Is postoperative transanastomotic feeding beneficial in neonates with congenital duodenal obstruction?

Purpose We aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal obstruction (CDO). Methods This is a retrospective study reviewing medical records of neonates operated for CDO during 2003–2020 and comparing postoperative feeding outcomes and complications in patients with and without TAFT. Approval from the hospital’s data protection officer was obtained. Results One hundred patients, 59% girls, were included, and 37% received TAFT. Mean birth weight and gestational age were 2628 (675.1) grams and 36.6 (2.4) weeks, respectively. Furthermore, 45% had no other malformations, and 36% had Down syndrome. Patient demographics were similar for TAFT and not-TAFT patients, except that not-TAFT neonates weighed median 335 g less (p = 0.013). The TAFT group got parenteral nutrition 2 days shorter (p < 0.001) and started enteral feeds 1.5 days earlier (p < 0.001) than the not-TAFT group. Fewer neonates with TAFT got a central venous catheter [65 vs 89%, (p = 0.008)]. In the TAFT group, 67% were breast fed at discharge compared to 49% in the not-TAFT group (p = 0.096). Conclusion Neonates with TAFT had earlier first enteral feed, fewer days with parenteral nutrition and fewer placements of central venous catheters.

Risk factors of early postoperative bowel obstruction for patients undergoing selective colorectal surgeries

Objective Postoperative bowel obstruction was one of the most severe complications in patients who received colorectal surgeries. This study aimed to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods The records of 1437 patients who underwent elective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 were retrospectively collected. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed robust discrimination, with the area under the receiver operating characteristic curve was 0.894 and was well-calibrated. Conclusion A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.

Risk Factors of Early Postoperative Bowel Obstruction for Patients Undergoing Selective Colorectal Surgeries

Objective: Postoperative bowel obstruction was one of the most severe complications in patients received colorectal surgeries. The aim of this study was to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods: The records of 1437 patients who underwent selective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 was retrospectively collect. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results: COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed a robust discrimination, with area under the receiver operating characteristic curve was 0.894 and was well calibrated. Conclusion: A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.

Digestion-Specific Acupuncture Effect on Feeding Intolerance in Critically Ill Post-Operative Oral and Hypopharyngeal Cancer Patients: A Single-Blind Randomized Control Trial

Malnourishment is prevalent in patients suffering from head and neck cancer. The postoperative period is crucial in terms of nutritional support, especially after composite resection and reconstruction surgery. These patients present with a number of risk factors that aggravate feeding intolerance, including postoperative status, prolonged immobility, decreased head elevation, mechanical ventilation, and applied sedative agents. Routine management protocols for feeding intolerance include prokinetic drug use and post-pyloric tube insertion, which could be both limited and accompanied by detrimental adverse events. This single-blind clinical trial aimed to investigate the effects of acupuncture in postoperative feeding intolerance in critically ill oral and hypopharyngeal cancer patients. Twenty-eight patients were randomized into two groups: Intervention group and Control group. Interventions were administered daily over three consecutive postoperative days. The primary outcome revealed that the intervention group reached 70% and 80% of target energy expenditure (EE) significantly earlier than the control group (4.00 ± 1.22 versus 6.69 ± 3.50 days, p = 0.012), accompanied by higher total calorie intake within the first postoperative week (10263.62 ± 1086.11 kcals versus 8384.69 ± 2120.05 kcals, p = 0.004). Furthermore, the intervention group also needed less of the prokinetic drug (Metoclopramide, 20.77 ± 48.73 mg versus 68.46 ± 66.56 mg, p = 0.010). In conclusion, digestion-specific acupuncture facilitated reduced postoperative feeding intolerance in oral and hypopharyngeal cancer patients.

