Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings?
|
|
- Reynold McDowell
- 5 years ago
- Views:
Transcription
1 Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings? Kate Willcutts, DCN, RD, CNSC University of Virginia Health System Charlottesville, VA kfw3w@virginia.edu
2 Objectives 1. Discuss research that supports early oral feeding after surgery. 2. Explain evidence supporting swifter advancement to regular diet after surgery
3 Financial Disclosures Presentation at CNW 2017 funded by Abbott
4 Introduction Prolonged periods of nil per os (NPO) associated with iatrogenic malnutrition & reduced patient satisfaction Leading reasons for NPO: peri-operative and pre-procedural fasting practices Fasting after surgery intended to reduce the risk of aspiration pneumonia and anastomotic leaks Since the late 70 s early 80 s -early post operative tube feeding is safe. Early oral feeding after all types of surgeries more common
5 Background Postop Bowel Function Postoperative ileus interruption of bowel function after surgery 1 Nasogastric tube (NGT) for decompression Return of bowel function no good marker. Traditionally bowel sounds, flatus, stool 5 Potential Negatives Nausea, vomiting Aspiration pneumonia Anastomotic leak Wound dehiscence Intra-abdominal infection/fistula 1. Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey. J. Gastrointest. Surg. May 2013;17(5):
6 Definition of terms Lower GI surgery = colorectal Upper GI surgery = esophagus, stomach, duodenum, liver and/or pancreas No universally accepted definition for early when referring to oral feeding Traditional or late timing usually means after the return of bowel function Oral feeding = initiation of diet progression most started with clear liquids. 6
7 Case Lower GI Surgery 60 year old female POD # 0 s/p elective L hemicolectomy & colostomy for colon CA. No intra-op complications. When would should oral diet be started? How would this decision be made?
8 Typical NPO at midnight for surgery the next day. NPO and/or no tube feeding and/or NGT for decompression after surgery until return of bowel function. What is the total time without nutrition? Minimum ~30 hours. What is the effect of this? Clinical outcomes? Patient satisfaction?
9
10
11
12
13
14
15
16
17
18 Early Versus Traditional Postoperative Feeding in Patients Undergoing Resectional Gastrointestinal Surgery: A Meta-Analysis Osland et al. JPEN 2011 Compared early to traditional (NPO) post op feeding. Mostly lower GI surgery. Some studies were combination of lower and upper GI - but most of the pts were lower GI. 5 tube feeding studies and 10 oral diet studies. Only included RCTs. Did not include immune enhancing tube feeding studies
19 Odds ratio for complications (nausea and vomiting excluded) Osland E et al. JPEN J Parenter Enteral Nutr 2011;35: Copyright by The American Society for Parenteral and Enteral Nutrition
20 Odds ratios for mortality Osland E et al. JPEN J Parenter Enteral Nutr 2011;35: Copyright by The American Society for Parenteral and Enteral Nutrition
21 Odds ratios for anastomotic leak Osland E et al. JPEN J Parenter Enteral Nutr 2011;35: Copyright by The American Society for Parenteral and Enteral Nutrition
22 Days to passing flatus Osland E et al. JPEN J Parenter Enteral Nutr 2011;35: Copyright by The American Society for Parenteral and Enteral Nutrition
23 Days to first bowel movement Osland E et al. JPEN J Parenter Enteral Nutr 2011;35: Copyright by The American Society for Parenteral and Enteral Nutrition
24 Length of stay (days) Osland E et al. JPEN J Parenter Enteral Nutr 2011;35: Copyright by The American Society for Parenteral and Enteral Nutrition
25 Case Upper GI Surgery 60 yr old female POD # 0 s/p gastrectomy. No intra-op complications. When would should oral diet be started? How would this decision be made?
26 Upper GI Surgery Usually for cancer High risk of malnutrition High risk of post op complications Increased chance for prolonged periods NPO Surgeons reluctant to start oral feeding until at least 5 days after upper GI surgery 1 Concern for leakage and possible fistula formation 2 May tube feed more likely if can achieve access distal to anastomosis. 1. Petrelli et al. 2. Wang et al.
27 Early Post Op Oral Feeding for upper GI Systematic review/meta-analysis to evaluate the practice of early oral feeding after upper GI surgery in adults. What is the effect of early oral feeding as compared to traditional (or late) timing of oral feeding on: length of stay? need for NGT reinsertion? anastomotic leaks? pneumonia? need for reoperation? mortality? readmission? Willcutts, Chung, Erenburg. et al. Ann Surg Jul;264(1):54-63.
