scholarly journals The effect of early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction on the patients’ nutritional status: randomized single-center study.

2021 ◽  
Author(s):  
Natalia Kovalerova
Keyword(s):  
Nutritional Status ◽  
Postoperative Period ◽  
Gastric Tube ◽  
Nutritional Support ◽  
Oral Feeding ◽  
Esophageal Reconstruction ◽  
Single Center ◽  
Subtotal Esophagectomy ◽  
Early Oral Feeding ◽  
Gastric Tube Reconstruction

Background: The efficiency of early oral feeding (EOF) in the postoperative period is well known. Though in the esophagus surgery doctors still prefer another types of nutritional support after esophagectomy (EE) with immediate gastric tube reconstruction. Aims: to improve the results of patients treatment after EE with gastric tube reconstruction by choosing the method of nutritional support and to evaluate nutritional status of the patients with EOF. Materials and methods: weve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, as well as anthropometric and laboratory indicators of the nutritional status before the operation, on 1, 3 and 6 postoperative day (POD). Results: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting EOF on the 1 POD and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 POD. The patients of EOF group had statistically significant earlier gas discharge (2[2;3] POD vs 4[3;6] POD, р = 0,000042) and stool appearance (3[2;4] POD vs 5[4;7] POD, р = 0,000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group (8[7;9] POD vs 9[8;9] POD, р=0,13). EOF does not affect on frequency (46,6% vs 53,3%, р=0,66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on 3 POD in EOF group (0,17 [0,13;0,21] vs 0,2 [0,16;0,34], р=0,03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups. Conclusions: EOF after EE with immediate gastric tube reconstruction is safe and effective. EOF doesnt increase the frequency of anastomotic insufficiency and other complications.

PS01.190: FLEXIBLE GASTRIC TUBE: A NOBLE METHOD OF GASTRIC TUBE RECONSTRUCTION WITHOUT ANASTOMOTIC LEAKAGE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 103-104
Author(s):  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Yutaka Tokairin ◽  
Akihiro Hoshino ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Clinical Outcomes ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Circular Stapler ◽  
Anastomotic Site ◽  
Subtotal Esophagectomy ◽  
The Status ◽  
Greater Curvature ◽  
Gastric Tube Reconstruction

Abstract Background Anastomotic leakage is one of the most frequent and severe morbidities after esophagectomy. For preventing anastomotic leakage, it is important to design a gastric tube with sufficient blood supply and to perform precise anastomosis at a well-conditioned site. We herein show our method of gastric tube reconstruction and evaluate the outcome. Methods Seven hundred and forty-six esophageal carcinoma patients who received subtotal esophagectomy with gastric tube reconstruction via the retrosternal route between 1994 and 2017 were enrolled in the present study. Although we previously used a greater curvature gastric tube with a 4 cm in diameter (narrow group), since 2000, a ‘flexible gastric tube,’ which was designed on an individual basis with the aim of preserving the vascular plexus in the center of the anterior and posterior stomach wall to the maximum possible extent in order to supply a sufficient amount of blood to the tip of the gastric tube was used (flexible group). Cervical esophagogastric end-to-side anastomosis using the circular stapler was performed during the whole period. The clinical outcomes were compared between the two groups. Results Anastomotic leakage was observed in 36 (4.8%) patients. While 24 of 155 (15.5%) patients showed anastomotic leakage in the narrow group, 12 of 591 (2.0%) patients showed anastomotic leakage in the flexible group and the clinical outcomes were significantly improved. Conclusion Our method of gastric tube reconstruction helped to improve the rate of anastomotic leakage after esophagectomy. At present, we are investigating the status of the blood flow using an ICG fluorescence method and by measuring the degree of oxygen saturation and hemoglobin using a new non-invasive monitoring tool during the operation. Postoperative assessments of the anastomotic site are performed using endoscopic examinations. We herein report the results of these assessments. Disclosure All authors have declared no conflicts of interest.

Does early oral feeding increase the likelihood of salivary fistula after total laryngectomy?

