This study aimed to investigate the effectiveness of preoperative and an extended 90-days postoperative use of ONS among patients undergoing elective surgery for breast and colorectal cancers. Ninety-one patients were randomised into (i) Group SS received ONS up to 14 days preoperatively and postoperatively up to discharge, (ii) Group SS-E received ONS up to 14 days preoperatively, postoperatively up to discharge and for an extended 90-days after discharge and (iii) Group DS received ONS postoperatively up to discharge. Preoperatively, SS had significantly higher body weight (66.1 ± 15.3 kg vs. 62.5 ± 12.0 kg, p = 0.010) and BMI (26.8 ± 6.8 kg/m2 vs. 26.1 ± 6.7 kg/m2, p = 0.022) than DS when adjusted for baseline values. Postoperatively, SS-E had significantly higher handgrip strength (26 ± 9 kgF vs. 24 ± 6 kgF, p = 0.044) than DS at 90-days post-discharge after adjusted for preoperative values. At 90-days post-discharge, the proportions of patients in SS with albumin < 35 g/d, CAR ≥ 0.1, mPINI ≥ 0.4, mGPS score 1 or 2 were significantly reduced while in SS-E, the reduction in proportions of patients with high hsCRP and mPINI ≥ 0.4 was significant compared to upon discharge. Preoperative ONS had modest benefits in attenuating weight loss whilst postoperative supplementation up to 90-days post-discharge improved handgrip strength and inflammatory prognostic markers.
Background: This prospective observational study aimed to determine the impact of bariatric surgery on the protein-energy intake, sleep quality and quality of life (QOL) of bariatric surgery patients in Malaysia.
Methods: The study evaluated 52 morbidly obese patients who underwent bariatric surgery. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF), Epworth Sleepiness Scale (ESS) questionnaire and three days 24-hour diet recall were used to evaluate the health-related QOL, sleep quality and protein-energy intake of patients. Patients were interviewed before and 3 months after surgery.
Results: The mean age was 42 years and 69.2% of them were female. The mean BMI was 42 kg/m2. Patients with morbid obese had significantly lowered QOL scores, mean intake of 1898 kilocalories and 75 g protein per day before the surgery. The reduction of weight after bariatric surgery showed an increase in QOL score in all areas (P < 0.05) and a decrease on ESS score from 6.3 ± 4.0 to 2.9 ± 2.3 (p < 0.00). The mean intake 3 months after surgery was 718 kilocalories, 39g protein per day.
Conclusion: Bariatric surgery is proven effective in achieving significant weight loss, improving sleep quality and QOL among Malaysian obese patients within 3 months of surgery. However, the newly restricted stomach after bariatric surgery significantly reduces food intake in the first 3 months. Therefore, a more careful follow-up with patients is required.
Background: Breast reconstruction is traditionally performed by the plastic surgeons. In the last four years, we have embarked on autologous breast reconstruction. We conducted a retrospective study to evaluate the complications and cosmetic outcomes of a pedicled transverse rectus abdominis myo-cutaneous (TRAM) flap breast reconstruction.Methods: We enrolled forty-one patients who underwent a TRAM flap reconstructive surgery between January 2016 and January 2020 at the hospital Kuala Lumpur, Malaysia. Thorough retrospective reviews of medical records were performed. Patient’s satisfaction on the cosmetic outcome were assessed with the breast-Q questionnaire.Results: Forty-one patients with a mean age of forty-six years old, had ipsilateral pedicled TRAM breast reconstructions for various breast pathologies including invasive carcinoma (n=31, 75.6%), ductal carcinoma in situ (n=8, 19.5%) and phylloides tumor (n=2, 4.9%). Immediate reconstruction was performed in thirty-nine patients and delayed reconstruction in two patients. Based on The American joint committee on cancer (AJCC) TNM system, the pathologic stages among those patients with breast cancer were 0 (n=8, 20.5%), I (n=3, 7.69%), II (n=9, 23.1%), III (n=18, 46.1%), and IV (n=1, 2.56%). During the mean follow-up of seventeen months, flap and donor site complications were reported in twelve patients (29.3%) and five patients (12.1%) respectively. Nineteen were very satisfied and sixteen were satisfied.Conclusions: Breast reconstruction with a TRAM flap can be safely performed by the oncoplastic breast surgeons with good aesthetic outcomes.
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