28 Inclusion & Exclusion Criteria 28
29 Results: Study Population 15 studies met the full-text inclusion criteria 8 RCTs N= non-rcts N = 1132 Type of Surgery RCT n (%) Non-RCT n (%) RCT + non-rct n (%) Gastrectomy 507 (52) 697 (61) 1204 (57) Esophagectomy 109 (11) 316 (39) 425 (20) Hepatobiliary 249 (25) 119 (10) 368 (17) Other 115 (12) (5) Total Willcutts, Chung, Erenburg. et al. Ann Surg Jul;264(1):
30 Results: Start Time of Oral Feeding Intervention (Early) Comparison (Traditional or Late) # of studies (%) Start time 12 (80%) POD 1 or earlier 2 (13%) POD 2 1 (7%) POD 3 (esoph.) # of studies (%) Start time 6 (40%) Return of bowel function 4 (27%) POD 3 2 (13%) POD 4 1 (7%) each POD 5, 6, & 7 Note: POD 3 for one study was the early group. Esophagectomy pts. Late group was POD 5.
31 Hospital Length of Stay P <0.01 P = 0.10 P <0.01 Hospital length of stay for early fed groups a mean difference of days shorter than the late (traditional) fed groups.
32 Need for NGT Reinsertion P = 0.12 P = 0.82 P = 0.18 Reduced need for NGT reinsertion in the early fed group although not 32 statistically significant
33 Pneumonia P < 0.01 P = 0.34 P= 0.01 Less pneumonia in the early fed group 33
34 Anastomotic Leaks P = 0.99 P = 0.31 P = Statistically not significant no increase in leaks in the early fed groups
35 Reoperations & Mortality P = 0.29 P = 0.73 P = 0.28 Statistically insignificant fewer reoperations in early fed group. Mortality only 3 studies did not have 0 in both groups Effect size /456 in study groups; 19/446 in control groups 35 p = 0.75
36 Conclusions from Meta Analysis Early postoperative oral feeding seems to be as safe as the traditional (or late) timing of postoperative oral feeding after upper GI surgeries. Statistically significant shorter LOS in early fed groups. Trend towards reduced anastomotic leaks, reoperations and need for NGT reinsertion in early fed groups. More studies of each type of upper GI surgery are needed. More data on the actual amount of oral intake and overall patient satisfaction with earlier oral feeding could demonstrate patient-centered benefits to a more progressive approach to postoperative feeding. 36
37
38
39
40
41
42 Enhanced Recovery After Surgery (ERAS) Multimodal Protocol 1999 Kehlet & Mogensen 1st multimodal Evidence-based interventions Preop, intraop and postop To reduce surgical stress and postoperative catabolism Quicker return to mobility, oral intake, home.
43 Factors that improve gut motility Reduced use of opioids Regional analgesia Reduced use of IV fluids Early mobilization Early oral intake Ljungqvist, L et al. JAMA Jan 11, 2017
44 Enhanced Recovery After Surgery Ljungqvist, L et al. JAMA Jan 11, 2017
45 ERAS Nutrition Components Preadmission nutrition screening and nutrition support Preop Carbs No NPO Early oral intake of fluids and solids Ljungqvist, L et al. JAMA Jan 11, 2017
46 ERAS Gastrectomy Summary and recommendation: Patients undergoing total gastrectomy should be offered drink and food at will from POD 1. They should be advised to begin cautiously and increase intake according to tolerance. Evidence level: Moderate Recommendation grade: Weak Patients clearly malnourished or those unable to meet 60 per cent of daily requirements by POD 6 should be given individualized nutritional support, as detailed above. Evidence level: Moderate Recommendation grade: Strong Mortensen, K et al. Brit J Surg
47 Take Home Points Early post op diet safe after lower GI surgery Early post op diet safe after upper GI surgery No evidence to support step-wise diet advancement after surgery ERAS protocols incorporate early oral diet.
