RESUMO
Background: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. Aim: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. Patients and Methods: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. Results: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%. The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. Conclusions: In these patients, surgical complications were common, although with low mortality.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Hepática Terminal , Índice de Gravidade de Doença , Chile/epidemiologia , Procedimentos Cirúrgicos Eletivos , Cirrose Hepática/cirurgia , Cirrose Hepática/complicaçõesRESUMO
BACKGROUND: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. AIM: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. PATIENTS AND METHODS: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. RESULTS: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%. The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. CONCLUSIONS: In these patients, surgical complications were common, although with low mortality.
Assuntos
Doença Hepática Terminal , Idoso , Chile/epidemiologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Total parenteral nutrition has a high cost and frequency of complications. Enteral feeding is a feasible alternative that can be started early in the postoperative period. AIM: To assess digestive tolerance to early enteral feeding in cancer patients undergoing total gastrectomy and to compare early enteral feeding (EEF) with total parenteral nutrition plus enteral feeding (TPN + EF), initiated after overcoming postoperative ileus. PATIENTS AND METHODS: Subjects with a resectable gastric cancer were considered eligible for the study. During surgery a nasoenteral tube was placed and patients were prospectively randomized to EEF or TPN + EF. Digestive tolerance, effectiveness, complications and costs between both modalities of nutritional support were compared. RESULTS: Twenty eight patients (15 male, aged 63 +/- 14 years old) were studied. Fourteen patients were randomized to EEF and 14 to TPN + EF. Diarrhea occurred in 14 and 29% of EEF and TPN + EF patients respectively, (p: NS). Patients with TPN + EF received an average of 28 Cal/kg/day and 1.1 g/kg/day proteins. Patients with EEF received an average of 29 Cal/kg/day and 0.8 g/kg/day proteins. At the eighth postoperative day, serum albumin was 3.9 +/- 0.7 and 3.2 +/- 0.5 g/dl in EEF and TPN + EF patients respectively (p < 0.05), serum prealbumin was 16.9 +/- 5 and 12.3 +/- 4.3 mg/dl in EEF and TPN + EF patients respectively (p < 0.05) and nitrogen balance was +2.4 +/- 1.5 and -1.6 +/- 0.6 g/24 h in EEF and TPN + EF patients respectively (p < 0.05). Postoperative hyperglycemia was observed with a lower frequency and nutritional support costs and length of hospital stay were significantly lower in the EEF group. CONCLUSIONS: After total gastrectomy EEF is well tolerated, safe and effective, even during the early postoperative ileus. This therapeutic modality could be the first choice for nutritional support in these patients.
Assuntos
Nutrição Enteral , Gastrectomia , Nutrição Parenteral Total , Idoso , Nutrição Enteral/economia , Feminino , Seguimentos , Humanos , Mucosa Intestinal/metabolismo , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral Total/economia , Cuidados Pós-Operatórios , Estudos Prospectivos , Neoplasias Gástricas/cirurgia , Fatores de Tempo , Redução de PesoRESUMO
Se estudiaron 21 pacientes portadores de cáncer gástrico, sometidos a gastrectomía total, entre septiembre 1983 y agosto de 1984 a los cuales se les colocó una sonda de alimentación naso yeyunal durante la intervención. Se inició la alimentación enteral (AE) con dieta semielemental (Hipalen 1000R) al 6 día postoperatorio, manteniéndola por 9,9 días (promedio). La tolerancia fue buena en 17 pacientes; 2 pacientes presentaron diarrea, uno regurgitación y otro, dolor abdominal, no siendo necesario suspender AE en ninguno de ellos. No se observó cambios significativos, pre y postoperatorios en los parámetros antropométricos y bioquímicos evaluados, 2 pacientes presentaron fístula anastomótica que cerró con manejo médico. Fallecen 2 pacientes (9,5%) por complicaciones sépticas, los 19 restantes reinician alimentación oral entre el 7 y 23 día. Esta técnica de alimentación enteral postoperatoria no registró morbilidad agregada en la evolución de los pacientes sometidos a gastrectomía total, permitiendo suspender la alimentación parenteral precozmente, mantener en cifras normales los índices nutricionales evaluados; es de bajo costo, fácil preparación y administración y presenta buena tolerancia. Por los resultados obtenidos recomendamos su uso rutinario en pacientes sometidos a gastrectomía total.
