scholarly journals Routine Use of Feeding Jejunostomy in Pancreaticoduodenectomy: A Metaanalysis

2020 ◽  
Author(s):  
Bhavin Vasavada ◽  
Hardik Patel
Keyword(s):  
Gastric Emptying ◽  
Surgical Site Infection ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Control Group ◽  
Site Infection ◽  
Feeding Jejunostomy ◽  
Significant Difference ◽  
Deep Surgical Site Infection ◽  
Meta Analyses

Aims and objectives: The primary aim of our study was to evaluate morbidity and mortality following feeding jejunostomy in pancreaticoduodenectomy compared to the control group. We also evaluated individual complications like delayed gastric emptying; post operative pancreatic fistula, superficial and deep surgical site infection. Material and Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2.the random-effects model was used. Results: Four studies including Total of 1639 patients were included in the analysis. Total 843 patients were included in Feeding jejunostomy group and 796 patients included in control group without feeding jejunostomy. Over all morbidity was significantly higher in feeding jejunostomy group. (P = 0.001). There was no significant difference between both the groups. (P=0.07). Delayed gastric emptying was significantly higher in feeding jejunostomy group. [P=0.021]. There was no significant difference in development of pancreatic fistula between the two groups. Deep surgical site infection was significantly higher in feeding jejunostomy group. (P=0.013). Hospital stay was significantly more in feeding jejunostomy group (p<0.0001). There was no significant difference between readmission; TPN requirement and time to start oral feed. Conclusion: Feeding jejunostomy seems to be associated with increased morbidity and increased length of stay.

scholarly journals Routine Use of Feeding Jejunostomy in Pancreaticoduodenectomuy: A Metaanalysis

2020 ◽  
Author(s):  
Bhavin Vasavada ◽  
Hardik Patel
Keyword(s):  
Odds Ratio ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Control Group ◽  
Site Infection ◽  
Weighted Mean ◽  
Feeding Jejunostomy ◽  
Significant Difference ◽  
Deep Surgical Site Infection ◽  
Total Parentral Nutrition

Aims and Objectives: The primary aim of our study was to evaluate morbidity and mortality following feeding jejunostomy in pancreaticoduodenectomy compared to the control group. We also evaluated individual complications like delayed gastric emptying, post operative pancreatic fistula, superficial and deep surgical site infection. We also looked for time to start oral nutrition and requirement of total parentral nutrition. Material and Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. [9,10]. We searched pubmed, cochrane library, embase, google scholar with keywords like “feeding jejunostomy in pancreaticodudenectomy”, “entral nutrition in pancreaticoduodenectomy, “total parentral nutrition in pancreaticoduodenectomy’, “morbidity and mortality following pancreaticoduodenectomy”. Two independent authors extracted the data (B.V and H.P).The meta-analysis was conducted using Open meta-analysis software. Heterogeneity was measured using Q tests and I2, and p < 0.10 was determined as significant , the random-effects model was used. The Odds ratio (OR) was calculated for dichotomous data, and weighted mean differences (WMD) were used for continuous variables. Both differences were presented with 95% CI. Results: Four studies including Total of 1639 patients were included in the analysis. Total 843 patients were included in Feeding jejunostomy group and 796 patients included in control group without feeding jejunostomy. Over all morbidity was significantly higher in feeding jejunostomy group. (odds ratio 1.39, p = 0.001). However, there was no significant difference between both the group. (p=0.07). Delayed gastric emptying was significantly higher in Feeding jejunostomy group. [p=0.021]. There was no significant difference in development of pancreatic fistula between the two group. (p=0.536). Deep surgical site infection were significantly higher in feeding jejunostomy group. (p=0.013). Hospital stay was significantly more in feeding jejunostommy group, weighted mean difference of 2.094 days. (p<0.0001). There was no significant difference between readmission (p=0.536) and TPN requirement between the two group. Time to start oral feed was significantly more in feeding jejunostomy group. Conclusion: Feeding jejunostomy seems to be associated with increased morbidity, increased complications, increased length of stay without any significant benefits.

scholarly journals Prophylaxis of Surgical Site Infection in Cranial Surgery with Vancomycin Powder Application into Wound

2019 ◽  
Vol 23 (3) ◽  
pp. 205-210
Author(s):  
SAMI UR REHMAN ◽  
RIFFAT ULLAH KHAN ◽  
GHAYUR ABBAS ◽  
USAMA BIN ZUBAIR ◽  
KAMRAN KHAN ◽  
...  
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Control Group ◽  
P Value ◽  
Site Infection ◽  
Significant Difference ◽  
Routine Prophylaxis ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
Lost To Follow Up

Objective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis. Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002. Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections.

scholarly journals DuraSeal Exact Is a Safe Adjunctive Treatment for Durotomy in Spine: Postapproval Study

2018 ◽  
Vol 9 (3) ◽  
pp. 272-278 ◽  
Author(s):  
Kee D. Kim ◽  
Dinesh Ramanathan ◽  
Jason Highsmith ◽  
William Lavelle ◽  
Peter Gerszten ◽  
...  
Keyword(s):  
Adverse Events ◽  
Surgical Site Infection ◽  
The United States ◽  
Csf Leak ◽  
Site Infection ◽  
Serious Adverse Events ◽  
Dural Repair ◽  
Significant Difference ◽  
Csf Leakage ◽  
Deep Surgical Site Infection

Study Design: A nonrandomized, two-armed prospective study. Objective: Water-tight dural closure is paramount to the prevention of cerebrospinal fluid (CSF) leakage and associated complications. Synthetic polyethylene glycol (PEG) hydrogel has been used as an adjunct to sutured dural repair; however, its expansion postoperatively is a concern for neurological complications. A low-swell formulation of PEG sealant was introduced as DuraSeal Exact Spine Sealant System (DESS). A Post-Approval Study was performed primarily to evaluate the safety and efficacy of DESS for spinal dural repair compared to current alternatives, in a large patient population, reflecting a real-world practice. Methods: A total of 36 sites in the United States enrolled 429 patients treated with DESS as an adjunct to dural repair in the spinal sealant group and 406 patients treated with all other modalities in the control arm, from October 2011 to June 2016. The primary endpoint was the incidence of CSF leak within 90 days of operation. The secondary endpoints evaluated were deep surgical site infection and neurological serious adverse events. Results: The CSF leakage in the DESS group (6.6%) was not significantly different from the control group (6.5%) ( p = .83), and there was no significant difference in the time to first leak. The two groups had no significant differences in deep surgical site infection (1.6% versus control 2.1%, p = .61) or proportion of subjects with neurological serious adverse events (2.9% versus control 1.6%, p = .516). Conclusions: DuraSeal Exact Spinal Sealant is safe when compared to current alternatives for spinal dural repair.

scholarly journals Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

2020 ◽  
pp. 219256822097822
Author(s):  
Muyi Wang ◽  
Liang Xu ◽  
Bo Yang ◽  
Changzhi Du ◽  
Zezhang Zhu ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Spinal Deformity ◽  
Recurrent Infection ◽  
Implant Removal ◽  
Site Infection ◽  
Initial Surgery ◽  
Spinal Deformity Surgery ◽  
Solid Fusion ◽  
Deep Surgical Site Infection

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

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