 18 years with a POI. Patients with acute colonic pseudo-obstruction, small bowel obstruction, and gastrointestinal malignancy were excluded. The intervention was MNTX administration. The primary outcome was time to ileus resolution. Secondary outcomes included LOS, duration of nasogastric tube, total parenteral nutrition requirement, and incidence of gastrointestinal perforations. Results 110 patients were included in the analysis; 28 received MNTX. Time to ileus resolution was 9.9 days for the MNTX group and 11.4 days for the control group ( P = .38). Duration of gastric decompression was 4.6 days for the MNTX group and 4.2 days for the control group ( P = .71). Length of stay was 19.9 days for the MNTX group and 19.7 days for the control group ( P = .96). The percentage of TPN requirement was 17.9% in the MNTX group and 22.0% in the control group ( P = .65). No gastrointestinal perforations were observed in either group. Conclusion For the treatment of POI, MNTX did not significantly reduce time to resolution of ileus, LOS, duration of gastric decompression, or TPN requirements. However, no gastrointestinal perforations were seen, indicating that MNTX may be safely used in these patients.

To Be or Knot to Be: A Rare Case of Nasogastric Tube Knotting

2020 ◽  
pp. 97-99
Author(s):  
Muzna Iftikhar ◽  
Shahbaz Bakhat Kayani ◽  
Atiq Ur Rehman
Keyword(s):  
Respiratory Distress ◽  
Young Patient ◽  
Nasogastric Tube ◽  
Tracheoesophageal Fistula ◽  
Rare Case ◽  
Rare Complication ◽  
Clinical Care ◽  
Nasogastric Intubation ◽  
Laryngeal Injury ◽  
Gastric Decompression

Nasogastric intubation is a frequent practice in clinical care used for administering enteral feed, gastric decompression, and lavage. The knotting of a nasogastric tube is a rare complication with only a few incidences of narrow bore nasogastric tube knotting and even fewer wide-bore tubes reported [1-4]. Unrecognized knotting of the nasogastric tube with inadvertent removal may cause catastrophic consequences like epistaxis, respiratory distress’ severe laryngeal injury, and tracheoesophageal fistula [5-7]. Tubes have been found to be kinked and less commonly knotted. Cases of knotting have previously been identified during insertion or blockage of the tubes post-insertion. Ours is a case of nasogastric tube knotting identified in a young patient with a working tube that knotted over itself during removal.

Percutaneous Endoscopic Transgastric Jejunostomy: A New Approach

2005 ◽  
Vol 71 (3) ◽  
pp. 216-218 ◽  
Author(s):  
Willie Melvin ◽  
Joss D. Fernandez
Keyword(s):  
Gastric Emptying ◽  
Feeding Tube ◽  
Seldinger Technique ◽  
New Approach ◽  
The Future ◽  
Gastric Decompression ◽  
Entire Procedure ◽  
Future Management

A percutaneous transgastric jejunostomy allows long-term simultaneous gastric decompression and jejunal feedings. We have developed a safe and effective bedside technique for placement of a large-bore (22 French) feeding tube while providing gastric drainage with no mortalities and minimal morbidities. We have modified the push technique used for percutaneous gastrostomies and introduced a cut-away sheath that is placed using a modified Seldinger technique. The entire procedure is performed under endoscopic visualization. Our experience with more than 100 successful tube placements has made this method common practice at our institute. This technique is ideal for patients with poor gastric emptying of any etiology. We feel that this technique will have an expanding and important role in the future management of this patient population's nutritional problems.

scholarly journals Management of paraesophageal hernia review of clinical studies: timing to surgery, mesh use, fundoplication, gastropexy and other controversies

2020 ◽  
Vol 33 (8) ◽  
Author(s):  
Nicolás H Dreifuss ◽  
Francisco Schlottmann ◽  
Daniela Molena
Keyword(s):  
Surgical Repair ◽  
Asymptomatic Patient ◽  
Elective Surgery ◽  
Surgical Team ◽  
Acute Presentation ◽  
Emergent Operation ◽  
Postoperative Reflux ◽  
Asymptomatic Patients ◽  
Gastric Decompression ◽  
Optimal Approach

SUMMARY Despite paraesophageal hernias (PEH) being a common disorder, several aspects of their management remain elusive. Elective surgery in asymptomatic patients, management of acute presentation, and other technical aspects such as utilization of mesh, fundoplication or gastropexy are some of the debated issues. The aim of this study was to review the available evidence in an attempt to clarify current controversial topics. PEH repair in an asymptomatic patient may be reasonable in selected patients to avoid potential morbidity of an emergent operation. In acute presentation, gastric decompression and resuscitation could allow to improve the patient’s condition and refer the repair to a more experienced surgical team. When surgical repair is decided, laparoscopy is the optimal approach in most of the cases. Mesh should be used in selected patients such as those with large PEH or redo operations. While a fundoplication is recommended in the majority of patients to prevent postoperative reflux, a gastropexy can be used in selected cases to facilitate postoperative care.

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