Temporary Decompression in Critically Ill Patients: Retrospective Comparison of Ileostomy and Colostomy.

BACKGROUND/AIMS: In critically ill patients, gastrointestinal function plays an important role in multiple organ dysfunction syndrome. Patients suffering from acute lower gastrointestinal dysfunction need to be performed a temporary fecal diversion after the failure of conservative treatment. This study aims to determine which type of fecal diversion is associated with better clinical outcomes in critically ill patients. METHODOLOGY: Data of critically ill patients requiring surgical decompression following acute lower gastrointestinal dysfunction between January 2008 and June 2013 were retrospectively analyzed. Comparison was made between ileostomy group and colostomy group regarding the stoma-related complications and the recovery after stoma creation. RESULTS: 63 patients consisted of temporary ileostomy group (n = 35) and temporary colostomy group (n = 28) were included in this study. First bowel movement and length of enteral nutrition intolerance after fecal diversion were both significantly shorter in the ileostomy group than in the colostomy group (1.70 ± 0.95 vs. 3.04 ± 1.40; p < 0.001 and 3.96 ± 2.84 vs. 8.12 ± 7.05; p = 0.009). In comparison of the complication rates, we found a significantly higher incidence of dermatitis (31.43% vs. 7.14%; p = 0.017), hypokalemia (25.71 vs. 3.57; p = 0.017) and hypocalcemia (28.57 vs. 7.14; p = 0.031), and slightly lower incidence of stoma prolapse (0% vs. 10.71%; p = 0.082) in the ileostomy group than in the colostomy group. CONCLUSIONS: Both procedures provide an effective defunctioning of the distant gastrointestinal tract with a low complication incidence. We prefer a temporary ileostomy to temporary colostomy for acute lower gastrointestinal dysfunction in critically ill patients.

Fast track programmes vs. traditional care in laparoscopic colorectal surgery: a meta-analysis of randomized controlled trials.

BACKGROUND/AIMS: To assess the efficacy and safety of fast track (FT) programmes in laparoscopic colorectal surgery by comparing FT programmes with traditional care in randomized controlled trials (RCTs). METHODOLOGY: RCTs comparing the effects of FT programmes and traditional care in the same context of laparoscopic colorectal surgery were found on PubMed, EMBASE and Cochrane Library. Primary hospital stay, overall hospital stay, readmission rate, morbidity and mortality were assessed. RESULTS: Four original RCTs investigating a total of 486 patients, of whom 235 received FT programmes and 251 received traditional care, met the inclusion criteria. The pooled weighted mean difference in primary hospital stay and overall hospital stay was -1.22 (95% CI: -1.57 to -0.87) and -1.00 (95% CI: -1.48 to -0.52), which showed a significant reduction with use of FT programmes (p < 0.05). The pooled odds ratio for readmission rate, morbidity and mortality was 0.85 (95% CI: 0.33 to 2.21), 0.68 (95% CI: 0.44 to 1.04) and 1.51 (95% CI: 0.29 to 7.77), suggesting no significant difference between the two groups (p > 0.05). CONCLUSIONS: FT programmes in elective laparoscopic colorectal surgery could significantly reduce primary hospital stay and overall hospital stay, and with no significant difference in readmission rate, morbidity and mortality compared with traditional care.

Restricted intravenous fluid regimen reduces the rate of postoperative complications and alters immunological activity of elderly patients operated for abdominal cancer: a randomized prospective clinical trail.