Perioperative Management of Cleft Lip Repair: A Meta-Analysis and Clinical Practice Guideline

Objective: Few studies have focused on perioperative management of cleft lip repair. We sought to evaluate the available data on this topic to create evidence-based clinical guidelines. Design: Systematic review, meta-analysis. Methods: A PubMed search was performed focusing on perioperative management of cleft lip repair. Studies were included if they included comparative data. A systematic review and meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Main Outcome Measures: Systematic review of literature regarding wound closure, postoperative arm restraints, perioperative antibiotics, outpatient or ambulatory surgery, or feeding restrictions postoperatively. Results: Twenty-three articles met inclusion criteria after initial screening of 3103 articles. This included 8 articles on wound closure, 2 on postoperative restraints, one on perioperative antibiotics, 6 on outpatient surgery, and 6 on postoperative feeding. Meta-analysis could be performed on dehiscence rates with postoperative feeding regimen and readmission rates after outpatient versus inpatient lip repair. There were few studies with low risk of bias. Outpatient cleft lip repair does not increase readmission (odds ratio [OR]: 0.92, 95% CI: 0.28-3.07). Allowing postoperative breastfeeding or bottle-feeding does not increase dehiscence (OR: 0.61, 95% CI: 0.19-1.95). There was no evidence of publication bias. Conclusion: Within the limitations of available data, there is no evidence of a clearly superior closure material. The evidence does not support use of postoperative arm restraints. The evidence does not support the use of preoperative nasal swabs for antibiotic guidance. With careful patient selection, outpatient cleft lip repair appears safe. The evidence supports immediate breastfeeding or bottle-feeding after cleft lip repair.

Alimentação precoce no pós-operatório de cirurgias digestivas

Objetivo: Avaliar os benefícios da alimentação precoce no pós-operatório de cirurgias digestivas. Métodos: Trata-se de uma revisão integrativa de literatura cujo tema foi pesquisado na base de dados da Scielo e Pubmed através dos descritores “alimentação no pós-operatório” e “postoperative feeding”, respectivamente, sendo incluídos artigos com pacientes maiores de 18 anos e sem restrição à data de publicação. Resultados: A revisão dos artigos selecionados evidenciou que o manejo tradicional da alimentação pós-operatória está ultrapassado e a formulação dos novos protocolos como Enhanced Recovery After Surgery (ERAS) e Aceleração da Recuperação Total Pós-Operatória (ACERTO) possibilitam uma mudança benéfica nessa conduta. A alimentação precoce no pós- operatório é responsável por acelerar a recuperação do paciente, bem como, por reduzir os custos hospitalares durante a internação do paciente. Esses benefícios são constatados tanto em cirurgias abertas quanto em videocirurgias. Outro aspecto importante é a região anatômica do procedimento, sendo as cirurgias colorretais as mais estudadas e com resultados positivos mais consistentes. Considerações Finais: A alimentação precoce no pós-operatório de cirurgias colorretais e cirurgias digestivas altas é segura, reduzindo a morbimortalidade e o tempo de internação hospitalar.

Changes in bowel sounds of inpatients undergoing general anesthesia

Background: General anesthesia can affect intestinal function, but there is no objective, practical and effective indicator to evaluate the inhibition and recovery of intestinal function. The main objectives of this study were to assess whether bowel sounds (BSs) changed before, immediately after and 3 hours after general anesthesia, and whether these changes in BSs are an effective indicator of intestinal function and an accurate guide for post-operative feeding. Methods: We randomly selected 26 inpatients and collected three sets of 5-minute continuous BS data before the operation (Pre-op), immediately after the operation (Pro-op) and three hours after the operation (3h-Pro-op) for each patient. Then the linear and nonlinear characteristic values (CVs) of each effective bowel sound were extracted and paired t-tests and rank-sum tests were used to evaluate the changes in the BSs. Results: The differences in CVs, between Pre-op and Pro-op, as well as between Pro-op and 3h-Pro-op, were statistically significant (p <0.05). However, there is no statistically significant differences between all the CVs between Pre-op and 3h-Pro-op (p >0.05). Conclusion: BSs changes before and after general anesthesia. Furthermore, the BSs are weakened due to general anesthesia and recover to the pre-op state three hours later. Therefore, the BSs can be an indicator of intestinal function under general anesthesia, so as to provide guidance for postoperative feeding, which is of considerable clinical significance.

