Inadvertent tracheal perforation during thyroidectomy (Br J Surg 2006; 93: 55 56)
and postoperative oedema are associated with poorer outcomes. Conversely, perioperative optimization of both the type and volume of intravenous fluid administered may indeed be beneficial2,3. This study highlights the methodological difficulty of assessing fluid flux in vivo. The authors used bioelectrical impedance analysis measurements using four frequencies. Developments in the field of electrophysiological body composition assessment now allow for simultaneous multi frequency bioelectrical impedance spectroscopy testing. This employs mathematical modelling and mixture tools which may allow for more accurate bedside body and fluid composition assessment. In agreement with the authors' own observations, further evaluation of the benefits of body composition assessment in daily clinical practice is indeed warranted. Second, and possibly more important, this study indirectly addresses the difficulty in assessing when exactly gut function returns postoperatively. Bowel sounds are very subjective, while the return of bowel motions has repeatedly been shown to be inaccurate4. Tolerance to oral or enteral diet may represent a more reliable way to assess this endpoint. M. M. Rao, M. Gatt, R. Kallam and J. MacFie Combined Gastroenterology Research Unit, Scarborough Hospital, Scarborough YO126QL, UK DOI: 10.1002/bjs.5478
The British journal of surgery