Post Operative Complications

Enteral Nutrition Promotes Closure of Post-Op Pancreatic Fistula

Enteral nutrition is superior to total parenteral nutrition for the treatment of grade B postoperative pancreatic fistulas, reported Dr. Stanislaw Klek and his colleagues in the July issue of Gastroenterology.

Indeed, not only does enteral nutrition facilitate fistula closure, but closure occurs more quickly and the enteral approach is less costly, wrote the researchers (Gastroenterology 2011 July [doi:10.1053/j.gastro.2011.03.040]).

Dr. Klek of the Jagiellonian University Medical College in Krakow, Poland, and his associates studied 78 adult patients with postoperative pancreatic fistula treated at a single academic center in Poland. All patients had a grade B fistula, according to the criteria of the International Study Group on Pancreatic Fistula. "Postoperative pancreatic fistula is the most common and potentially life-threatening complication after pancreatic surgery," they noted.

Patients were excluded if they had any cardiocirculatory, pulmonary, renal, or liver failure; if their fistula required surgical intervention; or if nutritional status was so depleted that it required both parenteral and enteral feeding.

Patients were randomized into two demographically similar groups; for 30 days, one group received enteral feeding while the other received total parenteral nutrition (TPN). All patients were treated conservatively without surgery, somatostatin analogues, or proton pump inhibitors.

Enteral feedings were started 2-4 hours after placement of a nasointestinal tube, located 20 cm below the Treitz’s ligament or, in the case of pancreaticoduodenectomy, 20 cm below the last jejeunal anastomosis. The formula, called Peptisorb (manufactured by Nutricia), contains 1 kcal/mL, is low in fat, and is peptide based, with an initial flow rate of 10 mL/hr, progressing up to 125 mL/hr.

Parenteral nutrition infusions also commenced 2-4 hours post insertion of a central venous catheter, and were prepared by the hospital pharmacy.

The mean age in both groups was 57 years, and almost half (45%) of each group was female.

Fistula closure was defined as an output of less than 10 mL during a 48-hour period, with no recurrence in the subsequent 30 days and no evidence of fluid collection on ultrasound or computed tomography scan.

At 30 days, the rate of fistula closure was 60% in the enteral group (24 of 40 patients) and 37% in the parenteral group (14 of 38 patients).

Lasik Post Operative Complications.

Lasik eye surgery very often produces great vision. However, there are also risks associated with the procedure. If you are thinking of having laser eye surgery such asLASIK, it is vital that you are aware of the possible limitations of the surgery and possible complications which may arise.

Here is an overview of some of the complications which can occur with lasik eye surgery.

1. Loss of best corrected vision.

In this case vision lost because of the surgery cannot be corrected or improved either with contact lenses, eyeglasses, contact lenses or further enhancement surgery.

2. Visual DistortionProblems

Occasionally LASIK surgery patients develop nuisance symptoms after the operation including glare, light halos and diplopia (double vision). A patient may also suffer with reduced night vision.

3. In complete or overcorrection.

Not all laser eye surgery patients will obtain 6/6 (20/20) vision without eyeglasses or corrective contact lenses. A patient may still need glasses after the surgery. Some patients may also need further laser eye enhancement surgery to obtain their best vision.

4. Dry Eye Problems.

About 5% of laser eye surgery patients can develop serious dry eye problems after LASIK. A dry eye condition can occur because as a result of surgery the eye is unable to secrete enough lubricating tears. This condition can necessitate regularly daily treatment of the eys with artificial tears.

5. Changing Vision.

For some short sighted/myopic patients, Lasik, laser eye surgery results may not be a final solution and as the patient ages a further need for glasses will arise.

6. Eye Infection or Irritation.

Some Lasik patients can develop eye infections , or other inflammatory eye diseases. These diseases will need treatment with antibiotic or steroidal anti inflammatory eye drops.

Post-Operative Complications

Handbook of postoperative complications

Lecture notes, General surgery

Spinal deformities, the essentials

International clinics, a quarterly of clinical lectures