48
49 References Bauer VP. The evidence against prophylactic nasogastric intubation and oral restriction. Clin. Colon Rectal Surg. Sep 2013;26(3): Kawamura YJ et al. Patient's appetite is a good indicator for postoperative feeding: a proposal for individualized postoperative feeding after surgery for colon cancer. Int J Colorectal Dis Ljungqvist, L et al. Enhanced Recovery After Surgery: A Review.JAMA Jan 11, 2017 Osland E et al. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. JPEN. 2011;35: Mortensen K et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS ) Society recommendations. Brit J Surg 2014 Petrelli NJ et al. Early postoperative oral feeding after colectomy: an analysis of factors that may predict failure. Ann Surg Oncol 2001; 8: Vather R et al. Defining postoperative ileus: results of a systematic review and global survey. J. Gastrointest. Surg. May 2013;17(5): Wang D et al. Is nasogastric or nasojejunal decompression necessary following gastrectomy for gastric cancer? A systematic review and meta-analysis of randomised controlled trials. J Gastrointest Surg 2015; 19: Warren J et al. Postoperative diet advancement: Surgical dogma vs evidence-based medicine. Nutr Clin Pract. 2011;26(2): Willcutts KF et al. Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A Systematic Review and Meta-analysis. Ann Surg 2016 Jul;264(1): Yeung SE, Fenton TR. Colorectal surgery patients prefer simple solid foods to clear fluids as the first postoperative meal. Dis Colon Rectum. 2009
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus
More informationEnhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid
More informationLaparoscopic Colorectal Surgery
Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment
More informationANICOLAU.RO. Enhanced Recovery after Colorectal Surgery. Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist*
Enhanced Recovery after Colorectal Surgery Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist* Clinical Emergency Hospital of Bucharest, Romania *Karolinska Institute, Stockholm, Sweden ERAS - Enhanced
More informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.3 Nutritional Support in the Perioperative Period Ken Fearon Learning Objectives Understand the principles behind nutritional care for
More informationNasogastric Tube Decompression in Stomach and Small Bowel Surgery
Original Article Nasogastric Tube Decompression in Stomach and Small Bowel Surgery Pokharel N,* Adhikari S,** *Resident, ** Professor, NAMS Bir Hospital, Kathmandu, Nepal ABSTRACT: INTRODUCTION: The use
More informationPrevent gastric distention and vomiting after surgery
Remove toxic and unwanted substances from the stomach Administration of enteral nutrition, drugs and so on It favors lung expansion in mechanically unconscious and ventilated subjects Aspiration gastric
More informationCreating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination
Creating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination Jason D. Sciarretta, MD, FACS Grand Strand Medical Center, Myrtle Beach, SC University of South Carolina
More information7/31/2015. Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice. Objectives. Enhanced Recovery Society
Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice Margaret Odhner MS, ANP-BC, COCN Kim Meacham, MSN FNP-C, CWON Objectives 1. Describe the Enhanced Recover After Surgery (ERAS) pathway.
More informationERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic
ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track
More informationR Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,
More informationThe effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting.
The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting. { Thalia Petropoulou, Clinical Fellow Paul Hainsworth,Colorectal
More informationTo staple or to sew. Zeng Xuan Hu
To staple or to sew Zeng Xuan Hu Fast Track Surgery Multimodal Rehabilitation Accelerated recovery Accelerated rehabilitation Enhanced recovery Optimize perioperative care by reducing the expected stress
More informationESPEN Congress Vienna Nutrition after discharge from hospital: The surgeon s responsability. O. Ljungqvist (Sweden)
ESPEN Congress Vienna 2009 Nutrition after discharge from hospital: The surgeon s responsability O. Ljungqvist (Sweden) Nutrition after discharge from hospital: The surgeon s responsability Olle Ljungqvist
More informationPostoperative Ileus. UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011
Postoperative Ileus UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Hobart W. Harris, MD, MPH Introduction Pathophysiology Clinical Research Management Summary Postoperative Ileus:
More informationOperational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy
Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Conor P. Delaney MD MCh PhD Chairman, Digestive Disease Institute Professor of Surgery, Cleveland, Ohio Disclosure Slide Conor Delaney MD PhD
More informationStellenwert der prä- und postoperativen Sicht des Chirurgen
Interdisziplinäre Chirurgie Stellenwert der prä- und postoperativen Ernährung Sicht des Chirurgen Kantonsspital Luzern 24.11.2005 Prof. L. Krähenbühl Chirurgische Klinik Hôpital Cantonal Fribourg Problems
More informationOptimising Perioperative Pain Management And Surgical Outcomes
Optimising Perioperative Pain Management And Surgical Outcomes Dr Chew Ghee Kheng MBBS FRCOG MD FAMS Senior Consultant Gynaecologist Subspecialist in Gynaecology Oncology Surgery Singapore General Hospital
More informationFast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery
12 Fast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery L Ndayizeye, A K Kiswezi University Teaching Hospital of Butare, Rwanda. Correspondence
More informationEarly enteral feeding by naso-enteric tube in patients with perforation peritonitis
International Surgery Journal Patbamniya NK et al. Int Surg J. 205 May;2(2):224-234 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: 0.5455/2349-2902.isj2050520 Early enteral
More informationESPEN Congress Copenhagen 2016
ESPEN Congress Copenhagen 2016 ESPEN GUIDELINES SURGERY A. Weimann (DE) ESPEN Guideline Clinical Nutrition in Surgery Conflicts of interest Speaker `s honoraria: Baxter Germany Berlin Chemie B. Braun Melsungen
More informationCurrent perioperative management of elective colorectal resections in Ireland: When is the ideal time to introduce feeding post operatively?
