DOI: https://doi.org/10.22141/2224-0586.2.97.2019.161649

Clinical significance of restrictive fluid therapy impact on the recovery of gastrointestinal motility after pancreaticoduodenectomy

V.O. Kuzmenko, A.V. Skums, A.P. Mazur, I.A. Kuchynska

Abstract


Background. Modern advances in surgical and anesthetic technologies have reduced mortality rates after pancreaticoduodenectomy (PDE) to 3 %; however, postoperative complications reach 29.5–70 % in this pathology. Therefore, the issue of finding and avoiding the factors that cause complications after PDE is one of the most important ones in modern surgical pancreatology. Materials and methods. To evaluate the efficacy of perioperative treatment regimens, a prospective and retrospective study of PDE outcomes was carried out in 78 patients with benign and malignant pathology of the biliary and pancreatoduodenal zone in 2003–2017. From 2015, we started the use of enhanced recovery program (ERP) in our clinic for patients undergoing PDE. For the purpose of comparative ana-lysis, the patients were divided into two groups: group I included
39 patients who were treated from January 2015 to December 2017 according to ERP; group II consisted of 39 patients who were retrospectively selected for the period from January 2003 to October 2014, their treatment was carried out according to the traditional method. The volume of intraoperative fluid therapy, the реriod of recovery of gastrointestinal motility and the rate of delayed gastric emptying were studied. Results. Intraoperative fluid therapy, in terms of the volume of solutions applied, was significantly lower in group I compared to group II — 2100 ml (95% (confidence interval) CI: 1988–2300) vs 3300 ml (95% CI: 3100–3500), p < 0.001. Patients in group I returned to normal diet faster than patients in group II — 1.00 (95% CI: 1.00–1.00) vs 6.00 (95% CI: 6.00–7.00), p < 0.001. During the statistical analysis, according to the ROC curve, the correlation was revealed between the volume of intraoperative fluid therapy, time of nasogastric tube removal and restoration of oral nutrition in the postoperative period. Conclusions. The use of the restrictive fluid therapy in the concept of ERP significantly reduces the реriod of gastrointestinal motility recovery, the rate of delayed gastric emptying in patients after PDE. The statistically significant factor influencing the possibility of early oral nutrition was the volume of intraoperative fluid in patients after PDE.


Keywords


multimodal enhanced recovery program; perio-perative treatment; pancreaticoduodenectomy; restrictive fluid therapy

References


Rebecca L. Siegel, Kimberly D. Miller, Ahmedin Jemal Cancer Statistics, 2018 // CA Cancer J. Clin. 2018; 68:

-30.

Pillai S., Palaniappan R., Pichaimuthu A. Feasibility of implementing fast-track surgery in pancreaticoduodenectomy with pancreaticogastrostomy for reconstruction — a prospective cohort study with historical control // Int. J. Surg. 2014; 12(9):

-9.

Kulemann В., Fritz M., Glatz T., Marjanovic G., Sick O., et al. Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: A single center retrospective cohort study // Annals of Medicine and Surgery. 2017; (16): 23-29.

Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation // Br. J. Anaesth. 1997; 78: 606-617.

Lassen K., Coolsen M., van Dam R., van der Wilt A., Slim K., Dejong C. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies // World J. Surg. 2012; 37: 1909-

Slim K. Fast-track surgery: the next revolution in surgery care following laparoscopy // Colorectal Dis. 2013:

-480.

Miller T., Roche A., Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Reco-

very After Surgery (ERAS) // Can. J. Anaesth. 2015 Feb; 62(2):

-68.

Bratzler D.W., Dellinger E.P., Olsen K.M., et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery // Am. J. Health-Syst. Pharm. 2013; 70: 195-283.

Дронов О., Кучинська І., Арешніков Д., Задорожна К. Особливості проведення нутритивної підтримки у пацієнтів із тяжким гострим некротичним панкреатитом // Медицина неотложных состояний. 2015; 1(64):

-126.

Передопераційний скринінг нутритивних порушень у дорослих пацієнтів: використання шкал MUST та MNA-SF // Гострі та невідкладні стани у практиці лікаря. 2018; (2): 49.

