Comparative Analysis of Early versus Late Enteral Feeding after Gastrointestinal Surgeries

2021 ◽  
Vol 15 (8) ◽  
pp. 2050-2053
Author(s):  
Amnah Ilyas Khan ◽  
Nazish Masood ◽  
Usman Ilyas ◽  
Zahra Raza ◽  
Jehangaiz Khan
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Enteral Feeding ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Early Enteral Nutrition ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Despite of widespread belief, clinical studies and animal experiments have suggested that initiation of early feeding after surgery has many advantages. Present study was planned for comparing outcomes of early and late enteral feeding in patients who were undergoing gastrointestinal surgeries in our settings. This would help the surgeons to select better option for earlier recovery after surgery Objective: To compare the outcome of early versus late enteral feeding in patients undergoing gastrointestinal surgeries. Design: It was a randomized controlled trial. Study Settings: The study was conducted at Department of General Surgery, PIMS Islamabad for a period of six months w.e.f 20-12-2017 to 19-06-2018. Patients and Methods: A total of two hundred (n=200) patients of both gender between age 15-70 years, who had been scheduled for elective or emergency gastrointestinal surgery were enrolled in the study. Patients were randomized early (Group A, <24 hours after surgery) and late enteral feeding (Group B, <24 hours after surgery). Outcomes were estimated in terms of infection, anastomotic leak and duration of hospital stay in both groups. Results: Mean age of the patients was 36.8±11.2. There were total 85 females and 115 males with female to male ratio of 1:1.35. Mean duration of hospital stay was 2.62 days ± 0.71 in group A and it was 6.55 days ± 0.71 2.93SD in groups B (P=0.001). Wound infection rate (8% vs 33%, P=0.001) and anastomotic leak rate (0% vs 10%, P=0.001) was also significantly lower in group A when compared with group B. Conclusion: Initiation of early enteral feeding (within 24 hours post operatively) in patients undergoing gastrointestinal surgeries has an immediate advantage of caloric intake and results in faster recovery with fewer complications. Similar results are found in the literature. We recommend early initiation (within 24 hours after surgery) of enteral feeding in patients undergoing gastrointestinal surgeries. Keywords: Anostomotic leak, early enteral nutrition (EEN), late enteral nutrition (LEN).

scholarly journals Early Enteral Nutrition in Neonates Following Abdominal Surgery

2018 ◽  
Vol 7 (2) ◽  
pp. 21 ◽  
Author(s):  
G. Raghavendra Prasad ◽  
J. V. Subba Rao ◽  
Amtul Aziz ◽  
T. M. Rashmi ◽  
Saniya Ahmed
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Abdominal Pressure ◽  
Early Enteral Nutrition ◽  
Necrosis Factor Alpha ◽  
Septic Complications ◽  
Tnf Α ◽  
Gut Mucosa ◽  
Group A ◽  
Group B

Introduction: Nil per oral (NPO)/nil by mouth has been the most commonly practiced convention in post-operative period. Misplaced fear of aspiration led to routine prescription of “NPO.” Starvation leads to atrophy of the gut mucosa leading to decreased barrier effect of gut mucosa. This starvation-induced gut mucosal injury increases septic complications and mortality. The study aims at establishing the feasibility and effect of early enteral nutrition (EEN) in neonates following abdominal surgeries.Materials and Methods: A total of 260 cases formed the cohort of prospective cohort study, 79 in EEN - Group “A” and 181 in NPO - Group “B.” Effect of EEN was evaluated with regard to outcome, hospital stay, surgical site infections (SSI), stress markers such as C-reactive protein (CRP), procalcitonin, tumor necrosis factor alpha (TNF α), and neonatal-predisposition, insult/injury, response, organ failure (Neo-PIRO) scores, intra-abdominal pressure (IAP) grade, tolerance of feeds, and time to first stool. Chi-square was the statistical method used. Epi info version 7 was the software used.Results: Group B had higher mortality (20.09%) than Group A (P < 0.05). 33.7 in Group B developed SSI, of which 90% were deep and intracavitary (P < 0.05). Hospital stay was less in Group A (P < 0.05). CRP and Neo-PIRO scores were less in Group A compared to Group B (P < 0.05). TNF-α expression and IAP scores were not statistically significant (P > 0.05). Procalcitonin levels were higher in Group B. Feeds were better tolerated in Group A. First stool appeared earlier in Group A than B. There was no difference in anastomotic leak in both the groups.Conclusion: EEN in neonates following abdominal surgeries is feasible, well tolerated reduces the hospital stay and mortality, and reduces SSIs, and early gut motility could be established.

