Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet.
OBJECTIVE
To evaluate the impact of the route of administration of artificial nutrition and the composition of the diet on outcome.


METHODS
Prospective, randomized, clinical trial.


METHODS
Department of surgery, university hospital.


METHODS
One hundred sixty-six consecutive patients undergoing curative surgery for gastric or pancreatic cancer.


METHODS
At operation, the patients were randomized into three groups to receive: a) a standard enteral formula (control group; n = 55); b) the same enteral formula enriched with arginine, RNA, and omega-3 fatty acids (enriched group; n = 55); and c) total parenteral nutrition (TPN group; n = 56). The three regimens were isocaloric and isonitrogenous. Enteral nutrition was started within 12 hrs following surgery. The infusion rate was progressively increased to reach the nutritional goal (25 kcal/kg/day) on postoperative day 4.


RESULTS
Tolerance of enteral feeding, rate and severity of postoperative complications, and length of hospital stay were recorded. Early enteral infusion was well tolerated. Side effects were recorded in 22.7% of the patients, but only 6.3% did not reach the nutritional goal. The enriched group had a lower severity of infection than the parenteral group (4.0 vs. 8.6; p < .05). In subgroups of malnourished (n = 78) and homologous transfused patients (n = 42), the administration of the enriched formula significantly reduced both severity of infection and length of stay compared with the parenteral group (p < .05). Moreover, in transfused patients, the rate of septic complications was 20.0% in the enriched group, 38.4% in the control group, and 42.8% in the TPN group.


CONCLUSIONS
Early enteral feeding is a suitable alternative to TPN after major abdominal surgery. The use of the enriched diet appears to be more beneficial in malnourished and transfused patients.
Braga
M
M
Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy.
Gianotti
L
L
Vignali
A
A
Cestari
A
A
Bisagni
P
P
Di Carlo
V
V
D000328:Adult; D004032:Diet; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome