Superior nitrogen balance after laparoscopic-assisted colectomy

A. J. Senagore, M. J. Kilbride, M. A. Luchtefeld, J. M. MacKeigan, A. T. Davis, J. D. Moore

Research output: Contribution to journalArticle

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Abstract

Background: Although early resumption of enteral feeding after gastrointestinal surgery results in improved nitrogen balance and lower infectious complications, no postoperative nutritional data after laparoscopic assisted colectomy exists. Objective: The authors prospectively compared nitrogen balance after laparoscopic-assisted colectomy versus open colectomy. Methods: This is a series of colon resections (open, N = 10; laparoscopic-assisted, N = 9) at the Ferguson-Blodgett Hospital, Grand Rapids, Michigan, between January and March 1993. Nitrogen intake and 24 hour urine collections were performed on postoperative days 1,3, and 7 for the analysis of total urinary nitrogen and urinary 3 methylhistidine-(3mH). Results: The time to passage of flatus (4.7 ± 0.6; 2.0 ± 0.2), resumption of oral intake (6.1 ± 0.7; 1.4 ± 0.2; p <0.05, Student's t test), first bowel movement (5.2 ± 1.0; 3.0 ± 0.3; p <0.05, Student's t test), and discharge (10.3 ± 1.3; 4.1 ± 1.8; p <0.05, Student's t test) occurred significantly earlier in the laparoscopic assisted colectomy group. Overall hospital charges were lower in the laparoscopic-assisted colectomy group ($11,572 ± $823 vs. $13,961 ± $1050). The operative time was higher in the laparoscopic-assisted colectomy group (176 ± 12 hours vs. 105 ± 17 hours, p <0.05, Student's t test). Blood loss was higher in the open group (805 ± 264 mL vs. 217 ± 32 mL, p <0.05, Student's t test). Urinary nitrogen losses were similar between the two groups; however, significantly more patients in the laparoscopic-assisted colectomy group achieved net positive nitrogen on day 3 (6/9; 0/10; p <0.05, Fisher's exact test), and day 7 (9/9; 4/10; p <0.05, Fisher's exact test). Infectious complications occurred less frequently in the laparoscopic-assisted colectomy group (0/9 vs. 4/10; p <0.05, Fisher's exact test). Conclusions: Patients undergoing laparoscopic-assisted colectomy can achieve early resumption of enteral nutrition with earlier return to positive nitrogen balance compared with open colectomy. This may offer benefits of fewer infectious complications and lower cost of care.

Original languageEnglish (US)
Pages (from-to)171-175
Number of pages5
JournalAnnals of Surgery
Volume221
Issue number2
StatePublished - 1995
Externally publishedYes

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Colectomy
Nitrogen
Students
Enteral Nutrition
Hospital Charges
Flatulence
Urine Specimen Collection
Operative Time
Colon
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Senagore, A. J., Kilbride, M. J., Luchtefeld, M. A., MacKeigan, J. M., Davis, A. T., & Moore, J. D. (1995). Superior nitrogen balance after laparoscopic-assisted colectomy. Annals of Surgery, 221(2), 171-175.

Superior nitrogen balance after laparoscopic-assisted colectomy. / Senagore, A. J.; Kilbride, M. J.; Luchtefeld, M. A.; MacKeigan, J. M.; Davis, A. T.; Moore, J. D.

In: Annals of Surgery, Vol. 221, No. 2, 1995, p. 171-175.