Original Article Current perioperative management of elective colorectal resections in Ireland: When is the ideal time to introduce feeding post operatively? Tahir Yasin Khan, Tariq Wahab Khanzada, J.B.O
More informationNutritional Issues. Perioperative Nutritional Interventions. A challenging case you are likely familiar with
Perioperative Nutritional Interventions Lygia Stewart MD, John Maa MD, and Annette Romani RD UCSF Post-Graduate Course Nutritional Issues Who needs nutritional supplementation? Oral, feeding tube, or TPN?
More informationEnhanced Recovery After Surgery Getting it Right
Enhanced Recovery After Surgery Getting it Right Aalok Agarwala, M.D., M.B.A. Division Chief, General Surgery Anesthesia Associate Director, Quality and Safety, MGH DACCPM Assistant Professor, Harvard
More informationThe safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric carcinoma
Gastric Cancer (2014) 17:324 331 DOI 10.1007/s10120-013-0275-5 ORIGINAL ARTICLE The safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric
More informationWHEN To Initiate Parenteral Nutrition A Frequent Question With New Answers
WHEN To Initiate Parenteral Nutrition A Frequent Question With New Answers Ainsley Malone, MS, RD, LD, CNSC, FAND, FASPEN Dubai International Nutrition Conference 2018 Disclosures No commercial relationship
More informationChirurgia del Colon in Week Surgery?
Chirurgia del Colon in Week Surgery? dr. V. Fiscon dr. G. Portale Chir. Generale, Cittadella -PD- ULSS 6 Euganea E il colon??? Kraft K et al., J C Visc 2013 Discharge early Colon in week surgery Readiness
More informationANICOLAU.RO. What is ERAS? Enhanced Recovery After Surgery. A.E.Nicolau*,Irina Grecu** Spitalul Clinic de Urgenta
Spitalul Clinic de Urgenta ANICOLAU.RO What is ERAS? Enhanced Recovery After Surgery A.E.Nicolau*,Irina Grecu** *Clinica de Chirurgie **Clinica de Anestezie Terapie Intensiva ERAS = Fast-track surgery
More informationPostoperative Ultrasound Evaluation of Gastric Distension; A Pilot study
Postoperative Ultrasound Evaluation of Gastric Distension; A Pilot study M Jaronczyk MD, W Boyan Jr. MD, M Goldfarb MD. FACS. MMC Dept of Surgery Nausea and vomiting are common complaints of postoperative
More informationJejunostomy after oesophagectomy, how and why I do it
Jejunostomy after oesophagectomy, how and why I do it Graeme Couper. Consultant Oesophago-gastric Surgeon, The Royal Infirmary of Edinburgh BAPEN Conference 2010 2nd & 3rd November Harrogate International
More informationOriginal article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic and open surgery?
Gastroenterology Report 1 (2013) 138 143, doi:10.1093/gastro/got008 Advance access publication 4 April 2013 Original article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic
More informationSafety of short stay Hospitalization in Reversal of Loop Ileostomy
Original Article Safety of short stay Hospitalization in Reversal of Loop Ileostomy Tayyab Abbas, Abid Nazir, Muhammad Lateef, Faisal Rauf, Zafar Ali Choudhary Abstract Study Design: Prospective, randomized
More informationColostomy & Ileostomy
Colostomy & Ileostomy Indications, problems and preference By Waleed Omar Professor of Colorectal surgery, Mansoura University. Disclosure I have no disclosures. Presentation outline Stoma: Definition
More informationMalnutrition: An independent Risk Factor for Postoperative Complications
Malnutrition: An independent Risk Factor for Postoperative Complications Bryan P. Hooks, D.O. University of Pittsburgh-Horizon June 24, 2017 Orthopedic Surgeon-Adult Reconstruction Disclosures: None Objectives:
More informationCOLORECTAL RESECTIONS
COLORECTAL RESECTIONS What is a colorectal (bowel) resection? Surgery to remove a part of the large bowel is called a resection. Different parts of the colon require different operations and have different