scholarly journals Effects of perioperative enteral glutamine on surgical outcome in gastrointestinal cancer patients

2019 ◽  
Vol 6 (3) ◽  
pp. 903
Author(s):  
Raghavendra . ◽  
Raghupathi S.
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leak ◽  
Gastrointestinal Cancer ◽  
Gastrointestinal Surgery ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Previous trials have shown that perioperative glutamine could protect patients from infectious complications after gastrointestinal cancer operations.Methods: 54 patients with a planned elective operation for gastrointestinal cancer were divided into two groups: GROUP A: patients given glutamine enriched enteral nutrition perioperatively (n=27), GROUP B: patients given enteral feed without glutamine (n=27). Patients were assessed in terms of post-operative complications like infective complications, anastomotic leak, need for reintervention, length of hospital stay and mortality.Results: In group A seven patients and in group B six patients had surgical site infection post operatively (p=0.750). In group A five patients and in group B three patients had lung and urinary tract infection post operatively (p=0.444). In group A three patients and in group B five patients had intra-abdominal abscess/collection post operatively (p=0.444). In group A one patient and in group B three patients had anastomotic leak post operatively (p=0.299). In group A three patients and in group B three patients had reintervention in form of ultrasound guided aspiration and ultrasound guided pigtail aspiration for intra-abdominal collection (p=1.000). In group A and in group B mean length of hospital stay was 26 days and 23 days respectively (p=0.346). In group A and in group B mean length of post-operative hospital stay was 13 and 12 days respectively (p=0.642). There was no mortality in our study. No significant difference between the groups was found in complication rates, length of hospital stay.Conclusions: Routine perioperative glutamine to the patients undergoing major gastrointestinal surgery is not beneficial.

scholarly journals A comparative study of single layer extra mucosal versus conventional double layer anastomosis of intestines in elective and emergency laparotomy

2019 ◽  
Vol 7 (1) ◽  
pp. 184
Author(s):  
K. Lohit Sai ◽  
C. Sugumar
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Double Layer ◽  
Single Layer ◽  
Duration Of Hospital Stay ◽  
Key Skills ◽  
Group A ◽  
The Difference ◽  
Group B

Background: Gastrointestinal anastomosis has been a part of research since decades and is one of the key skills in surgeon’s armamentarium. This study compared the outcome of single layer anastomosis with double layer anastomosis.Methods: The study was designed as a prospective comparative study and 29 cases were included in the study during December 2016 to September 2017, who consented for being part of the study. Patients were alternatively allotted into the either group. Group A underwent single layer anastomosis and Group B underwent double layer anastomosis. Outcome parameters were analysed in the form of ‘duration required to perform anastomoses, ‘duration of hospital stay’ and ‘dnastomotic leak.Results: Mean duration required to perform anastomosis in Group A is 21.64±1.60 minutes and in Group B is 29.6±2.02 minutes. The difference between the mean duration required for anastomosis between the two groups were statistically significant (p<0.005). Mean duration of hospital stay in Group A was 12.35±1.72 days and Group B was 12±2.44 days (difference was statistically insignificant), 3 (10%) cases in Group A and 2 (6.8 %) cases in Group B developed anastomotic leak and the difference was statistically insignificant.Conclusions: Our study concluded that there is statistically significant difference between the single layer anastomosis and double layer anastomosis in terms of time taken to perform anastomosis, however there is no difference in postoperative anastomotic leak and duration of hospital stay.

scholarly journals Comparison of In-Hospital Outcomes Between Patients With or Without Acute Kidney Injury Developed After Hospitalization Following Acute Coronary Syndrome

2020 ◽  
Vol 16 (1) ◽  
pp. 3-10
Author(s):  
Md Sajjad Safi ◽  
Msi Tipu Chowdhury ◽  
Tanjima Parvin ◽  
Khurshed Ahmed ◽  
Md Ashraf Uddin Sultana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Cardiogenic Shock ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Hospital Stays ◽  
Group B

