[Immediate post-operative enteral nutrition].
Clinica Chirurgica, Ospedale Multizonale Fondazione E. Macchi, Varese, Università degli Studi di Pavia. Chirurgia italiana
Patients with cancer of the upper digestive tract may present with malnutrition, which may cause immunodepression and an increased rate of postoperative complications. In this study we describe the rationale and the feasibility of immediate postoperative enteral nutrition (NEPI) and evaluate its effectiveness for the nutritional support of patients undergoing surgery of the upper digestive tract. We studied 46 patients undergoing the following procedures: total gastrectomy (n = 22); oesophageal resection (n = 12); duodenocephalopancreasectomy (n = 12). NEPI was started on postoperative day 0 with a polymeric diet (calories: 53% as CHO, 22% as proteins, 25% as lipids) aiming at a calorie intake of 25 Kcal/Kg/day by postoperative day 4. It was possible to administer 24 Kcal/kg/day with the enteral diet from the 4th to the 10th postoperative day. Oral intake was resumed on average on postoperative day 13, and the mean hospital stay was 27 +/- 17 days. Tolerance of NEPI was good in most patients: only 5 patients (11%) interrupted the enteral nutrition. The mean postoperative weight loss was 3.7%. The rate of septic complications was 27%; mortality was nil. The surgical procedures caused a transient and reversible acute-phase decrease of nutritional and immunological parameters in the early postoperative period. However the NEPI preserved the nutritional status postoperatively as shown by the lack of significant changes in the nutritional indices at 10-14 days after surgery, as compared with baseline. In summary, we documented that NEPI can be started from postoperative day 0 with good intestinal tolerance, allowing adequate nutritional support, after extensive surgical procedures on the upper digestive tract.
Available from: Andrea Imperatori
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ABSTRACT: Malnutrition is a well-known risk factor significantly influencing the occurrence of postoperative infectious complications. There is consensus that nutritional support is an essential component of the multidisciplinary treatment of surgical and critically ill patients. Nutritional support of surgical patients can be carried out with different modalities, depending on the underlying disease and on the patient's general condition. Several studies have shown that the early administration of enteral nutrition promotes the restoration of gastrointestinal mucosa integrity; with total parenteral nutrition such beneficial effect is not observed. The timing of feeding also influences the clinical outcome. During the last few years, standard enteral preparations have been modified by the addition of immunonutrients, such as arginine, glutamine, omega-3 fatty acids, nucleotides and others. These substrates have been shown to up-regulate host immune responses, to control inflammatory responses and to improve nitrogen balance and protein synthesis after injury. A recent study reported that in patients with cancer of the gastro-intestinal tract the nutritional supplementation given only preoperatively was as effective as the combined pre- and postoperative (perioperative) approach, and it could reduce gastro-intestinal side effects. This is probably due to the effect of the immune-enhancing diet on the immune and inflammatory responses.
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