More informationSimone Targa. Impact of an ERAS Colorectal Program on clinical outcomes and costs
Impact of an ERAS Colorectal Program on clinical outcomes and costs Simone Targa U.O. di Clinica Chirurgica Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna ERAS Protocol ENHANCED RECOVERY
More informationEducational Learning Objectives. Evidence into Practice. Audience. Case Presentation. Outline. Multimodal Approach to Colorectal Surgery
Educational Learning Objectives Multimodal Approach to Colorectal Surgery Value and Impact of Nutrition Interventions May 5, 2011 Dr. Corilee A. Watters, MSc, RD, PhD, CNSC Asst. Prof, Nutrition, University
More informationNational Horizon Scanning Centre. Methylnaltrexone (MOA-728) for postoperative ileus. April 2008
(MOA-728) for postoperative ileus April 2008 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a definitive statement
More informationFast Track Colorectal Surgery A new era of perioperative care. Jauch, LMU Grosshadern,, Munich
Fast Track Colorectal Surgery A new era of perioperative care P. Rittler,, Karl-Walter Jauch, LMU Grosshadern,, Munich FAST Track = ERAS(Enhanced Enhanced Recovery After Surgery) ) = Multimodal Rehabilitation
More informationPost operative nutritional supplementation and early feeding: an evidence based view of current treatment Steven Thomas University Hospitals Bristol
Post operative nutritional supplementation and early feeding: an evidence based view of current treatment Steven Thomas University Hospitals Bristol Stephen Lewis Derriford Hospital Plymouth Structure
More informationFluid Balance in an Enhanced Recovery Pathway. Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017
Fluid Balance in an Enhanced Recovery Pathway Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017 No Disclosures 2 Introduction The optimal intravenous fluid regimen
More informationNasogastric tube (NT) decompression after
Original Article Elective Bowel Surgery with or without Prophylactic Nasogastric Decompression: A Prospective, Randomized Trial H. G. Vinay, Mohammed Raza, G. Siddesh Department of General Surgery, JSS
More informationMultimodal Approach for Managing Postoperative Ileus: Role of Health- System Pharmacists (ACPE program H01P)
1. In the normal gastrointestinal tract, what percent of nutrient absorption occurs in the jejunum? a. 20%. b. 40%. c. 70%. d. 90%. 2. According to Dr. Erstad, the four components of gastrointestinal control
More informationEvaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University Hospital
Med. J. Cairo Univ., Vol. 85, No. 5, September: 1911-1916, 2017 www.medicaljournalofcairouniversity.net Evaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University
More informationRepeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease
ORIGINAL ARTICLE pissn 2234-778X eissn 2234-5248 J Minim Invasive Surg 2018;21(1):38-42 Journal of Minimally Invasive Surgery Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic
More informationNosocomial Pneumonia in Patients with Prolonged Ryles Tube Insertion
ISSN: 2319-7706 Special Issue-1 (2015) pp. 65-70 http://www.ijcmas.com Original Research Article Nosocomial Pneumonia in Patients with Prolonged Ryles Tube Insertion Bushra Siddiqui 1*, Shahbaz Habib Faridi
More informationFTS Oesophagectomy: minimal research to date 3,4
Fast Track Programme in patients undergoing Oesophagectomy: A Single Centre 5 year experience Sullivan J, McHugh S, Myers E, Broe P Department of Upper Gastrointestinal Surgery Beaumont Hospital Dublin,
More informationEarly enteral nutrition in the major trauma patient requiring intensive care: An overview of the evidence.