Changes in bowel sounds of inpatients undergoing general anesthesia

Background: General anesthesia can affect intestinal function, but there is no objective, practical and effective indicator to evaluate the inhibition and recovery of intestinal function. The main objectives of this study were to assess whether bowel sounds (BSs) changed before, immediately after and 3 hours after general anesthesia, and whether these changes in BSs are an effective indicator of intestinal function and an accurate guide for post-operative feeding. Methods: We randomly selected 26 inpatients and collected three sets of 5-minute continuous BS data before the operation (Pre-op), immediately after the operation (Pro-op) and three hours after the operation (3h-Pro-op) for each patient. Then the linear and nonlinear characteristic values (CVs) of each effective bowel sound were extracted and paired t-tests and rank-sum tests were used to evaluate the changes in the BSs. Results: The differences in CVs, between Pre-op and Pro-op, as well as between Pro-op and 3h-Pro-op, were statistically significant (p <0.05). However, there is no statistically significant differences between all the CVs between Pre-op and 3h-Pro-op (p >0.05). Conclusion: BSs changes before and after general anesthesia. Furthermore, the BSs are weakened due to general anesthesia and recover to the pre-op state three hours later. Therefore, the BSs can be an indicator of intestinal function under general anesthesia, so as to provide guidance for postoperative feeding, which is of considerable clinical significance.

Modified Intravascular Interventional Operation of Balloon-Bound Elastase Induction Method to Establish Rabbit Aneurysm Model Using Cardiovascular Angiography

Objective: In this paper, we establish a simple, efficient and stable rabbit aneurysm model using modified intravascular interventional operation of balloon-bound elastase induction method. Methods: We selected 20 healthy adult New Zealand white rabbits. An aortic aneurysm model of rabbit right common carotid artery was established by modified intravascular interventional balloon-binding elastase induction method using cardiovascular angiography. The cerebral angiography confirmed the model successfully after 4 weeks. Some animals were given paraffin-embedded H-E staining and elastic fiber staining after sacrifice. Angiography was performed for all experiments to build our models and to confirm our findings. Results: Two rabbits died during postoperative feeding, and the remaining 18 rabbits were cultured for 4 weeks and confirmed by angiography to make an aneurysm model. The success rate of aneurysm was 90%, the diameter of the tumor-bearing artery was 3.12±0.20, the short diameter of the tumor was 3.41±0.88, the long diameter of the tumor was 6.30±1.65, and the width of the neck was 3.49±0.80. HE pathology showed that the destruction of the elastic layer of the aneurysm disappeared, similar to the pathological changes of human aneurysms. Conclusions: The rabbit model of aneurysm was established by modified intravascular intervention combined with elastase induction based on angiography. It is similar to human aneurysm in morphology, histology and hemodynamics. The method is simple, the damage is small, the aneurysmal formation rate is high, and the performance is high. Stable and reliable, low production cost, it is an ideal animal model for the development of preclinical neurological interventional devices.

Changes in bowel sounds of inpatients undergoing general anesthesia

Background: General anesthesia can affect intestinal function, but there is no objective, practical and effective indicator to evaluate the inhibition and recovery of intestinal function. The main objectives of this study were to assess whether bowel sounds (BSs) changed before, immediately after and 3 hours after general anesthesia, and whether these changes in BSs are an effective indicator of intestinal function and an accurate guide for post-operative feeding. Methods: We randomly selected 26 inpatients and collected three sets of 5-minute continuous BS data before the operation (Pre-op), immediately after the operation (Pro-op) and three hours after the operation (3h-Pro-op) for each patient. Then the linear and nonlinear characteristic values (CVs) of each EBS were extracted and paired t -tests and rank-sum tests were used to evaluate the changes in the BSs. Results: The differences in CVs, between Pre-op and Pro-op, as well as between Pro-op and 3h-Pro-op, were statistically significant ( p <0.05). However, there is no statistically significant differences between all the CVs between Pre-op and 3h-Pro-op ( p >0.05). Conclusion: BSs changes before and after general anesthesia. Furthermore, the BSs are weakened due to general anesthesia and recover to the pre-op state three hours later. Therefore, the BSs can be an indicator of intestinal function under general anesthesia, so as to provide guidance for postoperative feeding , which is of considerable clinical significance.