Background: Acute Kidney Injury (AKI), a common complication of acute coronary syndromes (ACS), is associated with higher mortality and longer hospital stays. ACS patients with renal impairment during hospitalization are associated with adverse in-hospital outcomes in the form of heart failure, cardiogenic shock, arrhythmia, dialysis requirement and mortality. Objective: To compare the in-hospital adverse outcomesof patients with ACS with or without AKI. Materials and Methods: This prospective comparative study was conducted in the Department of Cardiology, BSMMU, Dhaka, during the period of August 2017 to July 2018. A total of 70 eligible patients were included in this study of which 35 patients were included in group A (ACS with AKI) and 35 patients were included in group B (ACS without AKI). AKI was diagnosed, on the basis of increased serum creatinine level 0.3mg/dL from baseline within 48 hours after hospitalization. They were subjected to electrocardiography, blood test for serum creatinine (on admission, 12 hours, 48 hours and at the time of discharge), lipid profile, 2-D echocardiography along with serum troponin, CK MB and electrolytes. Results: It was observed that mean age was 58.0±8.5 years in group A and 55.6±12.3 years in group B. Heart failure was more common in group A than in Group B (74.3% vs 34.2% p=0.001 respectively) and arrhythmia was more common in group A than in Group B (100% vs 74.2% respectively). 7(20%) patients of group A required dialysis. The mean duration of hospital stay was significantly higher in Group A than in the Group B (9.4±2.3 vs 7.2±0.6; p=0.001) days. Multiple logistic regression analysis revealed that heart failure, cardiogenic shock, duration of hospital stay were found to be the independently significant predictors of outcome of the patients with AKI with odds ratio being 5.53 (p=0.001), 4.353 (p=0.001) and 6.92 (p=0.001) Conclusion: This study shows that, heart failure, cardiogenic shock, arrhythmia, dialysis requirement, were more common in the patients with AKI (group A) than in the patients without AKI (group B). The duration of hospital stays were longer in patients with AKI (group A) than in the patients without AKI (group B). Therefore, an important research target is the identification of high-risk patients with ACS experiencing AKI, thereby appropriate medication and follow-up should be implemented. University Heart Journal Vol. 16, No. 1, Jan 2020; 3-10

scholarly journals Adrenaline and Dexamethasone, vs Adrenaline and Fluticasone, vs Adrenaline alone in Bronchiolitis: A Randomized Controlled Trial

2020 ◽  
pp. 20-28
Author(s):  
Jayendra R. Gohil ◽  
Atul M. Sheladiya ◽  
N. B. Adithya ◽  
Ratna D. Bhojak
Keyword(s):  
Hospital Stay ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Primary Objective ◽  
Assessment Instrument ◽  
Clinical Severity ◽  
Group A ◽  
The Difference ◽  
Group B

Background and Objectives: There is no consensus over which drug best reduces symptoms in Bronchiolitis syndrome. The primary objective of our study is to establish comparative effect of adrenaline nebulisation alone and combination of adrenaline nebulisation plus injectable dexamethasone and adrenaline nebulisation plus fluticasone nebulisation in the treatment of clinical cases of bronchiolitis. Methods: 100 patients diagnosed clinically as bronchiolitis were enrolled in study from 1 month to 24 months of age. Patients were enrolled by purposive sampling. Patients with respiratory distress assessment instrument score [RDAI] of 4 to 15 were chosen, randomized into three groups and treatment given till patient fullfilled discharge criteria. Group A (n=33) were given nebulised adrenaline alone, Group B (n=34) were given nebulised adrenaline plus injectable dexamethasone and Group C (n=33) were given nebulised adrenaline plus nebulised fluticasone. Results: The mean reduction in clinical severity-RDAI score was 1.75 ±0.86 in Group A, 2.30 ± 0.68 in Group B and 1.42 ± 0.9 in Group C when measured in terms of difference in clinical scores between day 1 and 2 (p=0.0003). Mean duration of hospital stay in the group A was (4.93±1.95 days), Group C (4.78±1.83) and Group B (3.91 ±1.37 days). The difference of stay between the Groups A and B was 1.02±0.58 days vs 0.87± 0.46 days in groups B and C (p-0.0048). Reduction in the length of hospital stay in group B was 22% compared to Group A & 19% compared to Group C (p-0.0048). Side effects were tachycardia in six patients. Conclusion: Combination of adrenaline nebulization and injectable dexamethasone was found significantly better as compared to nebulised adrenaline plus nebulised fluticasone and nebulised adrenaline alone in patients of clinical bronchiolitis in reducing severity of clinical symptoms and duration of hospitalization.

scholarly journals Comparison of early versus late enteral feeding following gut anastomosis.

