-
In Vivo (Athens, Greece) 2020The safety and efficacy of laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) remains unclear. The purpose of this study was to compare the clinical...
BACKGROUND/AIM
The safety and efficacy of laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) remains unclear. The purpose of this study was to compare the clinical outcomes of LTG with open total gastrectomy (OTG) for RGC.
PATIENTS AND METHODS
Twenty-two patients who underwent total gastrectomy for RGC were enrolled in this study.
RESULTS
LTG was carried out in seven patients, and OTG was performed in the remaining 15 patients. The mean operation time in the LTG group was longer than that in the OTG group. The estimated blood loss in the LTG group was less than that in the OTG group. No cases in the LTG group required open conversion. Postoperatively, the first meal and defecation were earlier in the LTG group than in the OTG group. The overall survival rates of the two groups were comparable.
CONCLUSION
Laparoscopic total gastrectomy is a feasible surgical option for RGC.
Topics: Gastrectomy; Humans; Laparoscopy; Operative Time; Postoperative Complications; Retrospective Studies; Stomach Neoplasms; Treatment Outcome
PubMed: 32606171
DOI: 10.21873/invivo.11996 -
World Journal of Surgical Oncology Jun 2020Enhanced recovery after surgery (ERAS) protocol has been identified to be beneficial in the amount of operations such as gastrointestinal surgery. However, the efficacy... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Enhanced recovery after surgery (ERAS) protocol has been identified to be beneficial in the amount of operations such as gastrointestinal surgery. However, the efficacy and safety in robot-assisted laparoscopic prostatectomy/laparoscopic radical prostatectomy (RALP/LRP) still remain controversial.
METHOD
We searched randomized controlled trials and retrospective cohort studies comparing ERAS versus conventional care for prostate cancer patients who have undergone RALP/LRP. ERAS-related data were extracted, and quality of included studies was assessed using the Newcastle-Ottawa quality assessment scale and the Jadad scale.
RESULT
As a result, seven trials containing 784 prostate cancer patients were included. ERAS was observed to be significantly associated with shorter length of hospital stay (SMD - 2.55, 95%CI - 3.32 to - 1.78, P < 0.05), shorter time to flatus (SMD - 1.55, 95%CI - 2.26 to - 0.84, P < 0.05), shorter time to ambulate (SMD - 6.50, 95%CI - 10.91 to - 2.09, P < 0.05), shorter time to defecate (SMD - 2.80, 95%CI - 4.56 to - 1.04, P < 0.05), and shorter time to remove drainage tube (SMD - 2.72, 95%CI - 5.31 to - 0.12, P < 0.05). Otherwise, no significant difference was reported in other measurements.
CONCLUSIONS
In conclusion, ERAS can reduce length of hospital stay, time to flatus, time to defecate, time to ambulate, and time to remove drainage tube in prostate cancer patients who have undergone RALP/LRP compared with conventional care.
Topics: Enhanced Recovery After Surgery; Humans; Laparoscopy; Length of Stay; Male; Prognosis; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 32552894
DOI: 10.1186/s12957-020-01897-6 -
Safety and efficacy of laxatives after major abdominal surgery: systematic review and meta-analysis.BJS Open Aug 2020Recovery of gastrointestinal function is often delayed after major abdominal surgery, leading to postoperative ileus (POI). Enhanced recovery protocols recommend... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recovery of gastrointestinal function is often delayed after major abdominal surgery, leading to postoperative ileus (POI). Enhanced recovery protocols recommend laxatives to reduce the duration of POI, but evidence is unclear. This systematic review aimed to assess the safety and efficacy of laxative use after major abdominal surgery.
METHODS
Ovid MEDLINE, Embase, Cochrane Library and PubMed databases were searched from inception to May 2019 to identify eligible RCTs focused on elective open or minimally invasive major abdominal surgery. The primary outcome was time taken to passage of stool. Secondary outcomes were time taken to tolerance of diet, time taken to flatus, length of hospital stay, postoperative complications and readmission to hospital.