2014 ◽  
Vol 128 (4) ◽  
pp. 372-378 ◽  
Author(s):  
A A Sousa ◽  
J M Porcaro-Salles ◽  
J M A Soares ◽  
G M de Moraes ◽  
G S Silva ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Neck Dissection ◽  
Total Laryngectomy ◽  
Randomised Trial ◽  
Oral Feeding ◽  
Early Group ◽  
Salivary Fistula ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
Late Group

AbstractObjective:This study compared the incidence of salivary fistula between groups with an early or late reintroduction of oral feeding, and identified the predictive factors for salivary fistula.Methods:A randomised trial was performed using 89 patients with larynx or hypopharynx cancer, assigned to 2 groups (early or late). In the early group, oral feeding was started 24 hours after total laryngectomy or total pharyngolaryngectomy, and in the late group, it was started from post-operative day 7 onwards. The occurrence of salivary fistula was evaluated in relation to the following variables: early or late oral feeding, nutritional status, cancer stage, surgery performed, and type of neck dissection.Results:The incidence of salivary fistula was 27.3 per cent (n = 12) in the early group and 13.3 per cent (n = 6) in the late group (p = 0.10). The following variables were not statistically significant: nutritional status (p = 0.45); tumour location (p = 0.37); type of surgery (p = 0.91) and type of neck dissection (p = 0.62). A significant difference (p = 0.02) between the free margins and invasive carcinoma was observed.Conclusion:The early reintroduction of oral feeding in total laryngectomised patients did not increase the incidence of salivary fistula.

scholarly journals NUTRITIONAL STATUS AND NUTRITIONAL SUPPORT IN CHILDREN WITH CONGENITAL MALFORMATIONS OF BRAIN IN UKRAINE: SINGLE-CENTER OBSERVATIONAL DESCRIPTIVE CROSS-SECTIONAL STUDY

2020 ◽  
Vol 7 (2) ◽  
pp. 94-101
Author(s):  
O. Riga ◽  
N. Orlova ◽  
T. Ishchenko
Keyword(s):  
Nutritional Status ◽  
Low Income ◽  
Congenital Malformations ◽  
Nutritional Support ◽  
Protein Energy Malnutrition ◽  
Cross Sectional Study ◽  
Z Score ◽  
Sectional Study ◽  
Single Center ◽  
Cross Sectional

NUTRITIONAL STATUS AND NUTRITIONAL SUPPORT IN CHILDREN WITH CONGENITAL MALFORMATIONS OF BRAIN IN UKRAINE: SINGLE-CENTER OBSERVATIONAL DESCRIPTIVE CROSS-SECTIONAL STUDY Riga O., Orlova N., Ishchenko T. In Ukraine, as one of low income and middle income countries (LMICs), PEM is detected and diagnosed not quite actively especially in children with neurologic impairment. Methods: Nutritive status and energy consumption was evaluated in 17 young and preschool children with congenital malformations of brain by anthropometry, 24-hour dietary recall and questionnaire of caregivers. Results: The study demonstrate nutritional disorders: Z-score BW for age in total cohort was -3.2, H/L for age was -2.7. The moderate PEM was diagnosed in 2/17 children, severe PEM in 12/17. The late appointment of nutritional support to such children has been demonstrated, its effect on increasing growth and body weight. Conclusion. The importance of drawing up individual plans for the energetic consumption of the children with congenital malformations of brain with training of caregivers and rehabilitative and palliative team was shown. Keywords: children, protein-energy malnutrition, congenital malformations of brain, LMICs.   Резюме. ХАРЧОВИЙ СТАТУС І ХАРЧОВА ПІДТРИМКА ДІТЕЙ З ВРОДЖЕНИМИ ВАДАМИ РОЗВИТКУ МОЗКУ В УКРАЇНІ: ОДНОЦЕНТРОВЕ НАОЧНО-ОПИСОВЕ КРОС-СЕКЦІЙНЕ ДОСЛІДЖЕННЯ Ріга О.О., Орлова Н.В., Іщенко Т.Б. В Україні, як одна із країн з низьким рівнем доходу та середнього доходу (LMICs), БЕН виявляється та діагностується не досить активно, особливо у дітей з порушеннями неврології. Методи: Харчовий статус та споживання енергії було оцінено у 17 дітей молодшого та дошкільного віку з вродженими вадами розвитку головного мозку за допомогою антропометрії, цілодобової дієти та анкетування опікунів. Результати: Дослідження демонструє харчові розлади: показник Z-score BW за віком у загальній когорті становив -3,2, H/L для віку -2,7. Помірну БЕН було діагностовано у 2/17 дітей, тяжку БЕН у 12/17. Продемонстровано несвоєчасне призначення харчової підтримки таким дітям, його вплив на збільшення росту та маси тіла. Висновки. Показано важливість складання індивідуальних планів енергетичного споживання дітей з вродженими вадами розвитку мозку під час навчання опікунів та реабілітаційно-паліативного колективу. Ключові слова: діти, білково-енергетична недостатність, вроджені вади розвитку мозку, LMICs.   Резюме. ПИЩЕВОЙ СТАТУС И ПИЩЕВАЯ ПОДДЕРЖКА ДЕТЕЙ С ВРОЖДЕННЫМИ ПОРОКАМИ РАЗВИТИЯ МОЗГА В УКРАИНЕ: ОДНОЦЕНТРОВОЕ НАГЛЯДНО-ОПИСАТЕЛЬНОЕ КРОСС-СЕКЦИОННОЕ ИССЛЕДОВАНИЕ Рига Е.А., Орлова Н.В., Ищенко Т.Б. В Украине, как одна из стран с низким уровнем дохода и среднего дохода (LMICs), БЄН оказывается и диагностируется недостаточно активно, особенно у детей с нарушениями неврологии. Методы: Пищевой статус и потребления энергии было оценено у 17 детей младшего и дошкольного возраста с врожденными пороками развития головного мозга с помощью антропометрии, круглосуточной диеты и анкетирования опекунов. Результаты: Исследование демонстрирует пищевые расстройства: показатель Z-score BW по возрасту в общей когорте составил -3,2, H/L для возраста -2,7. Умеренную БЄН было диагностировано у 2/17 детей, тяжелую БЄН у 12/17. Продемонстрировано несвоевременное назначение пищевой поддержки таким детям, его влияние на увеличение роста и массы тела. Выводы. Показана важность составления индивидуальных планов энергетического потребления детей с врожденными пороками развития мозга во время обучения опекунов и реабилитационно-паллиативного коллектива. Ключевые слова: дети, белково-энергетическая недостаточность, врожденные пороки развития мозга, LMICs.

