Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial
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The use of glutamine and arginine has shown several advantages in postoperative outcomes in patients after gastrointestinal surgery. We determined the effects of its use in patients with enterocutaneous fistula after operative treatment.
Patients and Methods
Forty patients with enterocutaneous fistula were randomly assigned to one of two groups. The control group received the standard medical care while the patients of the experimental group were supplemented with enteral administration of 4.5 g of arginine and 10 g of glutamine per day for 7 days prior to the surgery. The primary outcome variable was the recurrence of the fistula and the secondary outcomes were preoperative and postoperative serum concentrations of interleukin 6 and C-reactive protein and postoperative infectious complications.
Twenty patients were assigned to each group. The fistula recurred in two patients (10%) of the experimental group and in nine patients (45%) of the control group (P < 0.001). We found a total of 13 infectious complications in six patients of the control group (all with fistula recurrence) and none in the experimental group. Mean preoperative serum concentrations of interleukin 6 and C-reactive protein were lower in patients from the experimental group. In addition, these levels were lower in patients who had recurrence if compared to patients that did not recur.
Preoperative administration of oral arginine and glutamine could be valuable in the postoperative recovery of patients with enterocutaneous fistulas submitted to definitive surgery.
KeywordsIntestinal fistula Postoperative complications Glutamine Arginine
Study conception and design: Martinez, Mendez, Roman, Juarez, Ferat
Acquisition of data: Martinez, Bosco, Souza, Ferat
Analysis and interpretation of data: Martinez, Bosco, Souza, Mendez, Roman, Juarez, Ferat
Drafting of manuscript: Martinez, Souza, Ferat
Critical revision: Martinez, Bosco, Souza, Mendez, Juarez, Roman, Ferat
Final approval: Martinez, Bosco, Souza, Mendez, Juarez, Roman, Ferat
All authors (Martinez, Bosco, Souza, Mendez, Juarez, Roman, Ferat) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
Compliance with Ethical Standards
The study was reviewed and approved by the Hospital de Especialidades de Centro Medico Nacional SXXI Institutional Review Board (R-2010-3601-98).
Conflict of Interest
The authors declare that they have no conflict of interest.
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