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1.
BJS Open ; 7(2)2023 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-37021546

RESUMO

BACKGROUND: The potential of haemostatic patches to reduce the rate of postoperative pancreatic fistula remains unclear. The aim of this trial was to evaluate the impact of a polyethylene glycol-coated haemostatic patch on the incidence of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. METHODS: In this randomized, single-centre, clinical trial, patients undergoing pancreatoduodenectomy were randomized 1 : 1 to receive pancreatojejunostomy reinforced with two polyethylene glycol-coated haemostatic patches (patch group) or without any reinforcement (control group). The primary outcome was clinically relevant postoperative pancreatic fistula, defined as grade B/C according to International Study Group of Pancreatic Surgery criteria, within 90 days. Key secondary outcomes were length of hospital stay, total rate of postoperative pancreatic fistula, and overall complication rate. RESULTS: From 15 May 2018 to 22 June 2020, 72 patients were randomized, and 64 were included in the analyses (31 in the patch group and 33 in the control group). The risk of clinically relevant postoperative pancreatic fistula was reduced by 90 per cent (OR 0.10, 95 per cent c.i. 0.01 to 0.89, P = 0.039). Moreover, the use of the polyethylene glycol-coated patch retained its protective effect on clinically relevant postoperative pancreatic fistula in a multivariable regression model, significantly reducing the risk of clinically relevant postoperative pancreatic fistula by 93 per cent (OR 0.07, 95 per cent c.i. 0.01 to 0.67, P = 0.021), regardless of patient age, sex, or fistula risk score. The incidence of secondary outcomes did not significantly differ between the groups. One patient died within 90 days in the patch group versus three patients in the control group. CONCLUSIONS: A polyethylene glycol-coated haemostatic patch reduced the incidence of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. REGISTRATION NUMBER: NCT03419676 (http://www.clinicaltrials.gov).


Assuntos
Hemostáticos , Fístula Pancreática , Humanos , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Pâncreas , Pancreaticojejunostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia
2.
Arch. Fac. Med. Zaragoza ; 44(2): 83-92, ago. 2004. ilus
Artigo em Espanhol | IBECS | ID: ibc-126875

RESUMO

Existe una elevada incidencia de desnutrición en los pacientes quirúgircos debido al periodo de dieta absoluta previa a la cirugía y a las complicaciones postoperatorias que inducen un estado hipercatabólico. La malnutrición además, es un factor precipitante para la aparición de complicaciones en el postoperatorio. Por esto cobra un especial interés el soporte nutricional del paciente tanto antes, como después de la cirugía, ya que se ha demostrado que la nutrición peri-operatoria reduce la morbimortalidad postoperatoria. En este documento, realizamos una revisión de la literatura sobre el estado actual de la nutrición postopeatoria, su tipos, ventajas, beneficios e indicaciones de cada una de ellas (AU)


There is a high incidence o malnutrition in surgical patients due to presurgery period and psotoperative complications that originate an hypercatabolic status. Besides, malnutrition induces itself the appearance of complications in the postoperatory. that is why artificial nutrition gets an important interest, because it has been proved that perioperative nutrition support, reduces surgical complications and mortality. In this paper, were make a revision about current state of postoperatory nutrition, its types, their advantages and benefits (AU)


Assuntos
Humanos , Desnutrição/prevenção & controle , Avaliação Nutricional , Estado Nutricional/fisiologia , Complicações Pós-Operatórias/prevenção & controle , Apoio Nutricional/métodos , Prática Clínica Baseada em Evidências/métodos
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