62 THE STERNO-TRACHEAL DISTANCE IS AN IMPORTANT FACTOR OF ANASTOMOTIC LEAKAGE OF RETROSTERNAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
S Inoue
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Independent Risk Factor ◽  
Cutoff Value ◽  
Subtotal Esophagectomy ◽  
Posterior Mediastinal ◽  
Route Reconstruction ◽  
Gastric Tube Reconstruction

Abstract Background Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009. Methods A total of 221 patients who underwent a subtotal esophagectomy with gastric tube reconstruction during January 2004—April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared. Results The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in the RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 mm to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2% to 11.1% in the RS route (p = 0.037). Conclusion The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD <13 mm.

P-OGC05 The introduction of an Upper Gastrointestinal (UGI) specific menu can reduce the need for routine jejunostomy (JEJ) placement following UGI Cancer resection

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Vida Dossou
Keyword(s):  
Patient Satisfaction ◽  
Staff Training ◽  
Nutritional Support ◽  
Enhanced Recovery ◽  
Oral Intake ◽  
Oral Feeding ◽  
Ward Staff ◽  
Cancer Resection ◽  
Early Oral Feeding ◽  
Satisfaction Surveys

Abstract Background Despite the fact that early oral feeding (EOF) after the surgical resection of oesophageal and gastric tumours is safe, and is associated with favourable early in-hospital outcomes, sooner return to physiological GI function and hospital discharge, there can still be some reluctance in establishing EOF. Concerns remain around risk of anastomotic leak, pneumonia, Naso-gastric tube (NGT) reinsertion, re-operation, readmissions and mortality. However, when utilising EOF, a reduction in length of stay, earlier removal of NGT and earlier initiation of soft diet can be observed. JEJ placement is beneficial however  complications can arise and the optimal nutritional pathway remains debatable.  Methods Patient satisfaction surveys were conducted amongst UGI Cancer patients following Cancer resection and analysed pre and post UGI menu development and staff training. Expert UGI Patient volunteers assisted in the UGI menu development through food tastings producing a new menu in collaboration with the catering department. The new menu was launched and an UGI snack box provided to the UGI Enhanced Recovery Unit (ERAS).  Oral intake of Diet and Oral Nutritional Support was analysed for calorie and protein content post menu change, ward staff training and specialist UGI dietetic counselling. This was then compared with calculated minimum estimated nutritional requirements.  Results Of the ten patients audited pre discharge: Remaining 1 patient achieved 51% of protein requirements, below the aim of 60%. No patient audited required supplementary Enteral feeding via JEJ or Naso-jejunal tube Patient satisfaction surveys were completed prior to catering staff training and menu revision, after the new menu was implemented. The results show a significant improvement in patient satisfaction following UGI menu implementation. Conclusions Specialist UGI RD support, UGI specific menu and Oral Nutritional Support can reduce the need for routine JEJ placement in favour of on an individual patient basis.  Collaborative working between UGI Dietitians, Ward staff, Catering staff and Expert patients is required for UGI specific menu development to be effectual.  This audit is limited to small numbers due to adapted operational procedures during the pandemic. This audit will be repeated on a larger scale to yield more meaningful data.   Future audit will capture data on how many UGI patients went on to require enteral nutritional support with three months of discharge.

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