scholarly journals Pancreatic duct fluid culture in patients with chronic pancreatitis undergoing operative intervention and its implications on post operative course

2021 ◽  
Vol 8 (12) ◽  
pp. 3569
Author(s):  
Sai P. Krishna ◽  
R. D. R. Somasekar ◽  
Sivasankar A. ◽  
Kesavan B. ◽  
Pon M. Chidambaram ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Hospital Stay ◽  
Pancreatic Duct ◽  
Fasting Blood Glucose ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Operative Intervention ◽  
Septic Complications ◽  
Fluid Culture

Background: The role of bacteria in pathogenesis of chronic pancreatitis is poorly understood. Our aim was to analyse pancreatic duct fluid culture in patients undergoing operative intervention for chronic pancreatitis and its implications in post operative outcomes.Methods: Among 35 patients, 17 underwent Freys, 13 underwent longitudinal pancreatico-jejunostomy, 5 underwent cystojejunostomy. Duct fluid culture was obtained intraoperatively and analysed and compared with preoperative parameters and post operative outcomes.Results: 20 patients had positive duct fluid culture. Most common pathogen isolated was Klebsiella (8 patients). The only preoperative parameter which showed significant association was fasting blood glucose level. Wound infections were seen in 11 of which 10 had positive duct culture, out of which 9 had the same organism of that in duct culture. Mean hospital stay was 9±1.07 and 10±1.13 days in patients without and with infectious complications respectively.Conclusions: Older concept of sterile PD fluid in patients with CP may no longer hold true. In our study upto 60% of patients showed positive PD culture. By starting appropriate antibiotic we can reduce the length of hospital stay in patients who have septic complications. However large centre studies may guide us further into the importance of this concept and the role of bacteria in the pathogenesis of CP.

scholarly journals Role of probiotics on surgical site infections in colorectal surgery

2020 ◽  
Vol 7 (6) ◽  
pp. 1867
Author(s):  
Mayank Bhasin ◽  
Praveendra Kumar Sachan
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Infectious Complications ◽  
Potential Alternative ◽  
Carcinoma Rectum ◽  
Tract Infections

Background: Elective colorectal procedures are well known for their high rates of surgical site infections (SSI). Perioperative stabilization of microflora is a potential alternative. Usage of probiotics has significantly improved intestinal microflora and reduced infectious complications and improved surgical outcome.Methods: Observational follow-up study on 100 patients. Probiotics were given along with standard preoperative protocol and development of SSI was inspected upto 30 days. The data thus collected was subjected to descriptive analysis.Results: Colorectal malignancy was the most common indication out of which carcinoma rectum was most common comprising of 40% of the total subjects. Mean days to passage of first flatus was 3.13±1.33 days. Mean days to passage of first defecation was 4.6±1.64 days. Mean days to first solid diet was 4.42±2.02 days. Mean duration of total length of hospital stay was 14.7±8.7 days. Surgical site infections were seen in 17% of the participants of the study. Urinary tract infections were seen in 2 (2%) patients. Lower respiratory tract infections were seen in 2 (2%) patients. Anastomotic leak was present in 2 cases (2.8%) out of 70 cases. Mortality was seen in 2 (2%) cases.Conclusions: Perioperative usage of probiotics can lead to decrease in incidence of infectious complications but cannot be statistically proved due to insufficient data. Also due to early bowel functioning there is decrease in the mean hospital stay which contributed to better surgical outcome and better quality of life.

Advanced Endoscopic Tools

2021 ◽  
Author(s):  
Eleanor C. Fung
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Length Of Hospital Stay ◽  
Therapeutic Endoscopy ◽  
Full Thickness ◽  
Evolution And Development ◽  
Improved Outcomes ◽  
Endoscopic Clips

AbstractThe advent and success of therapeutic endoscopy has expanded the utilization of endoscopy as an effective alternative to surgical intervention in some cases with decreased morbidity, improved outcomes, and shortened length of hospital stay. Gastrointestinal bleeding, perforations, leaks, fistulas, and strictures have become increasingly managed by endoscopy with the evolution and development of endoscopic tools for effective closure of full-thickness gastrointestinal defects, dilation, and hemostasis. This article reviews the characteristics and role of endoscopic clips, stents, dilation balloons, endoscopic knives, and suturing devices.

