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A nil-by-mouth regime with enteral nutrition via an artificial route is frequently applied following esophagectomy. However, early initiation of oral feeding could potentially improve recovery and has shown to be beneficial in many types of abdominal surgery. Although short-term nutritional safety of oral intake after an esophagectomy has been documented, long-term effects of this feeding regimen are unknown. In this cohort study, data from patients undergoing minimal invasive Ivor-Lewis esophagectomy between 04-2012 and 09-2015 in three centers in Netherlands were collected. Patients in the oral feeding group were retrieved from a previous prospective study and compared with a cohort of patients with early enteral jejunostomy feeding but delayed oral intake. Body mass index (BMI) measurements, complications, and nutritional re-interventions (re- or start of artificial feeding, start of total parenteral nutrition) were gathered over the course of one year after surgery. One year after surgery the median BMI was 22.8 kg/m2 and weight loss was 7.0 kg (9.5%) in 114 patients. Patients in the early oral feeding group lost more weight during the first postoperative month (P = 0.004). However, in the months thereafter this difference was not observed anymore. In the early oral feeding group, 28 patients (56%) required a nutritional re-intervention, compared to 46 patients (72%) in the delayed oral feeding group (P = 0.078). During admission, more re-interventions were performed in the delayed oral feeding group (17 vs. 46 patients P < 0.001). Esophagectomy reduces BMI in the first year after surgery regardless of the feeding regimen. Direct start of oral intake following esophagectomy has no impact on early nutritional re-interventions and long-term weight loss. [ABSTRACT FROM AUTHOR]

Background and aim Despite recent advancements in perioperative care, postoperative morbidity following an esophagectomy remains substantial. Studies in other major abdominal surgery, have shown that prehabilitation can improve short-term outcomes. This single-center cohort study investigated the effect of prehabilitation in patients undergoing minimally invasive Ivor-Lewis esophagectomy (MIE-IL). Methods Data were collected on consecutive patients receiving a standardized ERAS program that included direct start of oral feeding following MIE-IL (from postoperative day one), between October 2015 and February 2020. The intervention group comprised patients enrolled in the PREPARE prehabilitation program that was implemented in 2018 as the standard care pathway for all patients. The control group comprised a retrospective cohort prior to implementation of PREPARE. Postoperative outcomes included (functional) recovery, length of hospital stay (LOHS), cardiopulmonary complications (CPC) and other predefined outcomes. Results The PREPARE group comprised 52 patients and control group 43 patients. Median time to functional recovery was 6 vs. 7 days (P  = 0.074) and LOHS 7 vs. 8 days (P  = 0.039) in the PREPARE and control group, respectively. Hospital readmission rate was 9.6% vs. 14.3% (P  = 0.484). Although thirty-day overall postoperative complication rate did not differ statistically significantly (P  = 0.106), a clinically relevant reduction of 17% was observed in PREPARE patients. Similarly, CPC rate was 14% lower in the PREPARE group (P  = 0.190). Anastomotic leakage rate was similar (9.6% vs 14.0%; P  = 0.511). Despite no difference in severity (Clavien-Dindo) of complications (P  = 0.311), ICU readmission rate was lower in PREPARE patients (3.8% vs. 16.3%, P  = 0.039). In the PREPARE group wherein maximum oxygen uptake capacity (VO2max) was assessed preoperatively during a Steep Ramp Test, VO2max was lower at baseline in patients diagnosed with postoperative complications (P  = 0.011). There were no data on VO2max in the control group. Conclusion Prehabilitating patients prior to a MIE-IL led to a shorter LOHS and reduced ICU readmission rate. Additionally, a clinically relevant improvement in (functional) recovery and reduction in postoperative morbidity was observed in patients that were prehabilitated. [ABSTRACT FROM AUTHOR]

Objectives: Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, Côte d'Ivoire and Burkina Faso. International and local strategies are now being considered. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventions into basic and maternal and child health (MCH) services.Methods: The following tasks were undertaken: a critical review of randomized trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-benefit of antiretroviral prophylaxis; a feasibility assessment of preventive strategies, including a postal survey on HIV voluntary counselling and testing (VCT) of pregnant women; the identification of requirements and research priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in November 1997. Conclusions were further refined, based on 1998 research findings.Results: A summary of relevant evidence and ten public health recommendations are reported. VCT for pregnant women, a short regimen of zidovudine together with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to alleviate overall maternal and infant morbidity and mortality.Conclusion: Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies. [ABSTRACT FROM AUTHOR]