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Utrilla Fornals A, Costas-Batlle C, Medlin S, Menjón-Lajusticia E, Cisneros-González J, Saura-Carmona P, Montoro-Huguet MA. Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting. Nutrients 2024; 16:246. [PMID: 38257141 PMCID: PMC10820062 DOI: 10.3390/nu16020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.
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Affiliation(s)
| | - Cristian Costas-Batlle
- Department of Nutrition and Dietetics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK;
| | | | - Elisa Menjón-Lajusticia
- Gastroenterology, Hepatology and Nutrition Unit, University Hospital San Jorge, 22004 Huesca, Spain;
| | - Julia Cisneros-González
- Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; (J.C.-G.); (P.S.-C.)
| | - Patricia Saura-Carmona
- Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; (J.C.-G.); (P.S.-C.)
| | - Miguel A. Montoro-Huguet
- Gastroenterology, Hepatology and Nutrition Unit, University Hospital San Jorge, 22004 Huesca, Spain;
- Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; (J.C.-G.); (P.S.-C.)
- Department of Medicine, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain
- Aragon Health Research Institute (IIS Aragon), University of Zaragoza, 22002 Huesca, Spain
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Alemrajabi M, Khavanin Zadeh M, Hemmati N, Banivaheb B, Alemrajabi F, Jahanian S, Bahadoram M, Barahman M. Inferior Part of Rectus Abdominis Muscle Flap Outcomes after Abdominoperineal Resection: A Case Series Pilot Study. World J Plast Surg 2021; 10:104-110. [PMID: 34912674 PMCID: PMC8662682 DOI: 10.29252/wjps.10.3.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/25/2021] [Accepted: 09/19/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The standard surgical treatment for low rectal cancer is abdominoperineal resection (APR). Comparing to primary closure, immediate flap reconstruction has shown to have good outcomes. We aimed to assess the inferior rectus abdominis muscle flap complications after APR surgery, a new method of reconstruction. METHODS This study was conducted from 2014 to 2016 in a single center in Firoozgar Hospital, Tehran, Iran. Eighteen patients who underwent pelvic floor closure with inferior part of abdominis rectus musculofascial flap were included enrolled. The sampling method used in this study was census. All patients had distal rectoanal malignancies. A checklist including age, gender, tumor location, complications after surgery, tumor type, length of hospital stay, length of operation, neoadjuvant chemotherapy and neoadjuvant radiotherapy history was filled for all patients. RESULTS Among 18 participants, 27.8% were female. The mean age of participants was 58.28 ± 17.86 yr (minimum of 19 and the maximum of 89 yr). The pathology of the tumor in all but one of the cases was adenocarcinoma (94.4%). The overall complication rate after surgery was 27.8%. In total, 80% received neoadjuvant chemoradiotherapy. In 12 months follow-up 2 patients needed reoperation. CONCLUSION Inferior part of rectus abdominis muscle flap was a reliable and comparable means of reconstruction after APR surgery with low rate of complications and mortality.
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Affiliation(s)
- Mahdi Alemrajabi
- Firoozgar Clinical Research Devel-opment Center (FCRDC), Firoozgar hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Morteza Khavanin Zadeh
- Hasheminejad Kidney Center (HKC), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nima Hemmati
- Firoozgar Clinical Research Devel-opment Center (FCRDC), Firoozgar hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Behrouz Banivaheb
- Firoozgar Clinical Research Devel-opment Center (FCRDC), Firoozgar hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemeh Alemrajabi
- Firoozgar Clinical Research Devel-opment Center (FCRDC), Firoozgar hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sepideh Jahanian
- Firoozgar Clinical Research Devel-opment Center (FCRDC), Firoozgar hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Bahadoram
- Firoozgar Clinical Research Devel-opment Center (FCRDC), Firoozgar hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maedeh Barahman
- Firoozgar Clinical Research Devel-opment Center (FCRDC), Firoozgar hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Inferior Part of Rectus Abdominis Muscle Flap Outcomes after Abdominoperineal Resection: A Case Series Pilot Study. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.3.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Alemrajabi M, Moradi S, Jahanian S, Banivaheb B, Hemmati N, Safari S. Inferior part of rectus abdominis muscle flap: A case report. Med J Islam Repub Iran 2020; 33:111. [PMID: 32002390 PMCID: PMC6983492 DOI: 10.34171/mjiri.33.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Abdominoperineal resection (APR) is the standard surgical treatment for low-lying anorectal malignancies. It seems that immediate flap reconstruction has fewer complications compared to primary closure. There are several options for local flap reconstruction of perineal wound closure, and each specific flap method has its own advantages and disadvantages.