2020 ◽  
Vol 27 (12) ◽  
pp. 2548-2552
Author(s):  
Zohra Jabeen ◽  
Ramlah Ghazanfor ◽  
Muhammad Usman Akram ◽  
Sara Malik ◽  
Maham Tariq ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enteral Feeding ◽  
Oral Feeding ◽  
P Value ◽  
Age Group ◽  
Bowel Sounds ◽  
Early Oral Feeding ◽  
Group A ◽  
Group B ◽  
Mean Time

Objectives: To compare early feeding versus late enteral feeding following gut anastomosis in term of hospital stay. Study Design: Prospective Randomized Control study. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi. Period: April to October 2017. Material & Methods: All patients, excluding paediatric age group (n= 60) undergoing emergency or non-emergency gut resection with primary anastomosis were incorporated. Two strata were devised. Group A (n=30) received early enteral feeding starting at 12th post-operative hours in form of 100-150ml fluid thrice daily. Group B endured being Nil per oral for 72hrs. Both groups were correlated for timing of return of bowel sounds and timespan of hospital stay. P value < 0.05 was considered noteworthy. Results: Overall 60 patients with 30 in each group were incorporated. They were predominantly males (55%) and belonged to middle age group (Group A=31.73+10.78 years; Group B= 36.00+10.53 years). Mean time for return of bowel sounds in both the groups was 24.40+5.88 hours and 35.20+10.88 hours respectively, which was striking (p value <0.05). Mean length of hospital stay in both the groups was also noteworthy i.e. 5.23+0.72 days and 6.40+1.67 days respectively. Conclusion: In the wake of gut anastomosis, early oral feeding at 12hours is superior to delayed oral feeding after 72hours, in terms of mean time for return of bowel sounds and period of hospital stay.

scholarly journals Compare outcome in patients of ileostomy and colostomy closure with surgical stapler versus ileostomy and colostomy closure with hand sewn anastomosis: a prospective study

2020 ◽  
Vol 7 (10) ◽  
pp. 3256
Author(s):  
Vikram B. Gohil ◽  
Jenil Y. Bhatt ◽  
Samir M. Shah ◽  
Rijuta Aphale
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Anastomotic Leak ◽  
Oral Intake ◽  
Anastomosis Group ◽  
Distal Anastomosis ◽  
Colostomy Closure ◽  
Stoma Closure ◽  
Group A ◽  
Group B

Background: Diverting temporary stoma is created to protect the primary bowel pathology and distal anastomosis. Once that primary pathology has been overcome or distal anastomosis gets healed, closure of temporary stomas can be carried out. Invention of stapling devices for intestinal anastomosis provided another dimension than hand sewn method to the stoma closure techniques. In this study, we have compared two methods of loop stoma closure-hand sewn method versus stapler method.Methods: This is prospective comparative study in which 50 cases of loop ileostomy/colostomy were taken. 25 patients underwent ileostomy/colostomy closure by hand sewn anastomosis (group A). Another 25 patients underwent ileostomy/colostomy closure by stapler anastomosis (group B). Time taken for operation, initiation of oral intake, anastomotic leak, post-operative wound infection and total hospital stay duration were compared between these two groups to conclude about which method is superior and in the best interest of patient and surgeon.Results: Mean operation time 105.96 minutes (group A) and 72.84 minutes (group B). Mean time to start oral intake 5.36 days (group A), 3.6 days (group B). 16% patients (4/25) group A and 4% patients (1/25) group B developed anastomotic leak. 28% patients (7/25) group A and 8% patients (2/25) group B had post-operative wound infection. Mean hospital stay 10.4 days in group A and 7.84 days in group B.Conclusions: Stapler method provides significant benefits in terms of less operative time, early oral intake and less hospital stay. Overall stapler method for stoma closure is more efficient and cost effective.

scholarly journals COMPARISON OF MINI CHOLECYSTECTOMY VERSUS OPEN CHOLECYSTECTOMY IN PATIENTS WITH CHOLELITHIASIS

2020 ◽  
Vol 11 (2) ◽  
pp. 34-42
Author(s):  
Dr. Uzair Karim Qasrani
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Teaching Hospital ◽  
Severe Pain ◽  
Controlled Trial ◽  
Open Cholecystectomy ◽  
Data Entry ◽  
P Value ◽  
Group A ◽  
Group B

