Perioperative Nutritional Management in Congenital Perineal and Vestibular Fistulas: A Systematic Review.
作者信息
Hofmeester Marrigje Josien, Draaisma Jos M T H, Versteegh Hendt P, Huibregtse Elizabeth C P, van Rooij Iris A L M, de Blaauw Ivo
机构信息
Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Amalia Children's Hospital, Nijmegen, The Netherlands.
Department of Surgery-Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
出版信息
Eur J Pediatr Surg. 2015 Oct;25(5):389-96. doi: 10.1055/s-0034-1544052. Epub 2015 Feb 5.
BACKGROUND
Surgical advancements have led to improved outcomes for children with congenital anorectal malformations with vestibular and perineal fistulas. However, the effect of perioperative nutritional management is debated and guidelines have not yet been established.
OBJECTIVE
The study aims to give an overview of available published evidence, regarding the impact of different perioperative nutritional management protocols on surgical outcome.
METHODS
A systematic literature review was conducted using PubMed, Embase, Cochrane Library, and CINAHL databases. All original articles concerning perioperative nutrition in children with vestibular and perineal fistulas were included. Methodological quality was assessed with the Rangel score. Included studies were subdivided into two groups: early enteral nutrition and prolonged fasting with or without parenteral nutrition.
RESULTS
The database search resulted in 768 publications. Nine studies were eligible for inclusion. Wound complications were present in 56 of the 1,557 patients (4%) in whom this was assessed, and were more frequently seen in the prolonged fasting group (2 vs. 10%, p < 0.0001). Regarding the long-term outcome, constipation (grade II-III) was seen in 4% of the early feeding group, compared with 13% in the prolonged fasting group (p < 0.0001).
CONCLUSION
This systematic review presents an overview of studies reporting on perioperative nutritional management in children with perineal and vestibular fistulas. Although study quality is low and study heterogeneity may also influence our results, early enteral feeding seems to be the preferable postoperative feeding strategy. Both early wound complications as well as long-term complications, in terms of clinically relevant constipation, seem to be lower in the early enteral feeding group. However, a prospective randomized, multicentered trial should be initiated to draw definitive conclusions regarding this matter.
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