RESULTS
Five RCTs with a total of 416 patients were included. Laxatives reduced the time to passage of stool (mean difference (MD) -0·83 (95 per cent c.i. -1·39 to -0·26) days; P = 0·004), but there was significant heterogeneity between studies for this outcome measure. There was no difference in time to passage of flatus (MD -0·17 (-0·59 to 0·25) days; P = 0·432), time to tolerance of diet (MD -0·01 (-0·12 to 0·10) days; P = 0·865) or length of hospital stay (MD 0·01(-1·36 to 1·38) days; P = 0·992). There were insufficient data available on postoperative complications for meta-analysis.
CONCLUSION
Routine postoperative laxative use after major abdominal surgery may result in earlier passage of stool but does not influence other postoperative recovery parameters. Better data are required for postoperative complications and validated outcome measures.
Topics: Abdomen; Data Management; Defecation; Elective Surgical Procedures; Humans; Ileus; Laxatives; Postoperative Complications; Randomized Controlled Trials as Topic; Time Factors
PubMed: 32459069
DOI: 10.1002/bjs5.50301 -
Supportive Care in Cancer : Official... Oct 2020Right-sided cancer accounts for approximately 30% of bowel cancer in women and 22% in men. Colonic resection can cause changes in bowel function which affect daily... (Review)
Review
BACKGROUND
Right-sided cancer accounts for approximately 30% of bowel cancer in women and 22% in men. Colonic resection can cause changes in bowel function which affect daily activity. The aims are to assess the impact of right hemicolectomy for cancer on bowel function and to identify useful treatment modalities for managing bowel dysfunction after right hemicolectomy.
METHOD
The review was conducted in line with PRISMA. Eligible studies evaluated the impact of right hemicolectomy on bowel function in those treated for colorectal neoplasia or assessed the effect of surgical technique or other intervention on bowel function after right hemicolectomy. Right hemicolectomy for inflammatory bowel disease or benign cases only were excluded. Articles were limited to studies on human subjects written in English published between January 2008 and December 2018.
RESULTS
The searches identified 7531 articles. Nine articles met the inclusion criteria, of which eight were cohort studies and one was a randomised trial. Loose stool, increased bowel frequency and/or nocturnal defaecation following right-sided colectomy occurs in approximately one in five patients. Some of these symptoms may improve spontaneously with time. Bile acid malabsorption and/or small bowel bacterial overgrowth may be the cause for chronic dysfunction. Some studies report that no or little difference in outcome between right-sided and rectal resections likely suggests poor function after right-sided resection.
CONCLUSION
Right hemicolectomy can result in changes to bowel function. Patients should be counselled preoperatively, and follow-up should be designed to identify and effectively treat significantly altered bowel function.
Topics: Colectomy; Colorectal Neoplasms; Female; Humans; Male; Postoperative Complications; Treatment Outcome
PubMed: 32430603
DOI: 10.1007/s00520-020-05519-5 -
Annals of Palliative Medicine May 2020Several enhanced recovery after surgery (ERAS) protocols for radical prostatectomy (RP) have been reported in recent years. Nonetheless, there is no sufficient evidence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several enhanced recovery after surgery (ERAS) protocols for radical prostatectomy (RP) have been reported in recent years. Nonetheless, there is no sufficient evidence to support the implementation of ERAS as a standard of care modality.
METHODS
A search was done in the PubMed, Embase, Clinical Trials.gov, Cochrane Library, CNKI Library databases and reference lists to identify relevant studies from inception until May 2019 to be included in the study. A systematic review of five randomized controlled trials (RCTs), one prospective cohort study and four retrospective studies covering 3,803 patients, comparing ERAS with conventional care was performed. Outcomes of interest for the study were intraoperative outcomes (operation time and blood loss), postoperative outcomes (hospital stay, catheter stay, first defecation and first anal exhaust) and postoperative complications. Random events meta-analyses were performed. Sensitivity analysis was also performed to determine whether the results of the meta-analysis were robust.
RESULTS
Notably, ERAS group had significantly shorter hospital stay [overall standardized mean difference (SMD) =-1.65, 95% confidence interval (CI): -2.53, -0.76, P<0.001], shorter time to first defecation (overall SMD =-1.56, 95% CI: -2.71, -0.42, P=0.008), shorter time to first anal exhaust (overall SMD =-1.23, 95% CI: -1.97, -0.50, P=0.001) and lower incidence of nausea [overall risk ratio (RR) =0.62, 95% CI: 0.40, 0.94, P=0.024] compared to the conventional group. There was no statistical difference in intraoperative outcomes, catheter stay and other postoperative complications between the two groups (P>0.05).
