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Funk Debleds P, Chambrier C, Slim K. Postoperative nutrition in the setting of enhanced recovery programmes. Eur J Surg Oncol 2023:S0748-7983(23)00177-4. [PMID: 36914532 DOI: 10.1016/j.ejso.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
Patients undergoing major surgery for gastrointestinal cancer are at high risk of developing or worsening malnutrition and sarcopenia. In malnourished patients, preoperative nutritional support may not be sufficient and so postoperative support is advised. This narrative review addresses several aspects of postoperative nutritional care in the setting of enhanced recovery programmes. Early oral feeding, therapeutic diet, oral nutritional supplements, immunonutrition, and probiotics are discussed. When postoperative intake is insufficient, nutritional support favouring the enteral route is recommended. Whether this approach should use a nasojejunal tube or jejunostomy is still a matter of debate. In the setting of enhanced recovery programmes with early discharge, nutritional follow-up and care should be continued beyond the short time in hospital. In enhanced recovery programmes, the main specific aspects of nutrition are patient education, early oral intake, and post-discharge care. The other aspects do not differ from conventional care.
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Affiliation(s)
- Pamela Funk Debleds
- Department of Supportive Care, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | - Cécile Chambrier
- Intensive Clinical Nutrition Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Karem Slim
- Department of Digestive Surgery, University Hospital, CHU, Clermont-Ferrand, France; Francophone Group for Enhanced Recovery After Surgery, France.
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Chalamgari A, Hey G, Dave A, Liu A, Nanduru A, Lucke-Wold B. Nutritional Optimization for Post-Spinal Surgery Recovery. J Clin Trials Regul 2023; 5:1-16. [PMID: 37143932 PMCID: PMC10156085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Adequate nutritional intake is a key component of uncomplicated recovery from spinal surgery. Though much in the literature exists regarding its importance, specific dietary regimens for spinal surgery remain understudied, and little is available in compiling both preoperative and postoperative nutritional recommendations for patients. The complexity that may exist with these recommendations -- especially in the context of patients with diabetes or those who use substances -- has led in recent years to the development of protocols such as Enhanced Recovery After Surgery (ERAS), which gives providers a guideline upon which to base their nutritional counselling. More innovative regimens, such as the use of bioelectrical impedance analyses to assess nutritional status, have also emerged, resulting in a vast array of dietary recommendations and protocols for spinal surgery. In the following paper, we aim to compile a few of these guidelines, comparing various preoperative and postoperative nutritional strategies as well as making note of special considerations, like patients with diabetes or those who use substances. We also work to overview several such dietary "protocols" available in the literature, with a special focus on ERAS and more recent regimens like the Northwestern High-Risk Spine Protocol. We briefly mentioned preclinical work on novel nutritional recommendations as well. Ultimately, we hope to highlight the importance of nutrition in spinal surgery and address the need for greater cohesion of dietary strategies already in existence.
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Affiliation(s)
- Anjalika Chalamgari
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Grace Hey
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Akanksha Dave
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Annika Liu
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Aparna Nanduru
- Post Graduate Student, School of Medicine, George Washington University, Washington, D.C., United States
| | - Brandon Lucke-Wold
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
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Abstract
Background Early oral feeding after major abdominal surgery has been clearly shown to be safe and not a risk factor for anastomotic dehiscence. Within the Enhanced Recovery after Surgery protocol, it is the nutritional plan A. Nonetheless, one must consider that postoperative protein and energy requirements will often be not covered by oral food intake alone. Because nutritional status has been shown to be a prognostic factor in patients undergoing major abdominal surgery, the preoperative identification of patients at risk may be mandatory. Malnutrition may be underestimated in an overweight society. With special regard to patients with cancer and those with preexisting malnutrition, an accumulating caloric gap may be harmful in the early and late postoperative periods. Furthermore, complications requiring reoperation and intensive care treatment may occur. Summary Therefore, a plan B for postoperative nutrition therapy is needed, using preferentially the enteral route. The European Society for Clinical Nutrition and Metabolism recently addressed perioperative nutritional management and the indications for enteral and even parenteral supplementation to achieve caloric requirements in the postoperative course. In the first months after surgery, persisting weight loss is common in patients with upper gastrointestinal resections, even in those with an uncomplicated course. This may delay the initiation of adjuvant chemotherapy, increase toxicity, and worsen long-term outcomes.