Early enteral nutrition in the major trauma patient requiring intensive care: An overview of the evidence. Dr. Gordon S. Doig Associate Professor in Intensive Care Northern Clinical School Intensive Care
More informationScott A. Lynch, MD, MPH,FAAFP Assistant Professor
Scott A. Lynch, MD, MPH,FAAFP Assistant Professor Lynch.Scott@mayo.edu 2015 MFMER 3543652-1 Nutrition in the Hospital Mayo School of Continuous Professional Development 2nd Annual Inpatient Medicine for
More informationRoutine nasogastric suction may be unnecessary after a pancreatic resection
DOI:10.1111/j.1477-2574.2011.00359.x HPB ORIGINAL ARTICLE Routine nasogastric suction may be unnecessary after a pancreatic resection William E. Fisher, Sally E. Hodges, Guillermina Cruz, Avo Artinyan,
More informationRandomized Controlled Trial of Bisacodyl Suppository Versus Placebo for Postoperative Ileus After Elective Colectomy for Colon Cancer
Original Article Randomized Controlled Trial of Bisacodyl Suppository Versus Placebo for Postoperative Ileus After Elective Colectomy for Colon Cancer Sukanya Wiriyakosol, Youwanuch Kongdan, Chakrapan
More informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.6 Facilitating Oral or Enteral Nutrition in the Postoperative Period Mattias Soop Learning Objectives To review the causes of postoperative
More informationDIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV
DIVERTICULAR DISEASE Dr. Irina Murray Casanova PGY IV Diverticular Disease Colonoscopy Abdpelvic CT Scan Surgical Indications Overall, approximately 20% of patients with diverticulitis require surgical
More informationObjectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE
Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation
More informationIMMUNONUTRITION AND GI SURGERY (UPPER AND LOWER) STUDIES COMPENDIUM
IMMUNONUTRITION AND GI SURGERY (UPPER AND LOWER) Colorectal or gastric cancer Xu 2006 (WJS;30:1284-1289) RCT to determine the effect of preoperative immunonutrition on nutritional status, immunity, and
More informationColorectal Liver Metastases Metachronous
Colorectal Liver Metastases Metachronous Professor Rowan Parks Professor of Surgical Sciences University of Edinburgh No disclosures Natural History of Unresected Untreated Colorectal Metastases Year N
More informationCase discussion. Anastomotic leakage. intern superviser
Case discussion Anastomotic leakage intern superviser Basic data Name : XX ID: M101881671 Age:51 Y Gender: male Past history: Hospitalized for acute diverticulitis on 2004/7/17, 2005/5/28 controlled by
More informationFasting Not Starving! Dr David Rowe FANZCA VMO Anaesthetist Armidale Rural Referral Hospital Rural SIG meeting Cradle Mountain July 2015
Fasting Not Starving! Dr David Rowe FANZCA VMO Anaesthetist Armidale Rural Referral Hospital Rural SIG meeting Cradle Mountain July 2015 Fasting or Starving? Outline Challenge dogma Why do we fast before
More informationDisclosures. Personalized Approaches to Gastrointestinal Cancers. Objectives. What is personalized cancer care. Go through some genomic studies
Personalized Approaches to Gastrointestinal Cancers Emily Groves, MD Colorectal Surgery Assistant Professor, Division of Surgical Oncology Disclosures None Objectives What is personalized medicine and
More informationProviding Optimal Nutritional Support on the ICU common problems and practical solutions. Pete Turner Specialist Nutritional Support Dietitian
Providing Optimal Nutritional Support on the ICU common problems and practical solutions Pete Turner Specialist Nutritional Support Dietitian ICU Nutritional Support ACCEPT study showed improved ICU survival
More informationEnhanced Recovery after Surgery Guideline
Administrative Office: 600 University Ave, 449 Toronto, ON M5G 1X5 T: 416.586.4800 x8534 F: 416.586.8644 E: epearsall@mtsinai.on.ca W: www.bpigs.ca Steering Committee Robin McLeod, Chair Mount Sinai Hospital
More informationGuidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: ASPEN-SCCM 2017
Number of Patients Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: ASPEN-SCCM 2017 Jorge A. Coss-Bu, MD Associate Professor of Pediatrics
More informationColorectal Surgery in the Elderly. Stephen Smith
Colorectal Surgery in the Elderly Stephen Smith Scope WHO >65 Social definition No COI Age specific incidence of CRC in Australia 2016 (new cases/100,000) My data: elective bowel resections
More informationUniversity of Cape Town
Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma Dr Mahammed Riyaad Moydien MBChB (UCT) Student Number: MYDMAH001 A dissertation submitted in fulfilment of the requirements for the
More informationPerioperative pathophysiology and the objectives behind Enhanced Recovery Care
Perioperative pathophysiology and the objectives behind Enhanced Recovery Care Francesco Carli, MD, MPhil McGill University Montreal, Canada franco.carli@mcgill.ca 60 patients (74 yo) Open colon resection
More informationUnderstanding the benefits of early enteral nutrition in the major trauma patient requiring intensive care: From clinical trials to costs.