CONCLUSIONS
The data presented so far consistently show that ERAS may be utilized as a standard of care in RP treatment.
Topics: Enhanced Recovery After Surgery; Humans; Length of Stay; Male; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Reference Standards; Retrospective Studies
PubMed: 32389010
DOI: 10.21037/apm.2020.04.03 -
Annali Dell'Istituto Superiore Di Sanita 2020To summarize the evidence in the literature about rehabilitative treatments that reduce low anterior resection syndrome (LARS) symptoms in patients who underwent surgery...
OBJECTIVE
To summarize the evidence in the literature about rehabilitative treatments that reduce low anterior resection syndrome (LARS) symptoms in patients who underwent surgery for colorectal cancer.
METHODS
We have search in PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health and Scopus databases. Studies selected were limited to those including only patient undergone low rectal resection with sphincter preservation and with pre-post assessment with a LARS score. Five articles fit the criteria.
RESULTS
The percutaneous tibial nerve stimulation demonstrated moderate results and sacral nerve stimulation was found to be the best treatment with greater symptom improvement. Only one study considered sexual and urinary problems in the outcomes assessment.
CONCLUSIONS
In clinical practice patients should evaluate with the LARS and other score for evaluation of urinary and sexual problems. Future research must be implemented with higher quality studies to identify the least invasive and most effective treatment/s.
Topics: Adenocarcinoma; Antineoplastic Agents; Colectomy; Colorectal Neoplasms; Combined Modality Therapy; Defecation; Exercise Therapy; Fecal Incontinence; Female; Follow-Up Studies; Humans; Implantable Neurostimulators; Lumbosacral Plexus; Male; Middle Aged; Postoperative Complications; Prospective Studies; Quality of Life; Rectum; Retrospective Studies; Syndrome; Tibial Nerve; Transcutaneous Electric Nerve Stimulation; Urination Disorders
PubMed: 32242534
DOI: 10.4415/ANN_20_01_07 -
World Journal of Urology Dec 2020Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and... (Meta-Analysis)
Meta-Analysis
PURPOSE
Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures.
MATERIALS AND METHODS
A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation.
RESULTS
The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) - 3.46 d, 95% confidence interval (CI) - 4.94 to - 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD - 1.37 d, 95% CI - 2.06 to - 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07).
CONCLUSION
Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.
Topics: Clinical Protocols; Cystectomy; Enhanced Recovery After Surgery; Humans; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 32124020
DOI: 10.1007/s00345-020-03133-y -
Journal of Gastrointestinal Surgery :... Nov 2020Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although recognised by the Enhanced Recovery After Surgery (ERAS) Society as one of the multimodal approaches to expedite recovery after surgery, strong evidence to support its use in routine postoperative practice is lacking.
METHODOLOGY
A comprehensive literature review of all randomised controlled trials (RCTs) was performed in the Medline and Embase databases between 2000 and 2019. Studies were selected to compare the use of chewing gum versus standard care in the management of postoperative ileus (POI) in adults undergoing colorectal surgery. The primary outcome assessed was the incidence of POI. Secondary outcomes included time to passage of flatus, time to defecation, total length of hospital stay and mortality.
RESULTS
Sixteen RCTs were included in the systematic review, of which ten (970 patients) were included in the meta-analysis. The incidence of POI was significantly reduced in patients utilising chewing gum compared to those having standard care (RR 0.55, 95% CI 0.39, 0.79, p = 0.0009). These patients also had a significant reduction in time to passage of flatus (WMD - 0.31, 95% CI - 0.36, - 0.26, p < 0.00001) and time to defecation (WMD - 0.47, 95% CI - 0.60, - 0.34, p < 0.00001), without significant differences in the total length of hospital stay or mortality.
CONCLUSION
The use of chewing gum after colorectal surgery is a safe and effective intervention in reducing the incidence of POI and merits routine use alongside other ERAS pathways in the postoperative setting.