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Affiliation(s)
| | - Arved Weimann
- Department for General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
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Kaplan T, Gonca C, Han S. Significance of losses of body compositions after oesophagectomy for oesophageal cancer. Eur J Cardiothorac Surg 2021; 61:267-268. [PMID: 34673941 DOI: 10.1093/ejcts/ezab459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tevfik Kaplan
- Department of Thoracic Surgery, Lokman Hekim University School of Medicine, Ankara, Turkey
| | - Cigdem Gonca
- Department of Thoracic Surgery, Lokman Hekim University School of Medicine, Ankara, Turkey
| | - Serdar Han
- Department of Thoracic Surgery, Lokman Hekim University School of Medicine, Ankara, Turkey
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Wang P, Liu Q, Chen X, Liu X, Li Y. The negative association between skeletal muscle and fat mass wasting caused by oesophagectomy in patients with oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg 2021; 61:259-266. [PMID: 34392342 DOI: 10.1093/ejcts/ezab377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/26/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES This prospective observational study aimed to investigate postoperative skeletal muscle and fat mass wasting and their clinical significance in oesophageal cancer patients undergoing minimally invasive McKeown oesophagectomy. METHODS Bioelectrical impedance analyses of body compositions were conducted before surgery and 1, 4 and 12 weeks after surgery. Curve-fitting analysis was used to describe the relationship between changes in the skeletal muscle mass index (ΔSMI) and fat mass index (ΔFMI). A logistic regression-based nomogram was established using the R tool. RESULTS Among the 78 patients, 74.4% were male, and the mean age was 64.8 [standard deviation (SD): 6.6] years. Decreased SMIs and FMIs were concentrated in the first 4 weeks after surgery, with proportions of -3.42% (SD: 4.58) and -17.7% (SD: 11.9), respectively. A negative relationship between ΔFMI and ΔSMI was detected by linear regression (coefficient -0.341, P < 0.001). Based on the median ΔSMI to ΔFMI ratio (35.5%), 2 postoperative weight loss types were defined: SMI-dominated (SMDT) and FMI-dominated (FMDT) types. SMDT patients reported increased feeding-related problems, poorer functional status and more unhealthy symptoms than FMDT patients within 12 weeks after surgery. SMDT patients also showed poorer 2-year overall survival (71.1% vs 87.3%, P = 0.021) and disease-free survival (60.5% vs 84.9%, P = 0.032) than FMDT patients. A nomogram based on baseline and perioperative parameters was established to quantify postoperative SMDT and FMDT tendencies with good accuracy (C-index: 0.897). CONCLUSIONS The negative relationship between ΔFMI and ΔSMI indicated differentiated metabolism post-oesophagectomy. SMDT was associated with adverse therapeutic outcomes and warranted aggressive interventions. CLINICAL REGISTRATION NUMBER The study protocol was registered at the Chinese Clinical Trial Registry with the registration number ChiCTR1800018511.
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Affiliation(s)
- Peiyu Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiankai Chen
- Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Beijing, China
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Beijing, China
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Pu H, Heighes PT, Simpson F, Wang Y, Liang Z, Wischmeyer P, Hugh TJ, Doig GS. Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: a meta-analysis of randomized clinical trials. Perioper Med (Lond) 2021; 10:10. [PMID: 33752757 PMCID: PMC7986268 DOI: 10.1186/s13741-021-00179-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023] Open
Abstract
Background Although current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centered benefits. We hypothesized this finding was attributable to pooling studies providing effective protein-containing diets with ineffective non-protein liquid diets. Therefore, the aim of this paper was to investigate the safety and efficacy of early oral protein-containing diets versus later (traditional) feeding after elective lower gastrointestinal tract surgery in adults. Methods PubMed, Embase, and the China National Knowledge Infrastructure databases were searched from inception until 1 August 2019. Reference lists of retrieved studies were hand searched to identify randomized clinical trials reporting mortality. No language restrictions were applied. Study selection, risk of bias appraisal and data abstraction were undertaken independently by two authors. Disagreements were settled by obtaining an opinion of a third author. Majority decisions prevailed. After assessment of underlying assumptions, a fixed-effects method was used for analysis. The primary outcome was mortality. Secondary outcomes included surgical site infections, postoperative nausea and vomiting, serious postoperative complications and other key measures of safety and efficacy. Results Eight randomized clinical trials recruiting 657 patients were included. Compared with later (traditional) feeding, commencing an early oral protein-containing diet resulted in a statistically significant reduction in mortality (odds ratio [OR] 0.31, P = 0.02, I2 = 0%). An early oral protein-containing diet also significantly reduced surgical site infections (OR 0.39, P = 0.002, I2 = 32%), postoperative nausea and vomiting (OR 0.62, P = 0.04, I2 = 37%), serious postoperative complications (OR 0.60, P = 0.01, I2 = 25%), and significantly improved other major outcomes. No harms attributable to an early oral protein-containing diet were identified. Conclusions The results of this systematic review can be used to upgrade current guideline statements to a grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00179-3.