ABSTRACT Objectives: The objective of this study is to compare the outcome of mini cholecystectomy with open conventional cholecystectomy in the management of cholelithiasis. Study Design: This was a randomized controlled trial. Study Period: Study was conducted in  Department Of Surgery, Teaching Hospital Dera Ghazi Khan, from June 2017 to Dec 2017 for a period of six month.   Patients and Methods: A total of 100 cases; 50 cases in each group was included in the study. 100 patients were admitted from OPD of Teaching Hospital Dera Ghazi Khan fulfilling inclusion criteria. Demographic information was recorded. All admitted patients were diagnosed on the basis of history, clinical examination and relevant investigations. Written consent was obtained. Data entry and analysis was done by using SPSS 11. Data was analyzed according to the proposed analysis plan.   Results: Mean age of all patients was 39.96±3.84 years. Age range of patients was 30-48 years. In Group-A mean hospital stay was 5.38±1.15 and in Group-B mean hospital stay was 3.02±0.58 days respectively. At 1st visit 14(28%) patients in Group-B and only 1(2%) patient in Group-A had wound infection. According to p-value wound infection was significantly associated with treatment group. Patients in Group-A had less infection rate as compared to Group-B patients. i.e. (p-value=0.000) Whereas at 2nd visit 8(16%) patients in Group-B and 3 patients in Group-A suffered from wound infection. At 2nd visit wound infection was statistically same in both treatment groups. i.e. (p-value=0.110). It was observed that in Group-B only 44(88%) of the patients had severe pain whereas only 12(24%) of the patients in Group-A had severe pain. Keeping in mind this results rate of severe pain at 12th hour was high in Group-B patients as compared to Group-A patients. i.e. (p-value=0.000).   Conclusion:  Mini cholecystectomy is effective and associated with less patients discomfort in terms of post operative pain and infection as well as with less hospital stay.

scholarly journals Evaluation of the use of subcutaneous drains to prevent wound complications in abdominal surgeries

2018 ◽  
Vol 5 (4) ◽  
pp. 1368
Author(s):  
G. V. Manoharan ◽  
T. Sivakumar ◽  
M. Ashok Kumar
Keyword(s):  
Hospital Stay ◽  
Abdominal Wall ◽  
Subcutaneous Tissue ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Skin Closure ◽  
Abdominal Wall Closure ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Wound complications like surgical site infections (SSI) and wound dehiscence are common following abdominal surgery for peritonitis. Drains have been used to remove collections from the early days of surgery. The use of drains to remove subcutaneous collections to prevent wound complications needs to be studied.Methods: Sixty patients who underwent surgery for peritonitis were selected for the study. 30 patients underwent conventional abdominal wall closure while the other 30 had suction drains inserted in the subcutaneous tissue. Wounds were observed for complications and time for healing.Results: The incidence of SSI was significantly less in Group A (23%) than in Group B (60%). Similarly, wound dehiscence occurred in 43% of SSI cases in Group A as against 89% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (9 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay. 

scholarly journals Protective Effect of Enterococcus faecium SF68 and Saccharomyces boulardii in Acute Severe Diarrhea in Infants: Randomized Controlled Trial

Esculapio ◽  
2021 ◽  
Vol 16 (4 (oct 2020 - dec 2020)) ◽  
Author(s):  
Fariha Ahmad Khan ◽  
Muhammad Zeeshan Khan ◽  
Abdul Mudabbir Rehan ◽  
Zoobia Irum ◽  
Fouzia Perveen ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enterococcus Faecium ◽  
Standard Treatment ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Saccharomyces Boulardii ◽  
Severe Diarrhea ◽  
Randomized Controlled ◽  
Group A ◽  
Group B

Objectives: This study was done to observe the effect of Enterococcus faecium SF68 and Saccharomyces boulardii in acute severe diarrhea in infants. Methods: It was a single blind, randomized controlled clinical trial done in Children Hospital, Lahore. The infants were selected between 6 months to 12 months of age. All the infants were suffering from acute diarrhea with severe dehydration. Total 105 infants were selected and randomly divided into three groups having 35 infants in each group. Infants in group A received standard treatment of diarrhea. Infants in group B and C received Enterococcus faecium SF68 and Saccharomyces boulardii respectively twice daily for five days along with standard treatment of diarrhea. All the infants were monitored for five days. The treatment response was observed in terms of frequency of diarrhea, duration of diarrhea, stool consistency and length of hospital stay. Results: The frequency of diarrhea, duration of diarrhea and length of hospital stay were significantly reduced in both group B and C as compared to group A. Conclusion: Enterococcus faecium SF68 and Saccharomyces boulardii helped to reduce the stool frequency, duration of diarrhea, length of hospital stay and also improved the stool consistency in acute severe diarrhea in infants. Key Words: Probiotics, Enterococcus faecium SF68, Saccharomyces boulardii, Acute severe Diarrhoea How to Cite: Ahmad F.K, Zeeshan M.K, Mudabbir A.R, Irum Z, Perveen F, Chiragh S. Protective Effect of Enterococcus Faecium Sf68 and Saccharomyces Boulardii in Acute Severe Diarrhea in Infants: Randomized Controlled Trial. Esculapio.2020;16(04):59-65.

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