Case presentation: In this case report, a new method of reconstruction is presented which contains only the inferior part of the rectus abdominis muscle in 2 patients, one with unilateral and the other with bilateral involvement and they both underwent APR. Both patients were referred to the colorectal surgery clinic for APR by an oncologist. Both patients had severe constipation and both reported pain on defecation and rectorrhagia. Patient 1 received a unilateral inferior part of rectus abdominis muscle flap and patient 2 received a bilateral flap.
Conclusion: Immediate flap reconstruction after APR has fewer complications than primary closure and the inferior part of rectus abdominis muscle flap seems to be a possible means of reconstruction after APR.
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Affiliation(s)
- Mahdi Alemrajabi
- Department of Surgery, Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Moradi
- Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Jahanian
- Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Behrouz Banivaheb
- Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Nima Hemmati
- Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Safari
- Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
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Closure of Intractable Enterocutaneous Fistula with a Rectus Abdominis Musculocutaneous Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2258. [PMID: 31624674 PMCID: PMC6635194 DOI: 10.1097/gox.0000000000002258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
Abstract
Large enterocutaneous fistulas of the small intestine are rare and difficult to close, particularly if the fistula is associated with massive leakage of digestive juice and the residual intestinal tract is too short for anastomosis. We present a patient who underwent small bowel resection and secondary anastomosis following massive necrosis of the small intestine due to superior mesenteric artery thrombosis. After resection of an enterocutaneous fistula and reanastomosis, the residual small bowel was only 70 cm long with a persistent fistula. We successfully closed the fistula by employing a hinged rectus abdominis musculocutaneous flap. Here, we report our procedure for treating a large enterocutaneous fistula without performing laparotomy and bowel resection.
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Lauro A, Cirocchi R, Cautero N, Dazzi A, Pironi D, Di Matteo FM, Santoro A, Faenza S, Pironi L, Pinna AD. Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature. G Chir 2017; 38:185-198. [PMID: 29182901 DOI: 10.11138/gchir/2017.38.4.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas). METHODS The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure. RESULTS The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation. CONCLUSIONS Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.
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Sheckter CC, Shakir A, Vo H, Tsai J, Nazerali R, Lee GK. Reconstruction following abdominoperineal resection (APR): Indications and complications from a single institution experience. J Plast Reconstr Aesthet Surg 2016; 69:1506-1512. [DOI: 10.1016/j.bjps.2016.06.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
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Gupta R, Singh H, Talukder S, Verma GR. A new technique of closing a gastroatmospheric fistula with a rectus abdominis muscle flap. BMJ Case Rep 2015; 2015:bcr2015209309. [PMID: 25819831 PMCID: PMC4386304 DOI: 10.1136/bcr-2015-209309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/04/2022] Open
Abstract
Proximal enteroatmospheric fistulae are difficult to manage and carry high mortality from sepsis and electrolyte imbalances. Conservative management with total parenteral nutrition, exclusion of fistula, resection and anastomosis are conventional methods of treatment with low success rate. Providing muscle cover to manage an enteroatmospheric fistula is a noble concept. A postoperative high-output gastroatmospheric fistula (GAF) was repaired by superior epigastric artery-based rectus abdominis muscle flap (RAMF). Postoperative recovery was uneventful. This technique may be useful for closure of proximal enteroatmospheric fistulae that fail to heal through medical and conventional surgical management.
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Affiliation(s)
- Rahul Gupta
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shibojit Talukder
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganga Ram Verma
- Surgical Gastroenterology Division, Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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