Understanding the benefits of early enteral nutrition in the major trauma patient requiring intensive care: From clinical trials to costs. Dr. Gordon S. Doig Associate Professor in Intensive Care Northern
More informationA high-volume surgical unit experience with enhanced recovery after surgery (ERAS)
A high-volume surgical unit experience with enhanced recovery after surgery (ERAS) Catalina Mosquera, Nicholas J. Koutlas, Nasreen A. Vohra, Emmanuel E. Zervos, Timothy L. Fitzgerald East Carolina University,
More informationOPTICS OPTimal nutrition by Informing and Capacitating family members of best nutrition practices OPTICS
OPTICS OPTimal nutrition by Informing and Capacitating family members of best nutrition practices Educational Booklet for Families Version April 26 th 2016 Page 1 of 12 This information booklet was originally
More informationENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY
Department of Surgery Divison of General Surgery ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAYS PARESH C. SHAH MD FACS VICE CHAIR OF SURGERY DIRECTOR OF GENERAL SURGERY December 2016 Disclosure Paresh
More informationImpact of a Pharmacist Implemented Protocol on Overall Use of Alvimopan (Entereg ) and Length of Stay in Laparoscopic Colorectal Surgeries
Journal of Pharmacy and Pharmacology 4 (2016) 521-525 doi: 10.17265/2328-2150/2016.10.001 D DAVID PUBLISHING Impact of a Pharmacist Implemented Protocol on Overall Use of Alvimopan (Entereg ) and Length
More informationSubtotal and Total Gastrectomy
DR ADEEB MAJID MBBS, MS, FRACS, ANZHPBA FELLOWSHIP GENERAL, HEPATOBILIARY AND PANCREATIC SURGEON CALVARY MATER HOSPITAL NEWCASTLE Information for patients and carers Subtotal and Total Gastrectomy Introduction
More informationThe impact of adhesions on operations and postoperative recovery in colon cancer surgery
The American Journal of Surgery (2013) -, - - The impact of adhesions on operations and postoperative recovery in colon cancer surgery Ramzi Amri, M.Sc., Hannah C. den Boon, B.Sc., Liliana G. Bordeianou,
More informationAPPLYING ENHANCED RECOVERY PRINCIPLES: EARLY TESTING IN UPPER GI CANCER
APPLYING ENHANCED RECOVERY PRINCIPLES: EARLY TESTING IN UPPER GI CANCER William Allum Consultant Surgeon, Royal Marsden NHS Foundation Trust ? POSSIBLE Major procedure Painful Anastomotic complications
More informationLONG TERM OUTCOME OF ELECTIVE SURGERY
LONG TERM OUTCOME OF ELECTIVE SURGERY Roberto Persiani Associate Professor Mini-invasive Oncological Surgery Unit Institute of Surgical Pathology (Dir. prof. D. D Ugo) Dis Colon Rectum, March 2000 Dis
More informationRisk factors for fatal outcome in surgical patients with postoperative. aspiration pneumonia
Original article Risk factors for fatal outcome in surgical patients with postoperative aspiration pneumonia Peter Studer 1, Genevieve Räber 1, Daniel Ott 2, Daniel Candinas 1, Beat Schnüriger 1 1 Department
More informationEarly Enteral Feeding in Intestinal Anastomosis
J Nepal Health Res Counc 2011 April;9(18):1-5 Original Article Early Enteral Feeding in Intestinal Anastomosis Thapa PB, 1 Nagarkoti K, 1 Lama T, 1 Maharjan DK, 1 Tuladhar M 1 1 Department of Surgery,
More informationSenior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view
Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view 1st Geneva International SCIENTIFIC DAY February 3 rd 2010 E. Schiffer Dept APSI, HUG 1 Fast-Track in colorectal
More informationA video demonstration of the Li s anastomosis the key part of the non-tube no fasting fast track program for resectable esophageal carcinoma
Surgical Technique A video demonstration of the the key part of the non-tube no fasting fast track program for resectable esophageal carcinoma Yan Zheng*, Yin Li*, Zongfei Wang, Haibo Sun, Ruixiang Zhang
More informationGENERAL SURGERY Jill Attia, NP
GENERAL SURGERY Jill Attia, NP Lisa Morgan, NP GOALS OF THIS PRESENTATION Review the role of Inpatient Nurse Practitioner Identify the 3 main General Surgery services Describe Surgical Oncology services
More informationHow to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion
How to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion Disclosure Slide No COI and no disclosures. Hospital Mortality rate : is it
More informationUsefulness of Gum Chewing to Decrease Postoperative Ileus in Colorectal Surgery with Primary Anastomosis: A Randomized Controlled Trial
REVISTA DE INVESTIGACIÓN CLÍNICA Contents available at PubMed www.clinicalandtranslationalinvestigation.com PERMANYER Rev Inves Clin. 2016;68:314-8 ORIGINAL ARTICLE Usefulness of Gum Chewing to Decrease
More informationSTRATEGIES TO IMPROVE ENTERAL FEEDING TOLERANCE. IS IT WORTH IT? ENGELA FRANCIS RD(SA)
STRATEGIES TO IMPROVE ENTERAL FEEDING TOLERANCE. IS IT WORTH IT? ENGELA FRANCIS RD(SA) DEFINITION OF ENTERAL FEEDING INTOLERANCE Gastrointestinal feeding intolerance are usually defined as: High gastric
More informationBRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT
BRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT By: Amy Cisyk Home for the Summer Program July, 2016 Brandon, Manitoba Supervisor: Dr. Marvin Goossen Whipple s Procedure Audit
More informationYOUR OPERATION EXPLAINED
RIGHT HEMICOLECTOMY This leaflet is produced by the Department of Colorectal Surgery at Beaumont Hospital supported by an unrestricted grant to better Beaumont from the Beaumont Hospital Cancer Research
More informationERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationEnhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience
Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC Our Data Experience No Disclosures 1/26/2015 2 Purpose To tell our story of how we collect and share our ERACS data 1/26/2015
More informationEnhanced Recovery after Surgery
Enhanced Recovery after Surgery AKA ERAS What is Enhanced Recovery (ER)? Paradigm shift in surgery and surgical care of the patient Philosophy of care Perioperative continuum Multidisciplinary Patient
More informationColorectal Clinical Pathways: A Method of Improving Clinical Outcome?
