Routine Use of Feeding Jejunostomy in Pancreaticoduodenectomuy: A Metaanalysis

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.

Profile of fungal septicaemia in new born at a tertiary care hospital in North India

Background: Advances in neonatal management have led to considerable improvement in new-born survival. The objective of this study was to determine the predominant organisms, antifungal sensitivity patterns and clinical risk factors in neonatal fungal blood stream infection cases (BSI) admitted to our hospital.Methods: This is a retrospective study of all neonatal fungal BSI cases between January 2015 to December 2015.Results: Fungal sepsis was found in 50/360 (13.6%) of cases. Non Albicans candida (NAC)species were responsible for 88% of cases with Candida. glabrata (54%)as the most predominant species. Other species isolated were C. tropicalis 9 (18%). C. albicans 6 (12%). C. paraspinolosis 5 (10%), C. Krusei 2 (4%) and C. Kodo1 (2%). Antifungal sensitivity results revealed that most of the NAC isolates especially candida glabrata,candida paraspinolosis were resistant to flucanazole, than Candida albicans. Amphoterician B had greater sensitivity than FLK over NAC species Among the risk factor observed for candidemia were low birth weight (62%), prematurity (60%,), broad spectrum antibiotic use (60%), ventilater support (56%) and total parentral nutrition (50%).Conclusions: The increase in neonatal fungal BSI and resistant organisms highlights the need to review use of strict infection control strategies, appropriate preventive and therapeutic measures such as prophylactic antifungal use and a restrictive policy of antibiotic use.

Role of preoperative nutrition in gastro-intestinal cancer patients: a prospective study

Background:This prospective study was carried out to compare outcome and postoperative complication in patients with gastro-intestinal malignancy who received preoperative total parentral nutrition with those whom doesn’t.Methods: The study was a prospective single-centre, two-arm, conducted in department of general surgery, Gandhi Medical College and Associated Hamidia Hospital, Bhopal, Madhya Pradesh, India of one year duration, a total of 60 patients with G. I. malignancy, with or without sign of malnutrition, were included in the study. Patients were randomized and 30 patients were placed in each arm (interventional and control group) patients in the control group were asked to continue their normal feeding while interventional arm were given TPN in addition to their normal diet, for 7 to 10 days before surgery.Results:Infectious complications were more in control group, while one case each of pneumonia and sepsis was observed in patients receiving supplementation. Complications related to nutritional status of the patient like wound infection and anastomotic leak were observed only in patients without supplementation. There was no death observed in interventional group but two deaths occurred in control group.Conclusions:Preoperative nutritional support is beneficial and should be routinely used in abdominal and gastrointestinal cancer patient with or without clinical signs of malnutrition.

TOTAL PARENTERAL NUTRITION

Surgical patients often present with conditions that have eitherimpaired ability to maintain their nutrition before operation or have made it impossible for them to obtain optimalnourishment by conventional means after surgical intervention. As rationing of the health care services became anincreasing reality, the pressure to justify intervention such as nutrition support was intensified. The study was designedto see the indications, management and anticipated complications of total parentral nutrition in adult surgical patients.Design: Retrospective controlled study. Place and Duration of Study: During August 1997 to August 1998 at surgicaldepartment Pakistan Naval Ship (PNS) Hospital Shifa Karachi. Material and Methods: 30 indoor patients wereselected. They were divided into three groups according to the pathological entities. After assessing nutritional status,providing emergency treatment of relative pathology and calculating calories, central line was maintained byapproaching subclavian (76.6%), femoral or antecubital vein. TPN was monitored, clinically and with laboratoryinvestigations. Results: The group-I lagged approximately three days behind the others in achieving goal calories.Weight gain in most of the patients was significant after two weeks. Initially all three groups showed hyperglycemia,which was tapered by regular insulin over a Period of 3 to 3.5 days and rescheduling the nutrient substrates. Albumindid not change significantly. Catheter sepsis was evident in third group. Conclusion: It was concluded that Judicioususe of TPN by thoughtful and conscientious nutritionist surgeons in surgical patients decreased morbidity/mortality rate,improved quality of life, with smooth recovery, convalescence and rehabilitation, decreased hospital stay andacceptable cost: benefit ratio.