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At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

Early oral feeding following total laryngectomy.

INTRODUCTION: Pharyngocutaneous fistula is one of the most common nonfatal laryngectomy complications (7.6% to 65% of all total patients). Preoperative radiotherapy, advanced tumor stage, poor preoperative medical status, and concomitant pharyngectomy are usually accepted causative factors in fistula formation. Delay of oral feeding is a common practice used by head and neck surgeons to prevent the development of pharyngocutaneous fistula. In this article we analyze our experience with special emphasis given to the early start of postoperative feeding. PATIENTS AND METHODS: The postoperative records of 48 patients who had undergone total laryngectomy or total laryngopharyngectomy were reviewed. All patients were orally fed with water and clear liquids on the first postoperative day. The patients were closely observed at every feeding attempt, and if any sign of fistula was noted, a nasogastric tube was inserted. Preoperative radiotherapy, stage of disease, tumor differentiation, and pharyngectomy with total laryngectomy were statistically analyzed as potential risk factors contributing to fistula formation. The Fisher exact test was used to analyze the data. RESULTS: The overall pharyngocutaneous fistula rate was 12.5% in our series. The only statistically significant factor that increased the rate of fistula formation was resection of pharyngeal mucosa as an extension of total laryngectomy. Other parameters failed to show any statistical significance in development of this complication. CONCLUSION: Evaluation of fistula incidence in our series indicates that initiating oral feeding on the first postoperative day does not contribute to fistula formation. Additionally, the relatively shortened hospital stay and elimination of the psychologic and traumatic side effects of tube feeding are benefits of this approach that should be studied in further prospective quality-of-life studies.

Adenocarcinoma↗
PubMed2002

The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota.

BACKGROUND & AIMS: Little is known about the cumulative incidence and natural history of fistulas in Crohn's disease in the community. METHODS: The medical records of all Olmsted County, Minnesota residents who were diagnosed with Crohn's disease from 1970 to 1993 and who developed a fistula were abstracted for clinical features and outcomes. Six patients denied research authorization. The cumulative incidence of fistula from time of diagnosis was estimated by using the Kaplan-Meier product-limit method. RESULTS: At least 1 fistula occurred in 59 patients (35%), including 33 patients (20%) who developed perianal fistulas. Twenty-six (46%) developed a fistula before or at the time of formal diagnosis. Assuming that the 9 patients with fistula before Crohn's disease diagnosis were instead simultaneous diagnoses, the cumulative risk of any fistula was 33% after 10 years and was 50% after 20 years (perianal, 21% after 10 years and 26% after 20 years). At least 1 recurrent fistula occurred in 20 patients (34%). Most fistulizing episodes (83%) required operations, most of which were minor. However, 11 perianal fistulizing episodes (23%) resulted in bowel resection. CONCLUSIONS: Fistulas in Crohn's disease were common in the community. In contrast to referral-based studies, only 34% of patients developed recurrent fistulas. Surgical treatment was frequently required.

Adolescent↗
PubMed2002

Sequential changes of body composition in patients with enterocutaneous fistula during the 10 days after admission.

AIM: To investigate the sequential changes of body composition in the metabolic response that occurred in a group of patients with enterocutaneous fistula after admission to the hospital. METHODS: Sixty-one patients with enterocutaneous fistula admitted to our hospital had measurements of body composition by multiple-frequency bioelectrical impedance analysis after admission and 5, 10 days later. Sequential measurements of plasma constitutive proteins were also made. RESULTS: The body weight, fat-free mass, body mass index, and body cell mass were initially well below the normal range, especially the body mass index and body cell mass. And all the data gradually moved up over the 10-day study period, only a highly significant difference was found in body cell mass. Once the patients received nutrition supplement, ECW began to return to normal range slowly as well as ICW and TBW began to rise up, and ECW/TBW significantly declined to near normal level by day 10 in either male or female patients. There was a reprioritization of plasma constitutive protein synthesis that was obligatory and independent of changes in FFM. CONCLUSION: Serial measurements can quantify the disturbance of body composition in enterocutaneous fistula patients. The early nutritional intervention rapidly ameliorates the abnormal distribution of body water while the state-of-the-art surgical management prevents the further deterioration in cellular composition.

Adult↗
PubMed2006

[Clinical experience with silicon pharyngeal tube for pharyngocutaneous fistula and cervical esophagus stenosis].

Total laryngectomy or laryngopharyngectomy are commonly performed for the treatment of laryngeal cancer or hypopharyngeal cancer. However pharyngocutaneous fistula and cervical esophageal stenosis have been reported as postoperative complications of these procedures. We used a silicon pharyngeal tube in cases that developed pharyngocutaneous fistula and cervical esophageal stenosis. The pharyngeal tube was useful for controlling aspiration pneumonia and for starting oral feeding in a case of pharyngocutaneous fistula after a total laryngectomy. It was also helpful for starting oral feeding in a case with cervical esophageal stenosis after total laryngopharyngectomy and free jejunum interposition. This patient was able to maintain a good quality of life until re-operation. Adverse effects from the insertion of the tube included a foreign body sensation and pharyngeal pain that was tolerable with the use of NSAIDs for a short time. Silicon pharyngeal tubes are useful for the treatment of pharyngocutaneous fistula and cervical esophageal stenosis.

Aged↗
PubMedDate not supplied

[Sandostatin treatment in postoperative external digestive fistulae].

The aim of the conservative treatment of postoperative external digestive fistulae is to obtain a reduction of the output, thus favoring spontaneous closure and shortening outcome. A retrospective comparative study has been performed on two groups of patients with postoperative anastomotic gastrointestinal and pancreatic fistulae. Group A included 18 cases (14 anastomotic, 4 pancreatic fistulae) receiving conventional treatment only. Group B included 25 cases (18 anastomotic and 7 pancreatic fistulae) in which Sandostatin was associated to conventional therapy, using daily doses ranging from 0.1 mg to 0.3 mg, administered after variable intervals after fistulas' occurrence. Duration of treatment ranged from 1 to 25 days. In group A, 27.77% of the cases were cured in comparison with group B in which the healing rate increased to 56%. Global hospital mortality rate was 25.58% (11 cases). In group A this was 44.44% (8 cases) in comparison with group B with 12% (3 cases) only. As a conclusion of our study, the use of Sandostatin is remarkable effective in the treatment of external digestive postoperative fistulae. Thus a doubling of healing rate and a reduction by 73% of mortality rate was achieved.

Cutaneous Fistula↗
PubMed1998

[A gastrocutaneous fistula secondary to the percutaneous drainage of a pancreatic abscess. A case report].

Pancreatic abscesses are a frequent complication of acute pancreatitis and their percutaneous drainage is usually accepted. A 76 years-old male patient admitted for acute pancreatitis (Ranson 3 at admission) has been treated with conservative therapy and percutaneous US directed drainage of the abscess, located between the tail of the pancreas and the gastric fundus. This kind of drainage was able to empty the abscess satisfactorily but it caused the onset of a gastrocutaneous fistula. This one was sutured on the gastric side by metal clips placed by gastroscopy. The patient was discharged on the 60th day in a good condition. An X-ray investigation with gastrografine before the drainage removal is therefore recommended.

Abscess↗