Dominykas Burneikis1, Luca Stocchi2, Ezra Steiger1, Denise Jezerski1, Sherief Shawki3. 1. Digestive Diseases and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave Desk A100, Cleveland, OH, 44195, USA. 2. Division of Colon and Rectal Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. 3. Digestive Diseases and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave Desk A100, Cleveland, OH, 44195, USA. shawkis@ccf.org.
Abstract
BACKGROUND: In majority of patients, early postoperative small bowel obstruction (EPSBO) resolves with nasogastric decompression and bowel rest alone, while in some patients, symptoms persist without urgent indications for surgery. The purpose of this study was the evaluation of home parenteral nutrition (HPN) instead of elective surgery as an initial approach to persistent EPSBO. METHODS: Patients developing EPSBO prescribed HPN without reoperation within 6 weeks after index intestinal surgery were identified from an institutional HPN registry and retrospectively compared with patients undergoing reoperation for EPSBO within the same time period. RESULTS: Thirty-four patients for the HPN group and 27 patients in elective reoperative (REOP) group met the inclusion criteria. In the HPN group, mean interval between surgery and PN initiation was 11 days. HPN duration ranged from 17 to 244 days with a median of 60 days. Thirty-one patients (91%) successfully recovered bowel function and resumed enteral nutrition without reoperation, while 3 patients required reoperation > 6 weeks after index surgery due to HPN failure. In the REOP group, mean interval between index surgery and reoperation was 17 days. At reoperation, 12 patients required bowel resection, 5 having incidental enterotomies, and 3 required new stoma creation. Postoperatively, 2 patients developed enterocutaneous fistulas, 1 experienced an anastomotic leak, and another had fascial dehiscence. CONCLUSION: HPN is a safe alternative to elective surgery in clinically stable patients with persistent EPSBO. This approach avoids hazardous reoperation during the recovery phase when adhesions are at their worst.
BACKGROUND: In majority of patients, early postoperative small bowel obstruction (EPSBO) resolves with nasogastric decompression and bowel rest alone, while in some patients, symptoms persist without urgent indications for surgery. The purpose of this study was the evaluation of home parenteral nutrition (HPN) instead of elective surgery as an initial approach to persistent EPSBO. METHODS:Patients developing EPSBO prescribed HPN without reoperation within 6 weeks after index intestinal surgery were identified from an institutional HPN registry and retrospectively compared with patients undergoing reoperation for EPSBO within the same time period. RESULTS: Thirty-four patients for the HPN group and 27 patients in elective reoperative (REOP) group met the inclusion criteria. In the HPN group, mean interval between surgery and PN initiation was 11 days. HPN duration ranged from 17 to 244 days with a median of 60 days. Thirty-one patients (91%) successfully recovered bowel function and resumed enteral nutrition without reoperation, while 3 patients required reoperation > 6 weeks after index surgery due to HPN failure. In the REOP group, mean interval between index surgery and reoperation was 17 days. At reoperation, 12 patients required bowel resection, 5 having incidental enterotomies, and 3 required new stoma creation. Postoperatively, 2 patients developed enterocutaneous fistulas, 1 experienced an anastomotic leak, and another had fascial dehiscence. CONCLUSION: HPN is a safe alternative to elective surgery in clinically stable patients with persistent EPSBO. This approach avoids hazardous reoperation during the recovery phase when adhesions are at their worst.
Entities:
Keywords:
Colorectal surgery; Home parenteral nutrition; Intestinal obstruction; Reoperation
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Pierre A Clavien; Jeffrey Barkun; Michelle L de Oliveira; Jean Nicolas Vauthey; Daniel Dindo; Richard D Schulick; Eduardo de Santibañes; Juan Pekolj; Ksenija Slankamenac; Claudio Bassi; Rolf Graf; René Vonlanthen; Robert Padbury; John L Cameron; Masatoshi Makuuchi Journal: Ann Surg Date: 2009-08 Impact factor: 12.969
Authors: Naeem Goussous; Kevin M Kemp; Michael P Bannon; Michael L Kendrick; Boris Srvantstyan; Mohammad A Khasawneh; Martin D Zielinski Journal: Am J Surg Date: 2014-10-13 Impact factor: 2.565
Authors: Bijo K John; Maqsood A Khan; Rex Speerhas; Kristen Rhoda; Cindy Hamilton; Robert Dechicco; Rocio Lopez; Ezra Steiger; Donald F Kirby Journal: JPEN J Parenter Enteral Nutr Date: 2011-12-28 Impact factor: 4.016
Authors: Sharif H Ellozy; Michael T Harris; Joel J Bauer; Stephen R Gorfine; Isadore Kreel Journal: Dis Colon Rectum Date: 2002-09 Impact factor: 4.585