Original Article Colorectal Clinical Pathways: A Method of Improving Clinical Outcome? Jane J.Y. Tan, Angel Y.Z. Foo and Denis M.O. Cheong, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
More informationIf you reduce variability in volume administration, HOW. you can reduce post-surgical complications, LOS and associated costs 1-4
A large body of clinical evidence* demonstrates If you reduce variability in volume administration, you can reduce post-surgical complications, LOS and associated costs 1-4 Complications Too Dry Too Wet
More informationThe Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5122-5129 Enhanced Recovery Program (ERP) versus Traditional care after Elective Left Side Colorectal Cancer Surgery Ahmad Aboelkassem
More informationNutritional Management in Enterocutaneous fistula Dr Deepak Govil
Nutritional Management in Enterocutaneous fistula Dr Deepak Govil MS, PhD (GI Surgery) Senior Consultant Surgical Gastroenterology Indraprastha Apollo Hospital New Delhi What is enterocutaneous fistula
More informationFast-Track Colonic Surgery: Status and Perspectives
Fast-Track Colonic Surgery: Status and Perspectives Henrik Kehlet H. Kehlet ( ) Section for Surgical Pathophysiology, Rigshospitalet, Section 4074, Blegdamsvej 9, 2100 Copenhagen, Denmark e-mail: henrik.kehlet@rh.dk
More informationBowel Preparation for Elective Colorectal Surgery: Helpful or Harmful? Michael J Stamos, MD University of California, Irvine
Bowel Preparation for Elective Colorectal Surgery: Helpful or Harmful? Michael J Stamos, MD University of California, Irvine History of Colon Surgery Early 20 th Century mortality rates for colorectal
More informationNutrition Support. John Cha Department of Surgery DHMC/UCHSC
Nutrition Support John Cha Department of Surgery DHMC/UCHSC Overview Why? When? How much? What route? Fancy stuff: enhanced nutrition Advantages of Nutrition Decreased catabolism Improved wound healing
More informationWith joy and great relief
Ulf Gustafsson All previously published papers and figures were reproduced with permissions from the publishers Published by Karolinska Institutet Printed by Larserics Digital Print AB Ulf Gustafsson,
More informationFeasibility Study of Early Oral Intake after Gastrectomy for Gastric Carcinoma
J Gastric Cancer 2011;11(2):101-108 DOI:10.5230/jgc.2011.11.2.101 Original Article Feasibility Study of Early Oral Intake after Gastrectomy for Gastric Carcinoma Dong Hoon Jo, Oh Jeong, Jang Won Sun, Mi
More informationTAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial
TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial Kim Gorissen Frederic Ris Martijn Gosselink Ian Lindsey Dept of Colorectal Surgery Dept of
More informationAppropriate Use of Enteral Nutrition: Part 1 A Team-Based Approach to. Presented at A.S.P.E.N. s Clinical Nutrition Week January 24, 2012 Orlando, FL
Appropriate Use of Enteral Nutrition: Part 1 A Team-Based Approach to Overcoming Clinical Barriers Presented at A.S.P.E.N. s Clinical Nutrition Week January 24, 2012 Orlando, FL According to the Commission
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationDiet what helps? Lindsey Allan Macmillan Oncology Dietitian Royal Surrey County Hospital, Guildford
Diet what helps? Lindsey Allan Macmillan Oncology Dietitian Royal Surrey County Hospital, Guildford Diet and cancer Diet and cancer Nutrition research Lack of funding RCTs Low quality Small sample sizes
More information