Objectives: ERAS has prompted changes to practice across the surgical, anaesthetic and nursing professions that have minimised the surgical stress response and reduced length of hospital stay. The next goal for ERAS teams is to return patients to normal function as quickly as possible following discharge. Occupational therapists support patients to recover and overcome any barriers that prevent them from doing activities (occupations) that matter to them. This study examines the current role of occupational therapy (OT) in ERAS. Methods: A broad literature search was conducted on 26 th January 2016 as described in Table 1. Results: 68 peer reviewed abstracts, in English, from 2000, were identified. This reduced to 17 once the abstracts had been filtered for duplicates and relevancy, and reduced to 4 once the full papers had been studied. The 4 remaining papers comprised a cohort study with some OT input described, but no OT specific outcome (Dawson-Bowling et al, 2014); and 3 comparative cohort studies (Husted et al, 2011; Pape et al, 2013; Petersen et al, 2008), 2 describing some OT input but no OT specific outcome, and 1 with an OT outcome, but little description of input. Conclusion: There is very little research describing the explicit role of OT in ERAS even though OTs work routinely within surgical MDTs. The skills of an OT would appear to be very useful in helping to accelerate return to full function post discharge. Further work is needed to evaluate whether OT input can help accelerate return to normal activities of daily living.
The problem of unsuccessful (incomplete) esophagoplasty is still urgent nowadays. Simultaneous esophagoplasty remains a method of choice in reconstructive surgery of the esophagus. However, in the case of ischemic disorders in the transplant, its initially insufficient length, deficiency of the organs of the plastic reserve, the completion of esophagoplasty seems to be a technically complicated task, forcing surgeons to perform multi-stage intervention techniques. These techniques are associated with longer treatment periods and deterioration in the quality of life of patients.The article highlights a rare experience of esophagoplasty with combined grafts consisting of visceral segments on a natural source of blood circulation. Applied operational techniques allowed to complete esophagoplasty in a single step, including rational disposal of compromised plastic material, and also to preserve digestion.
Introduction. Despite increasing trends toward the early initiation of oral feeding after gastrointestinal surgeries, current evidence about feeding patients after esophagectomy (EE) with gastric tube reconstruction has not been convincing. The further research is needed. The present clinical trial aimed to compare the clinical outcomes of early oral feeding (EOF) with late oral feeding following EE with gastric conduit reconstruction. Objectives. To improve the results of treatment of patients after EE with gastric tube reconstruction by choosing the method of nutritional support in the postoperative period. Materials and methods. Forty patients undergoing esophagectomy with gastric conduit reconstruction enrolled in this prospective randomized controlled trial, and were randomly assigned to a group starting EOF on the first postoperative day (POD) and another group that remained nil by mouth and got parenteral feeding until the 5 POD. The clinical and surgical outcomes were compared between the two groups. Results. Comparing the treatment results of both groups, we did not find a statistically significant difference in the number of patients with postoperative complications in the main and control groups. The patients of EOF group had statistically significant earlier gas discharge-2 vs 4 (3-5.5) POD (p = 0.001) and the appearance of stool - 3 (2-3) vs 4 (2-4.5) POD (p = 0.0002). Early activisation and nutrition support, the absence of intestinal paresis allowed us to note a tendency to reduction of the total time of postoperative hospital stay - 7 (6.5-8.5) vs 8 (7-9) POD (p = 0.1). Conclusions. Early oral nutrition in patients who have undergone EE with gastric conduit reconstruction is safe and effective. However, its use in routine practice is possible only if surgical safety is observed and within the framework of a perioperative support program that includes all the components of ERAS protocol.
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