Early Versus Delayed Oral Feeding in Emergency Gastrointestinal Surgeries.

BACKGROUND: Early postoperative oral feeding has been documented to improve outcomes in patients who have undergone open or laparoscopic elective bowel surgeries. Available data on the safety and outcomes of early postoperative oral feeding in patients who underwent emergency gastrointestinal surgeries are inconclusive. OBJECTIVE: This study was conducted to compare and determine the safety, benefits and outcomes of early postoperative oral feeding and delayed oral feeding after emergency gastrointestinal surgeries. METHODS: Sixty patients who underwent emergency gastrointestinal surgeries were randomized either into the early feeding group (EFG) or the delayed feeding group (DFG). The patients in EFG commenced a graded oral liquid diet on postoperative day 1 (POD 1) while patients in DFG were commenced on a graded oral diet after the return of bowel function. The main endpoints were the need to re-insert the nasogastric tube and the overall length of hospital stay. RESULTS: The mean age of patients in the EFG and DFG were similar ((33.2±8.94 versus 33.9±8.91; p= 0.7407). Seventeen (56.7%) patients in EFG failed to tolerate early oral feeding compared to 8 (26.7%) patients in DFG who failed to tolerate feeding following the commencement of oral feeding (p= 0.036). Of the patients that were unable to tolerate oral feeding; thirteen (76.5%) of the 17 patients in EFG required re-insertion of NG tube for stomach decompression as compared to two (25%) of the 8 patients in DFG (p=0.0441). The mean length of hospital stay was longer in EFG (9±2.34 vs 6.5±1.04; p<0.001). CONCLUSION: Early postoperative oral feeding in patients who underwent emergency gastrointestinal surgeries was associated with a high failure rate and increased risk of postoperative complications with a prolonged length of hospital stay.

CONTEXTE: L'alimentation orale précoce après une intervention chirurgicale a été documentée pour améliorer les résultats chez les patients ayant subi des chirurgies électives ouvertes ou laparoscopiques de l'intestin. Les données disponibles sur la sécurité et les résultats de l'alimentation orale précoce chez les patients ayant subi des chirurgies gastro-intestinales d'urgence sont inconclusives. OBJECTIF: Cette étude a été menée pour comparer et déterminer la sécurité, les avantages et les résultats de l'alimentation orale précoce et retardée après des chirurgies gastro-intestinales d'urgence. MÉTHODES: Soixante patients ayant subi des chirurgies gastrointestinales d'urgence ont été randomisés soit dans le groupe d'alimentation précoce (EFG), soit dans le groupe d'alimentation retardée (DFG). Les patients du groupe EFG ont commencé un régime liquide oral progressif dès le premier Jour 1 postopératoire (JPO 1), tandis que les patients du groupe DFG ont commencé un régime oral progressif après le retour de la fonction intestinale. Les principaux critères d'évaluation étaient la nécessité de réinsérer la sonde nasogastrique et la durée totale de l'hospitalisation. RÉSULTATS: L'âge moyen des patients dans les groupes EFG et DFG était similaire (33,2±8,94 contre 33,9±8,91; p=0,7407). Dixsept (56,7%) patients du groupe EFG n'ont pas toléré l'alimentation orale précoce, contre 8 (26,7%) patients du groupe DFG qui n'ont pas toléré l'alimentation après le début de l'alimentation orale (p=0,036). Parmi les patients incapables de tolérer l'alimentation orale, treize (76,5%) des 17 patients du groupe EFG ont nécessité une réinsertion de la sonde nasogastrique pour décompression gastrique, contre deux (25%) des 8 patients du groupe DFG (p=0,0441). La durée moyenne de l'hospitalisation était plus longue dans le groupe EFG (9±2,34 contre 6,5±1,04; p<0,001). CONCLUSION: L'alimentation orale précoce chez les patients ayant subi des chirurgies gastro-intestinales d'urgence était associée à un taux d'échec élevé et à un risque accru de complications postopératoires, avec une prolongation de la durée de l'hospitalisation. Mots-clés: Postopératoire, Alimentation orale précoce, Alimentation orale retardée, Chirurgie intestinale.

Treatment of colorectal cancer in Sub-Saharan Africa: Results from a prospective Nigerian hospital registry.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer worldwide. Mortality for CRC is improving in high income countries, but in low and middle income countries, rates of disease and death from disease are rising. In Sub-Saharan Africa, the ratio of CRC mortality to incidence is the highest in the world. This study investigated the nature of CRC treatment currently being offered and received in Nigeria. METHODS: Between April 2013 and October 2017, a prospective study of consecutively diagnosed cases of CRC was conducted. Patient demographics, clinical features, and treatment recommended and received was recorded for each case. Patients were followed during the study period every 3 months or until death. RESULTS: Three hundred patients were included in our analysis. Seventy-one percent of patients received a recommended surgical operation. Of those that didn't undergo surgery as recommended, 37% cited cost as the main reason, 30% declined due to personal reasons, and less than 5% absconded or were lost to follow up. Approximately half of patients (50.5%) received a chemotherapy regimen when it was recommended, and 4.1% received radiotherapy when this was advised as optimal treatment. With therapy, the median overall survival for patients diagnosed with stage III and stage IV CRC was 24 and 10.5 months respectively. Overall, we found significantly better median survival for patients that received the recommended treatment (25 vs 7 months; P < .01). CONCLUSIONS: A number of patients were unable to receive the recommended treatment, reflecting some of the burden of untreated CRC in the region. Receiving the recommended treatment was associated with a significant difference in outcome. Improved healthcare financing, literacy, training, access, and a better understanding of tumor biology will be necessary to address this discrepancy.