scholarly journals Role of early enteral feeding in mild and moderate acute pancreatitis

2021 ◽  
Vol 8 (11) ◽  
pp. 3387
Author(s):  
Aswin George Roy ◽  
Haridas T. V.
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Enteral Feeding ◽  
Significant Risk ◽  
Length Of Hospital Stay ◽  
Advantages And Disadvantages ◽  
Early Enteral Feeding ◽  
Systemic Complication ◽  
Infective Complications

Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

scholarly journals Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4997
Author(s):  
Madelon Dijkstra ◽  
Sanne Nieuwenhuizen ◽  
Robbert S. Puijk ◽  
Florentine E. F. Timmer ◽  
Bart Geboers ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Hospital Stay ◽  
Colorectal Liver Metastases ◽  
Local Treatment ◽  
Length Of Hospital Stay ◽  
Progression Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Subgroup Analyses

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).

scholarly journals Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

2017 ◽  
Vol 24 (3) ◽  
pp. 153-158
Author(s):  
Gabrielius Jakutis ◽  
Ieva Norkienė ◽  
Donata Ringaitienė ◽  
Tomas Jovaiša
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Prolonged Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Research Database ◽  
Elective Cardiac Surgery ◽  
The Impact

Background. Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes. Materials and methods. Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons. Results. The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed. Conclusions. Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

scholarly journals Early Risk Stratification in Acute Pancreatitis: The Role of Biochemical and Hematological Parameters

2020 ◽  
Vol 17 (3) ◽  
pp. 11-18
Author(s):  
Georgiana Cătălina Crișu ◽  
Vasile Daniel Balaban ◽  
Laura Elena Gaman ◽  
Mariana Jinga ◽  
Flavius Stefan Marin ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Acute Pancreatitis ◽  
Risk Stratification ◽  
Hospital Stay ◽  
Hematological Parameters ◽  
Length Of Hospital Stay ◽  
Systemic Complications ◽  
Early Risk ◽  
Length Of Hospitalization

AbstractAcute pancreatitis (AP) represents an inflammatory condition,-with a wide spectrum of local and systemic complications. Early stratification of severity of pancreatitis is an important step in guiding the management of the disease and improving outcomes. Throughout the years many researchers have looked at various risk stratification parameters which could be used from the admission of patients, however current available scores are cumbersome.Our aim was to evaluate the role of biochemical and hematological parameters in the early stratification of severity of AP, regarding the length of hospitalization.We conducted an observational study which included 100 patients with AP admitted to the Gastroenterology Department over a period 18 months. AP diagnosis was set according to 2013 ACG criteria. Demographic, clinical and imaging data related to the pancreatitis flare were collected from their charts. Length of hospital stay was used as surrogate marker for severity of AP. We evaluated different biochemical and hematological parameters which influenced the length of hospitalization.Several hematological parameters and ratio did not correlate with length of hospital stay in our study cohort, however there was a significant relation of hyperglycemia and alkaline phosphatase levels with hospitalization duration.Early risk stratification in AP remains difficult with routine blood work done at admission. Glycemic control and serum level of alkaline phosphatase seems to be correlated with length of hospital stay.

scholarly journals Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045031
Author(s):  
Zongqing Lu ◽  
Xingxing Zhu ◽  
Tianfeng Hua ◽  
Jin Zhang ◽  
Wenyan Xiao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Cohort Studies ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Efficacy And Safety ◽  
All Cause Mortality ◽  
Abdominal Paracentesis

ObjectivesTo conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional ‘step-up’ strategy based on percutaneous catheter drainage (PCD).DesignSystematic review and meta-analysis.MethodsPubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional ‘step-up’ strategy based on PCD were included.OutcomesThe primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay.ResultsFive cohort studies and three RCTs were included in the analysis. Compared with the conventional ‘step-up’ method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) −0.31, 95% CI −0.53 to –0.10 and p=0.005; RCTs: SMD −0.45, 95% CI −0.64 to –0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD −2.49, 95% CI −4.46 to –0.51 and p<0.001; RCTs: SMD −0.67, 95% CI −0.89 to –0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04).ConclusionsThe findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the ‘step-up’ strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials.PROSPERO registration numberCRD42020168537.

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