Weimann A. et al. ESPEN guideline: Clinical nutrition in surgery // Clinical Nutrition. 2017; 36: 623-650.

Ruess D., Makowiec F., Chikhladze S., Sick O., Riediger H., Hopt U., Wittel U. The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma // BMC Surg. 2015; 15: 123.

Orr R. Outcomes in pancreatic cancer surgery // Surg. Clin. North Am. 2010; 90: 219-234.

Kengo A., Zaydfudim V., Truty M., Lombardo K., Kendrick M., Que F., Nagorney D., et al. Management of а delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques // HPB. 2015; 17: 902-908.

Robertson N., Gallacher P., Peel N., Garden O., Duxbury M., Lassen K., Parks W. Implementation of an enhanced recovery programme following pancreaticoduodenectomy // HPB. 2012; 14: 700-708.

Hallet J., Zih F., Deobald R., Scheer A., Law C., Coburn N., Karanicolas P. The impact of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction on pancreatic fistula after pancreaticoduodenectomy: meta-analysis of randomized controlled trials // HPB. 2015; 17: 113-122.

Callery M., Pratt W., Kent T., Chaikof E., Vollmer C. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy // J. Am. Coll. Surg. 2013; 216: 1-14.

Ren L., Zhu D., Wei Y., Pan X., Liang L., Xu J., et al. Enhanced recovery after surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial // World J. Surg. 2012; 36: 407-414.

Nisanevich V., Felsenstein I., Almogy G., et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery // Anesthesiology. 2005; 103: 25-32.

Chowdhury A.H., Lobo D.N. Fluids and gastrointestinal function // Curr. Opin. Clin. Nutr. Metab. Care. 2011; 14: 469-476.

Lobo D.N., Bostock K.A., Neal K.R., Perkins A.C., Rowlands B.J., Allison S.P. Effect of salt and water balance on reco-very of gastrointestinal function after elective colonic resection: a randomised controlled trial // Lancet. 2002; 359: 1812-1818.

Brandstrup B., Tonnesen H., Beier-Holgersen R., Hjortso E., Ording H., Lindorff-Larsen K., et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial // Ann. Surg. 2003; 238: 641-648.

McClave S.A. The physiologic response and associated clinical benefits from provision of early enteral nutrition / S.A. McClave, D.K. Heyland // Nutr. Clin. Pract. 2009; 24, № 3: 305-315.

Wright G., Koehler T., Davis A., Chung M. The drowning whipple: perioperative fluid balance and outcomes follo-wing pancreaticoduodenectomy // J. Surg. Oncol. 2014; 110:

-411.

Weinberg L., Wong D., Karalapillai D., et al. The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenectomy (Whipple’s procedure) // BMC Anesthesiol. 2014; 14: 14-35.

Fischer M., Matsuo K., Gonen M., et al. Relationship between intraoperative fluid administration and perioperative outcome after pancreaticoduodenectomy: results of a prospective randomized trial of acute normovolemic hemodilution compared with standard intraoperative management // Ann. Surg. 2010; 252: 952-958.

Lindenblatt N., Park S., Alsfasser G., et al. Intraoperative fluid management in pancreatic resectionsda surgeon’s view // Zentralbl. Chir. 2008; 133: 168-175.

Melis M., Marcon F., Masi A., et al. Effect of intra-

operative fluid volume on perioperative outcomes after pancreaticoduodenectomy for pancreatic adenocarcinoma // J. Surg. Oncol. 2012; 105: 81-84.

Grant F., Protic M., Gonen M., Allen P., Brennan M. Intraoperative fluid management and complications following pancreatectomy // J. Surg. Oncol. 2013; 107: 529-535.

van Samkar G., Eshuis W.J., Bennink R.J., van Gulik T.M., Dijkgraaf M.G.W., Preckel B., et al. Intraoperative Fluid Restriction in Pancreatic Surgery: A Double Blinded Randomised Controlled Trial // PLoS One. 2015; 10(10): e0140294.




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