Stapled versus handsewn intestinal anastomosis in emergency laparotomy

“This study hypothesized that there may be additional differences between trauma surgery (TS) and emergency general surgery (EGS) patients, because the physiologic conditions are typically dominated by hemodynamic instability from hemorrhage in the former, whereas the latter is predominantly complicated by sepsis. The 2 groups may also have different patient demographics, with TS patients being younger and more likely to be male than EGS patients.”

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Article of interest: The C-reactive protein-to-prealbumin ratio predicts fistula closure

Harriman S, Rodych N, Hayes P, Moser MA. The C-reactive protein-to-prealbumin ratio predicts fistula closure. Am J Surg. 2011 Aug;202(2):175-8.

Full-text for Emory users.

Background: The purpose of this study was to evaluate the predictability of fistula closure using the ratio of C-reactive protein to prealbumin (C:P ratio).

Methods: A database of 89 patients with gastrointestinal fistulas (1994-2009) was created based on the records of our Nutrition Support Services Team. All patients had weekly blood work including C-reactive protein level, prealbumin level, and albumin level. Forty-three fistulas were managed without surgery for 6 weeks or more; of these, 29 closed.

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Management of enterocutaneous fistulas

Owen RM, Love TP, Perez SD, Srinivasan JK, Sharma J, Pollock JD, Haack CI, Sweeney JF, Galloway JR. Definitive surgical treatment of enterocutaneous fistula: outcomes of a 23-year experience. JAMA Surg. 2013 Feb;148(2):118-26.

Full-text for Emory users.

Figure 1. Causes of enterocutaneous fistula between 1987 and 2010. IBD indicates inflammatory bowel disease; other includes radiation, neoplasm, and trauma. Percentages may total more than 100% owing to the fact that some patients’ ECFs were secondary to multiple causes.

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Nutritional support of the enterocutaneous fistula patient

Kumpf VJ, et al. ASPEN-FELANPE Clinical Guidelines: Nutrition Support of Adult Patients With Enterocutaneous Fistula.JPEN J Parenter Enteral Nutr. 2017 Jan;41(1):104-112. doi: 10.1177/0148607116680792.

Free full-text. 

Questions addressed in these guidelines: 

In adult patients with enterocutaneous fistula: (1) What factors best describe nutrition status? (2) What is the preferred route of nutrition therapy (oral diet, enteral nutrition, or parenteral nutrition)? (3) What protein and energy intake provide best clinical outcomes? (4) Is fistuloclysis associated with better outcomes than standard care? (5) Are immune-enhancing formulas associated with better outcomes than standard formulas?(6) Does the use of somatostatin or somatostatin analogue provide better outcomes than standard medical therapy? (7) When is home parenteral nutrition support indicated?

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Enterocutaneous fistulas: causes, management, and Emory authors

One discussion this week involved enterocutaneous fistulas.

Reference: Haak CI, Galloway JR, Srinivasan J. Enterocutaneous fistulas: a look at causes and management. Current Surgery Reports. 2014 Oct;2:71.

Summary: Despite advances in medical technology and surgical care, the management of enterocutaneous fistulas (ECF) remains one of the most challenging problems faced by physicians. Success depends on an expert multidisciplinary team, access to long-term enteral and parenteral nutrition support, advanced wound care, optimal medical management and meticulous, methodical, surgical decision-making and technique.

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