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Affiliation(s)
- Hong Pu
- Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.,Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Philippa T Heighes
- Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia
| | - Fiona Simpson
- Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.,Nutrition Services, Royal North Shore Hospital, Sydney, Australia
| | - Yaoli Wang
- Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.,Department of Critical Care Medicine, Daping Hospital, Chongqing, People's Republic of China
| | - Zeping Liang
- Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.,Department of Critical Care Medicine, Daping Hospital, Chongqing, People's Republic of China
| | - Paul Wischmeyer
- Department of Anesthesiology and Surgery, Duke University, Durham, NC, USA
| | - Thomas J Hugh
- Upper GI Surgical Department, Royal North Shore Hospital and the University of Sydney, Sydney, Australia
| | - Gordon S Doig
- Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.
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Loncar Y, Lefevre T, Nafteux L, Genser L, Manceau G, Lemoine L, Vaillant JC, Eyraud D. Preoperative nutrition forseverely malnourished patients in digestive surgery: A retrospective study. J Visc Surg 2019; 157:107-116. [PMID: 31366442 DOI: 10.1016/j.jviscsurg.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Malnutrition increases postoperative morbidity and mortality. The objective of this study was to evaluate preoperative refeeding in malnourished patients at risk of refeeding syndrome (RS). METHODOLOGY A retrospective study, conducted between June 2016 and January 2017, reported to the CNIL, compared two groups of malnourished patients: a group of refeeding patients (RP) and a group of non-refeeding patients (NRP). The inclusion criteria were weight loss of more than 10% or albuminemia less than 35g/L and RS risk factor. The primary endpoint was postoperative morbidity. The secondary endpoints were weight change and serum albumin over 6 months. RESULTS Seventy-three patients (30 RP and 43 NRP) were included. At the time of initial management, median weight loss was 18% [1-71], while albuminemia was 26g/L [13-40] in the RP group and 32.5g/L [32-48] in the NRP group (P=0.01). The overall postoperative morbidity rate was 88% (83% RP versus 90% NRP, P=0.47), and there was no significant difference between the 2 groups. The rate of anastomotic complications was 4% for RP versus 26% for NRP (P=0.03) after exclusion of liver surgery. Medium-term weight loss tended to be greater in RP (P=0.7). Nutritional support was continued until the third postoperative month in 13% of RPs vs. no NRPs (P=0.0002). CONCLUSION After preoperative renutrition, we did not observe a decrease in morbidity but rather a decrease in the rate of anastomotic complications in favor of the RP group. This study underscores the middle-term importance of nutritional management in view of preserving the benefits of preoperative renutrition.
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Affiliation(s)
- Y Loncar
- Department of anesthesia and resuscitation, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France; Dietetics unit, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France.
| | - T Lefevre
- Department of anesthesia and resuscitation, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France; Sorbonne university, 75000 Paris, France.
| | - L Nafteux
- Dietetics unit, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France.
| | - L Genser
- Visceral and hepato-biliary surgery and transplantation unit, hospital group Pitié-Salpêtrière Charles Foix, université de la Sorbonne, AP-HP, 75013 Paris, France; Sorbonne university, 75000 Paris, France.
| | - G Manceau
- Visceral and hepato-biliary surgery and transplantation unit, hospital group Pitié-Salpêtrière Charles Foix, université de la Sorbonne, AP-HP, 75013 Paris, France; Sorbonne university, 75000 Paris, France.
| | - L Lemoine
- Department of anesthesia and resuscitation, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France.
| | - J C Vaillant
- Visceral and hepato-biliary surgery and transplantation unit, hospital group Pitié-Salpêtrière Charles Foix, université de la Sorbonne, AP-HP, 75013 Paris, France; Sorbonne university, 75000 Paris, France.
| | - D Eyraud
- Department of anesthesia and resuscitation, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France; Sorbonne university, 75000 Paris, France.
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Martos-Benítez FD, Gutiérrez-Noyola A, Soto-García A, González-Martínez I, Betancourt-Plaza I. Program of gastrointestinal rehabilitation and early postoperative enteral nutrition: a prospective study. Updates Surg 2018; 70:105-12. [PMID: 29429053 DOI: 10.1007/s13304-018-0514-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/01/2018] [Indexed: 01/01/2023]
Abstract
Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit. The program of gastrointestinal rehabilitation and early postoperative enteral nutrition consisted on: (1) general rules: pain relive, early mobilization, antibiotic prophylaxis, deep vein thrombosis prophylaxis and respiratory physiotherapy; and (2) gastrointestinal rules: gastric protection, control of postoperative nausea and vomiting, early nasogastric tube remove and early enteral nutrition. The most frequent surgical sites were colorectal (44.9%), gynecological with intestinal suturing (15.7%) and esophagus/stomach (11.0%). Emergency surgery was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complications (19.2 vs. 10.2%; p = 0.030), respiratory complications (p = 0.040), delirium (p = 0.032), infectious complications (p = 0.047) and gastrointestinal complications (p < 0.001). Intensive care unit mortality (p = 0.018), length of intensive care unit stay (p < 0.001) and length of hospitalization (p < 0.001) were reduced as well. A program of gastrointestinal rehabilitation and early postoperative enteral nutrition is associated with reduced postoperative complications and improved clinical outcomes in patients undergoing gastrointestinal surgery for cancer.
