scholarly journals Routine use of Feeding Jejunostomy in Pancreaticoduodenectomy: A meta-analysis

2021 ◽  
Vol 25 (1) ◽  
pp. S362-S362
Author(s):  
Bhavin VASAVADA ◽  
Hardik PATEL
Keyword(s):  
Meta Analysis ◽  
Feeding Jejunostomy

scholarly journals Routine Use of Feeding Jejunostomy in Pancreaticoduodenectomuy: A Metaanalysis

2020 ◽  
Author(s):  
Bhavin Vasavada ◽  
Hardik Patel
Keyword(s):  
Odds Ratio ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Control Group ◽  
Site Infection ◽  
Weighted Mean ◽  
Feeding Jejunostomy ◽  
Significant Difference ◽  
Deep Surgical Site Infection ◽  
Total Parentral Nutrition

Aims and Objectives: The primary aim of our study was to evaluate morbidity and mortality following feeding jejunostomy in pancreaticoduodenectomy compared to the control group. We also evaluated individual complications like delayed gastric emptying, post operative pancreatic fistula, superficial and deep surgical site infection. We also looked for time to start oral nutrition and requirement of total parentral nutrition. Material and Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. [9,10]. We searched pubmed, cochrane library, embase, google scholar with keywords like “feeding jejunostomy in pancreaticodudenectomy”, “entral nutrition in pancreaticoduodenectomy, “total parentral nutrition in pancreaticoduodenectomy’, “morbidity and mortality following pancreaticoduodenectomy”. Two independent authors extracted the data (B.V and H.P).The meta-analysis was conducted using Open meta-analysis software. Heterogeneity was measured using Q tests and I2, and p < 0.10 was determined as significant , the random-effects model was used. The Odds ratio (OR) was calculated for dichotomous data, and weighted mean differences (WMD) were used for continuous variables. Both differences were presented with 95% CI. Results: Four studies including Total of 1639 patients were included in the analysis. Total 843 patients were included in Feeding jejunostomy group and 796 patients included in control group without feeding jejunostomy. Over all morbidity was significantly higher in feeding jejunostomy group. (odds ratio 1.39, p = 0.001). However, there was no significant difference between both the group. (p=0.07). Delayed gastric emptying was significantly higher in Feeding jejunostomy group. [p=0.021]. There was no significant difference in development of pancreatic fistula between the two group. (p=0.536). Deep surgical site infection were significantly higher in feeding jejunostomy group. (p=0.013). Hospital stay was significantly more in feeding jejunostommy group, weighted mean difference of 2.094 days. (p<0.0001). There was no significant difference between readmission (p=0.536) and TPN requirement between the two group. Time to start oral feed was significantly more in feeding jejunostomy group. Conclusion: Feeding jejunostomy seems to be associated with increased morbidity, increased complications, increased length of stay without any significant benefits.

scholarly journals Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—a systematic review and meta-analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 68-68
Author(s):  
Xu Shen ◽  
Ze-Guo Zhuo ◽  
Gang Li ◽  
Gu-Ha Alai ◽  
Tie-Niu Song ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Feeding Jejunostomy

Is it necessary to routinely perform feeding jejunostomy at the time of esophagectomy? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Li-Xiang Mei ◽  
Yong-Yong Wang ◽  
Xiang Tan ◽  
Yong Chen ◽  
Lei Dai ◽  
...  
Keyword(s):  
Weight Loss ◽  
Postoperative Complications ◽  
Intestinal Obstruction ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Postoperative Pneumonia ◽  
Current Evidence ◽  
Cochrane Library ◽  
Feeding Jejunostomy

Summary Feeding jejunostomy (FJ) is a routine procedure at the time of esophagectomy in some centers. With the widespread popularization of enhanced recovery after surgery, the necessity of FJ has been increasingly questioned. This study aims to analyze the differences in safety and effectiveness between with (FJ group) or without (no-FJ group) performing FJ at the time of esophagectomy. PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched for relevant studies, including randomized controlled trials and cohort studies. The primary outcome was the length of hospital stay (LOS). Secondary outcomes were overall postoperative complications, postoperative pneumonia, intestinal obstruction, and weight loss at 3 and 6 months after esophagectomy. Weighted mean differences (WMD) and odds ratios (OR) were calculated for statistical analysis. About 12 studies comprising 2,173 patients were included. The FJ group had a longer LOS (WMD = 2.05, P = 0.01) and a higher incidence of intestinal obstruction (OR = 11.67, P < 0.001) than the no-FJ group. The incidence of overall postoperative complications (OR = 1.24, P = 0.31) and postoperative pneumonia (OR = 1.43, P = 0.13) were not significantly different, nor the weight loss at 3 months (WMD = 0.58, P = 0.24) and 6 months (P > 0.05) after esophagectomy. Current evidence suggests that routinely performing FJ at the time of esophagectomy appears not to generate better postoperative outcomes. FJ may need to be performed selectively rather than routinely. More studies are required to further verify.

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yali Wei ◽  
Yan Meng ◽  
Na Li ◽  
Qian Wang ◽  
Liyong Chen
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acid ◽  
Meta Analysis ◽  
Chain Polyunsaturated Fatty Acid ◽  
Inflammation Markers ◽  
Pufa Supplementation ◽  
Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

2013 ◽  
Vol 18 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Robert J. Barth
Keyword(s):  
Health Outcomes ◽  
Pain Perception ◽  
Driving Forces ◽  
Psychological Treatment ◽  
Dominant Role ◽  
Meta Analysis ◽  
General Medicine ◽  
Pain Syndrome ◽  
Problematic Relationship

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

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