Topics: Abdomen; Adult; Chewing Gum; Colorectal Surgery; Gastrointestinal Motility; Humans; Ileus; Length of Stay; Postoperative Complications
PubMed: 32103455
DOI: 10.1007/s11605-019-04507-3 -
Medicine Feb 2020The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis. (Comparative Study)
Comparative Study
INTRODUCTION
The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis.
METHODS AND ANALYSIS
We will electronically search PubMed, MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database from their inception. Furthermore, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating acute pancreatitis will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data will be synthesized using a fixed effects model or random effects model depending on the heterogeneity test. The overall response rate and the visual analog scale score will be the primary outcomes. The time of first bowel sound, the time of first defecation, the length of hospitalization, acute physiology and chronic health evaluation II score, and the adverse events will also be assessed as secondary outcomes. RevMan 5 (version 5.3) statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation. Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals, whereas dichotomous data will be expressed in the form of risk ratios with 95% confidence intervals.
ETHICS AND DISSEMINATION
The protocol of this systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and present at relevant conferences.
PROSPERO REGISTRATION NUMBER
CRD42019147503.
Topics: Abdominal Pain; Acupuncture Therapy; China; Defecation; Humans; Length of Stay; Meta-Analysis as Topic; Pancreatitis; Randomized Controlled Trials as Topic; Severity of Illness Index; Visual Analog Scale
PubMed: 32080079
DOI: 10.1097/MD.0000000000019044 -
BMC Infectious Diseases Feb 2020Intestinal infection is still an important public health problem in low-income countries. Food handlers may be infected by a wide range of enteropathogens and have been... (Meta-Analysis)
Meta-Analysis
Prevalence and factors associated with intestinal parasitic infections among food handlers working at higher public University student's cafeterias and public food establishments in Ethiopia: a systematic review and meta-analysis.
BACKGROUND
Intestinal infection is still an important public health problem in low-income countries. Food handlers may be infected by a wide range of enteropathogens and have been implicated in the transmission of many infections to the public. Therefore, the aim of this review was to produce the pooled prevalence and factors associated with intestinal parasitic infections among food handlers working at higher public University student's cafeterias and public food establishments in Ethiopia.
METHODS
Articles published in PubMed/Medline, Hinari, Web of Science, Science Direct, and Google Scholar were used using a search strategy. Observational studies (cross-sectional) revealing the prevalence and factors associated with intestinal parasitic infections at higher public University student's cafeterias and public food establishments were incorporated. Meta-analysis was computed using STATA version 14 statistical software. Heterogeneity of the study was assessed using Cochrane Q test statistics and I test. The pooled prevalence of the intestinal parasitic infection and associated factors among food handlers was calculated by the random-effect model.
RESULTS
Out of 138 reviewed studies, 18 studies were included to estimate the pooled prevalence of intestinal parasitic infections among food handlers in Ethiopia. All the eighteen articles were included in the analysis. This study revealed that the pooled prevalence of intestinal parasitic infections was 28.5% (95% CI: 27.4, 29.7). E. hystolitica /E. dispar complex 6.38 (95% Cl: 5.73, 7.04), A.lumbricodes 4.12 (95% Cl: 3.56, 4.67), and G. lamblia 3.12(95% Cl: 2.65, 3.60) were the most common intestinal parasitic infections in this study. Untrimmed fingernail 3.04 (95% CI: 2.19, 4.22), do not washing hands after defecation 2.71 (95% CI: 1.93, 3.82), do not washing hands after touching any body parts 2.41 (95% CI: 1.64, 3.56), do not made medical checkup 2.26 (95% CI: 1.57, 3.25), and do not receive food safety training 1.79 (95% CI: 1.30, 2.45) were factors significantly and positively associated with intestinal parasitic infections.
CONCLUSION
Parasitic infections among food handlers were significantly high. Untrimmed fingernail, do not washing hands after defecation, do not washing hands after touching any body parts, do not made regular medical checkup and do not receive food safety training were factors that increase the prevalence of intestinal parasitic infections.
Topics: Cross-Sectional Studies; Ethiopia; Food Handling; Food Services; Humans; Intestinal Diseases, Parasitic; Prevalence; Risk Factors; Universities
PubMed: 32075585
DOI: 10.1186/s12879-020-4884-4