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Zhu HB, Zhang HP, Pan TJ. Clinical effects of early enteral nutrition support with peptison in patients with severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2017; 25:71-76. [DOI: 10.11569/wcjd.v25.i1.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the influence of early enteral nutrition support with peptison on postoperative nutrition, immune function, and intestinal mucosal barrier function in patients with severe acute pancreatitis.
METHODS One hundred and twelve patients with severe acute pancreatitis treated from October 2012 to October 2015 were randomly divided into two groups: 56 patients receiving parenteral nutrition support as a control group and 56 patients receiving early enteral nutrition support with peptison as an observation group. Postoperative nutrition status, changes in immune function and intestinal mucosal barrier function, gastrointestinal function recovery, and complications were compared between the two groups.
RESULTS After nutritional support, total protein, albumin, pre-albumin, transferrin, CD4+ T cells, CD4+/CD8+ ratio, IgM, and IgG in the observation group were significantly higher than those in the control group (P < 0.05). Calcitonin, D-lactic acid, blood amylase, blood lipase, and complication rate in the observation group were significantly lower than those in the control group (P < 0.05). Time to bowel sound recovery, time to first anal exhaust, time to defecation, time to food intake, and hospitalization time in the observation group were significantly shorter than those in the control group (P < 0.05).
CONCLUSION Early enteral nutrition support with peptison is helpful to improve postoperative nutrition status in patients with severe acute pancreatitis, and it can enhance immune function and intestinal mucosa barrier function, shorten the recovery time of gastrointestinal function and has higher safety.
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Mukhopadhyay A, Maity D, Dey R, Choudhury KB, Das G, Bhattacharya U. Can Postoperative Nutrition be Favourably Maintained by Oral Diet in Patients with Emergency Temporary Ileostomy? A Tertiary Hospital Based Study. J Clin Diagn Res 2016; 9:PC04-8. [PMID: 26816941 DOI: 10.7860/jcdr/2015/15220.6879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Temporary ileostomy is an emergency procedure performed in cases having septic peritonitis in presence of perforation or obstruction or gangrene of small intestine. These patients usually suffer from gross malnutrition following surgery. AIM To measure nutritional status of patients with emergency temporary ileostomy and to determine whether their postoperative nutrition can be favourably maintained by oral diet alone. MATERIALS AND METHODS Sixty patients were enrolled for the study on the basis of inclusion and exclusion criteria during the study period from January 2012 to December 2013. Oral feeding was started as soon as ileostomy started functioning and patients expressed hunger, about 48-72 hours postoperatively. An individualized diet chart was formulated for each patient using Harris Benedict Equation. Nutritional assessment was done on 1) 1(st) day of oral feeding, 2) After 7 days of oral feeding, 3). After three months of oral feeding. Nutritional parameters (anthropometric, biochemical) employed were tabulated and statistically analysed with SPSS v 17, Chicago. RESULTS Out of 60 patients, 36 males and 24 females were enrolled in the study. The patients were in the age group of 20-60 years with a mean age of 45 years. After 7 days of oral nutrition the nutritional status deteriorated with a significant decrease in body weight (p<0.001) and serum haemoglobin (p <0.001). However, at the end of the study, the patients had their nutritional status restored satisfactorily with normalization of basic parameters like bodyweight, haemoglobin and serum albumin (p<0.001). CONCLUSION Proper dietary advice and oral nutrition were found to be sufficient for gradual restoration and maintenance of satisfactory nutritional status in the postoperative period.
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Affiliation(s)
- Arunima Mukhopadhyay
- Assistant Professor, Department of Surgery, Calcutta National Medical College , Kolkata, India
| | - Debabrata Maity
- Registrar, Department of Surgery, Appollo Gleneagles Hospital , Kolkata, India
| | - Ramprasad Dey
- Associate Professor, Department of Obstetrics and Gynaecology, Chittaranjan Seva Sadan, College of Obstetrics , Gynaecology and Child Health, Kolkata, India
| | | | - Gautam Das
- Professor, Department of Surgery, North Bengal Medical College , West Bengal, India
| | - Ujjwal Bhattacharya
- Professor, Department of Surgery, Calcutta National Medical College , Kolkata, India
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