Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
-
J. Gastrointest. Surg. · Apr 2009
Review Meta AnalysisIs gum chewing useful for ileus after elective colorectal surgery? A systematic review and meta-analysis of randomized clinical trials.
The evaluation of the usefulness of gum chewing for postoperative ileus has given inconclusive results. We evaluated the efficacy of gum chewing in the treatment of ileus after elective colorectal surgery. ⋯ In patients with ileus after colonic surgery, gum chewing in addition to standard treatment significantly reduces the time to first flatus and the time to first passage of feces when compared to standard treatment alone. There is also a trend to reduce the length of hospital stay. Gum chewing should be added to the standard treatment of these patients.
-
J. Gastrointest. Surg. · Apr 2009
Comparative StudyReduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy.
Metaanalysis of retrospective studies employing various definitions of pancreatic fistulas demonstrated a reduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy. Prospective trials failed to do so, which causes an ongoing debate on the superiority of one or the other procedure. The aim of this study was to compare the two types of anastomosis at our institution with regard to postoperative pancreatic fistula and other complications. ⋯ Surgeons should be aware of a higher rate of delayed gastric emptying and perform meticulous hemostasis to prevent intraluminal bleeding with pancreatogastrostomy. Pancreatogastrostomy is superior to pancreaticojejunostomy in terms of relevant postoperative pancreatic fistula.
-
J. Gastrointest. Surg. · Apr 2009
Hemorrhage-induced hepatic injury and hypoperfusion can be prevented by direct peritoneal resuscitation.
Crystalloid fluid resuscitation after hemorrhagic shock (HS) that restores/maintains central hemodynamics often culminates in multi-system organ failure and death due to persistent/progressive splanchnic hypoperfusion and end-organ damage. Adjunctive direct peritoneal resuscitation (DPR) using peritoneal dialysis solution reverses HS-induced splanchnic hypoperfusion and improves survival. We examined HS-mediated hepatic perfusion (galactose clearance), tissue injury (histopathology), and dysfunction (liver enzymes). ⋯ CR from HS restored and maintained central hemodynamics but did not restore or maintain liver perfusion and was associated with significant hepatocellular injury and dysfunction. DPR added to conventional resuscitation (blood and crystalloid) restored and maintained liver perfusion, prevented hepatocellular injury and edema, and preserved liver function.