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Early enteral immunonutrition following gastric and oesophageal surgery

Introduction

The study investigates the effect of early enteral immunonutrition on patient recovery after extensive elective surgery in the upper abdomen [1, 2]. It investigates the speed of patient recovery administering early enteral immunonutrition combined with total parenteral nutrition [3].

Materials and methods

The total of 40 patients who had undergone this type of surgery were involved in this study. Near the end of the surgery procedure a percutaneous jejunostomy was performed in 20 patients (G1), and enteral nutrition started on the first postoperative day with small doses of immunonutrient (Reconvan) 10 ml/hour. After every 12 hours the tolerance was estimated (abdominal distension, diarrhoea, vomiting). After every 24 hours the immunonutrient dose was increased by 20 ml/hour until we reached the maximum of 80 ml/hour. In the first three postoperative days the patients were also administered total parenteral nutrition, and after that only enteral nutrition. The other group of 20 patients (G2) was administered only parenteral nutrition from the first postoperative day. Preoperatively, every patient was measured for body weight, body height and body mass index, and using laboratory tests we established the levels of albumin, transferine, blood urea nitrogen and creatinine. On the third and ninth postoperative days we repeated the same laboratory tests, and measured the daily loss of nitrogen by excretion of urea in urine.

Results and discussion

Patient recovery was faster in G1. The average patient stay in ICU was 5 ± 1 days (G1) vs 10 ± 2 days (G2). The average hospital stay was 22 ± 3 days (G1) vs 29 ± 5 days. Peristalsis was detected on the third day as an average (G1) vs 4.5 days (G2). A decrease in pulmonary complications was achieved in G1 (one pleural effusion) vs G2 (eight pleural effusions). Laboratory tests show that patients in G1 are in lower catabolism compared with G2 patients.

Conclusion

Early enteral immunonutrition through jejunostomy is an efficient and safe method of patient nutrition with fewer postoperative complications, and also accounts for a hospital cost decrease of 50%.

References

  1. 1.

    Delaney HM, Carenevale NH, Garvey JW: Jejunostomy by a needle catheter technique. Surgery 1973, 73: 786-945.

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    Braga M, Giannoti L, Radaelli G, et al.: Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blinded phase 3 trial. Arch Surg 1999, 134: 428-433. 10.1001/archsurg.134.4.428

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    Moore EE, Jones TN: Benefits of immediate jejunostomy feeding after major abdominal trauma: a prospective randomized study. J Trauma 1986, 26: 874-881.

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Vukosavljevic, S., Randjelovic, T., Pavlovic, D. et al. Early enteral immunonutrition following gastric and oesophageal surgery. Crit Care 11, P153 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5313

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Keywords

  • Pleural Effusion
  • Parenteral Nutrition
  • Blood Urea Nitrogen
  • Enteral Nutrition
  • Total Parenteral Nutrition