Research output: Contribution to journalArticle

Senagore, AJ, Kilbride, MJ, Luchtefeld, MA, MacKeigan, JM, Davis, AT & Moore, JD 1995, 'Superior nitrogen balance after laparoscopic-assisted colectomy', Annals of Surgery, vol. 221, no. 2, pp. 171-175.
Senagore AJ, Kilbride MJ, Luchtefeld MA, MacKeigan JM, Davis AT, Moore JD. Superior nitrogen balance after laparoscopic-assisted colectomy. Annals of Surgery. 1995;221(2):171-175.
Senagore, A. J. ; Kilbride, M. J. ; Luchtefeld, M. A. ; MacKeigan, J. M. ; Davis, A. T. ; Moore, J. D. / Superior nitrogen balance after laparoscopic-assisted colectomy. In: Annals of Surgery. 1995 ; Vol. 221, No. 2. pp. 171-175.
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abstract = "Background: Although early resumption of enteral feeding after gastrointestinal surgery results in improved nitrogen balance and lower infectious complications, no postoperative nutritional data after laparoscopic assisted colectomy exists. Objective: The authors prospectively compared nitrogen balance after laparoscopic-assisted colectomy versus open colectomy. Methods: This is a series of colon resections (open, N = 10; laparoscopic-assisted, N = 9) at the Ferguson-Blodgett Hospital, Grand Rapids, Michigan, between January and March 1993. Nitrogen intake and 24 hour urine collections were performed on postoperative days 1,3, and 7 for the analysis of total urinary nitrogen and urinary 3 methylhistidine-(3mH). Results: The time to passage of flatus (4.7 ± 0.6; 2.0 ± 0.2), resumption of oral intake (6.1 ± 0.7; 1.4 ± 0.2; p <0.05, Student's t test), first bowel movement (5.2 ± 1.0; 3.0 ± 0.3; p <0.05, Student's t test), and discharge (10.3 ± 1.3; 4.1 ± 1.8; p <0.05, Student's t test) occurred significantly earlier in the laparoscopic assisted colectomy group. Overall hospital charges were lower in the laparoscopic-assisted colectomy group ($11,572 ± $823 vs. $13,961 ± $1050). The operative time was higher in the laparoscopic-assisted colectomy group (176 ± 12 hours vs. 105 ± 17 hours, p <0.05, Student's t test). Blood loss was higher in the open group (805 ± 264 mL vs. 217 ± 32 mL, p <0.05, Student's t test). Urinary nitrogen losses were similar between the two groups; however, significantly more patients in the laparoscopic-assisted colectomy group achieved net positive nitrogen on day 3 (6/9; 0/10; p <0.05, Fisher's exact test), and day 7 (9/9; 4/10; p <0.05, Fisher's exact test). Infectious complications occurred less frequently in the laparoscopic-assisted colectomy group (0/9 vs. 4/10; p <0.05, Fisher's exact test). Conclusions: Patients undergoing laparoscopic-assisted colectomy can achieve early resumption of enteral nutrition with earlier return to positive nitrogen balance compared with open colectomy. This may offer benefits of fewer infectious complications and lower cost of care.",
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AU - Kilbride, M. J.

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AU - Davis, A. T.

AU - Moore, J. D.

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N2 - Background: Although early resumption of enteral feeding after gastrointestinal surgery results in improved nitrogen balance and lower infectious complications, no postoperative nutritional data after laparoscopic assisted colectomy exists. Objective: The authors prospectively compared nitrogen balance after laparoscopic-assisted colectomy versus open colectomy. Methods: This is a series of colon resections (open, N = 10; laparoscopic-assisted, N = 9) at the Ferguson-Blodgett Hospital, Grand Rapids, Michigan, between January and March 1993. Nitrogen intake and 24 hour urine collections were performed on postoperative days 1,3, and 7 for the analysis of total urinary nitrogen and urinary 3 methylhistidine-(3mH). Results: The time to passage of flatus (4.7 ± 0.6; 2.0 ± 0.2), resumption of oral intake (6.1 ± 0.7; 1.4 ± 0.2; p <0.05, Student's t test), first bowel movement (5.2 ± 1.0; 3.0 ± 0.3; p <0.05, Student's t test), and discharge (10.3 ± 1.3; 4.1 ± 1.8; p <0.05, Student's t test) occurred significantly earlier in the laparoscopic assisted colectomy group. Overall hospital charges were lower in the laparoscopic-assisted colectomy group ($11,572 ± $823 vs. $13,961 ± $1050). The operative time was higher in the laparoscopic-assisted colectomy group (176 ± 12 hours vs. 105 ± 17 hours, p <0.05, Student's t test). Blood loss was higher in the open group (805 ± 264 mL vs. 217 ± 32 mL, p <0.05, Student's t test). Urinary nitrogen losses were similar between the two groups; however, significantly more patients in the laparoscopic-assisted colectomy group achieved net positive nitrogen on day 3 (6/9; 0/10; p <0.05, Fisher's exact test), and day 7 (9/9; 4/10; p <0.05, Fisher's exact test). Infectious complications occurred less frequently in the laparoscopic-assisted colectomy group (0/9 vs. 4/10; p <0.05, Fisher's exact test). Conclusions: Patients undergoing laparoscopic-assisted colectomy can achieve early resumption of enteral nutrition with earlier return to positive nitrogen balance compared with open colectomy. This may offer benefits of fewer infectious complications and lower cost of care.

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