BACKGROUND: Perioperative fluid restriction can lead to better clinical outcomes and reduced complications. However, whether perioperative fluid restriction can alter the patient's postoperative cellular immunity is unknown. Therefore, a randomized, prospective clinical study was designed to determine whether fluid restriction improves immunological outcome in elderly patients who undergo gastrointestinal surgery for cancer removal. METHODS: A total of 179 patients aged 65 years or older were recruited for the study and were randomly assigned to receive the restricted fluid regimen (R group) or the standard fluid regimen (S group). Postoperative T-lymphocyte subpopulations (CD3(+), CD4(+), and CD8(+)) frequencies and monocyte HLA-DR expression was investigated. Perioperative complications and cellular immunity changes were analyzed comparatively between the two groups. RESULTS: The restricted intravenous fluid regimen was associated with significantly less postoperative complications (1.5 complications/patient vs. S group: 2.2 complications/patient), especially for infection complications (15% vs. S group: 27%, p = 0.04). Circulating CD3(+) T-cells were suppressed after surgery in both treatment groups, but the cell frequency (cell/µL) was higher in the R group (746 vs. S group: 480 at postoperative day (POD) 2, p = 0.022; 878 vs. 502 at POD 3, p = 0.005; 892 vs. 674 at POD 5, p = 0.042). Similarly, the HLA-DR expression (% of all T cells) in monocytes were decreased in both groups, but the expression remained higher in the R group (66.20 vs. S group: 51.97 at POD 1, p = 0.029; 68.19 vs. 51.26 at POD 2, p = 0.039; 72.19 vs. 57.45 at POD 3, p = 0.014; 73.92 vs. 60.46 at POD 5, p = 0.036). Multivariate analysis suggested that perioperative CD3(+) T cell changes were associated with the development of postoperative complications [odds ratio (OR) = 1.963; 95% confidence interval (CI) 1.019-3.782; p = 0.044] and postoperative infections (OR = 3.106; 95% CI 1.302-7.406; p = 0.011). CONCLUSIONS: In elderly gastrointestinal cancer patients, cellular immunity is better preserved by the perioperative fluid restriction regimen. The better preserved cellular immunological function is correlated with a reduced perioperative complications rate.

[Systemic review of the safety and efficacy of fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer].

OBJECTIVE: To conduct a systemic review of the safety and efficacy of fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer. METHODS: The databases, including CNKI, Wangfang, VIP, PubMed, EMBASE and Cochrane Library, were searched to collect randomized controlled trials(RCTs) or clinical controlled trials(CCTs) on the comparison of fast-track surgery combined with laparoscopy versus fast-track surgery or laparoscopy separately used in radical gastrectomy for gastric cancer between January 1994 and December 2012. After data were extracted, meta-analysis was conducted by using RevMan 5.1.0 software. RESULTS: A total of 3 RCTs and 2 CCTs, involving 524 patients, were included. There were 257 patients in the study group and 267 patients in the control group. Compared with the control group, the study group had earlier first flatus(SMD=-1.29, 95%CI:-2.17 to -0.40, P<0.05), shorter postoperative hospital stay(WMD=-1.72,95%CI:-2.56 to -0.89, P<0.05) and lower postoperative complication rate(OR=0.51, 95%CI:0.31 to 0.84, P<0.05). However, no significant differences were found in operation time, harvested lymph node number, intraoperative blood loss and hospital charge(P>0.05). CONCLUSION: Fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer can accelerate postoperative rehabilitation by promoting postoperative bowel function recovery, and decreasing postoperative hospital stay and complication rate.

[Influence of preoperative nutritional support on surgical outcomes of chronic radiation enteritis patients complicated with intestinal obstruction].

OBJECTIVE: To investigate the effect of preoperative nutritional support in the management of patients with chronic radiation enteritis (CRE) with intestinal obstruction undergoing resectional surgery. METHODS: Clinical data of 158 CRE patients undergoing diseased bowel resection from 2001 to 2011 were analyzed retrospectively. A total of 130 patients received preoperative nutritional support, including 28 patients with enteral nutrition support, 60 patients with total parenteral nutrition support, and 42 patients with combined nutritional support. The nutritional parameters, procedures, operation-related complications, and postoperative hospital stay were recorded. RESULTS: After aggressive nutritional support in 130 patients, patients nutritional index, such as serum prealbumin, transferrin, serum albumin improved significantly preoperatively, while the change of body mass index and hemoglobin was not significant. Compared to those without preoperative nutritional support, those who received preoperative nutritional support had lower stoma rate (31.5% vs. 53.6%, P=0.027), less postoperative infection rate (13.8% vs. 32.1%, P=0.019), shorter postoperative hospital stay [(14.1±7.3) d vs. (18.8±15.8) d, P=0.013). Enteral nutrition group had less postoperative infection rate (7.1% vs. 21.7%, P=0.017), lower stoma rate (28.6% vs. 48.3%, P=0.02), and shorter postoperative hospital stay [(15.5±9.6) d vs. (21.7±19.0) d, P=0.025) as compared to total parenteral nutrition group. CONCLUSIONS: Preoperative nutritional support can decrease the stoma rate, postoperative infection rate, and shorten hospital stay in CRE patients complicated with intestinal obstruction. If tolerated, enteral nutrition support should be chosen.

[Manipulative reduction and small splint fixation for treatment of three-part fractures of proximal humerus: a case-control study].

OBJECTIVE: To study Chinese medicine treatment in the three-part of the proximal humerus fractures. METHODS: From January 2009 to February 2012, 118 cases of proximal humerus three-part fractures were used two methods of operation and manipulation treatment,that were all acute and closed. In operation group: there were 22 males and 37 females,the mean age of the patients was (65.80 +/- 10.62) years (ranged from 45 to 83 years), and the interval from injury to hospital was (22.58 +/- 22.11) hours (ranged from 1 to 96 hours), used open reduction and locking plate fixation surgery. In manipulation group: there were 21 males and 38 females, the mean age of the patients was (65.98 +/- 11.10)years (ranged from 45 to 85 years), and the interval from injury to hospital was (20.85 +/- 22.63) hours (ranged from 1 to 107 hours), used manipulative reduction and small splinting external fixation. All patients were evaluated with shoulder pain, function, activity and anatomical indicators after treatment. RESULTS: All patients were followed up for 3 to 12 months with an average of 8.2 months. According to Neer Score, the total scores was 85.47 +/- 6.15 in operation group, 84.95 +/- 5.70 in manipulation group. The satisfaction rate of the operation group were 88.20%, and the manipulation group were 86.40%. The difference was not statistically significant between two groups (P > 0.05). CONCLUSION: The two treatment were able to achieve satisfactory results. The manipulative reduction and splinting treatment has the advantage of avoiding the risk of surgery, less blood damage, ensureing the efficacy, and reducing costs. It can effectively treat the proximal humerus three-part fracture.

[Case-control study on the manipulation reduction combined with small-splint fixation for the treatment of closed fracture of radius].

OBJECTIVE: To explore the clinical effects of the manipulation reduction combined with small splint fixation for the treatment of fresh closed fracture of radius for shorten hospital stays and reduce medical cost. METHODS: From July 2007 to December 2009, 200 patients (ranged the age from 40 to 80 years) with distal radius comminute fracture were treated and divided into CP group (including 21 males and 79 females, with a mean age of (62.98 +/- 0.85) years), and control group (including 20 males and 80 females, with a mean age of (63.19 +/- 0.88) years). All patients were treated manipulation reduction combined with small-splint fixation, control group removed small-splint 30 days after treatment, CP group removed 25 days after treatment. Two groups were checked by X-ray and took traditional chinese medicine (taking Yuanhu tablets, Chuangshangning tablets on the early stage; Guixiangzhenggu pill was taken on the middle stage; Shuanglongjie gu pill on the late stage), functional exercise was guided after removing of small splint. The condition of reduction and position of bone were evaluated and Gartland-Werlley scale was used to evaluate the function of wrist joint. RESULTS: Treatment time in CP group was decreased from (30.08 +/- 3.06) to (25.06 +/- 1.07) days; treatment cost in CP group was decreased from (2 100.00 +/- 332.12) to (1 644.00 +/- 125.20) Yuan. There was no significant difference in reduction and function recover of wrist joint between two groups. The results showed the effects of TCM clinic can be promised. CONCLUSION: Clinical pathway for outpatient can promote standardization of outpatient, short treatment time less medical economic burden, and worth widely used.

[To explore the relation between erythrocyte sedimentation rate and postoperative recurrence of spinal tuberculosis].

OBJECTIVE: To explore the relation between erythrocyte sedimentation rate(ESR) and postoperative recurrence of spinal tuberculosis. METHODS: Eighty cases (36 males and 44 female,ranging from 20 to 71 years with an average of 38.2 years)of spinal tuberculosis treated with focus debridement were divided into two groups according to the preoperative value of ESR: Group A (ESR > or = 40 mm/h) and Group B (ESR < 40 mm/h). Patients in two groups were treated by the same method. The postoperative recurrences in two groups were analyzed. RESULTS: All the patients were followed up. The recurred cases were 5 in Group A and 4 in Group B. There is no significant difference between two groups. CONCLUSION: ESR is not the key factor to choose the right operative time to perform debridement.