Early enteral supply of fiber and Lactobacilli versus conventional nutrition: a controlled trial in patients with major abdominal surgery.
OBJECTIVE
Early enteral nutrition with fiber-containing solutions plus Lactobacillus may reduce bacterial translocation and minimize the incidence of infections after surgery.


METHODS
In a prospective, randomized trial in three groups (n = 30/group) of patients after major abdominal surgery, we compared our previous regimen with parenteral nutrition or fiber-free enteral nutrition (group A) with enteral fiber-containing nutrition with living Lactobacillus (group B) and heat-killed Lactobacillus (group C). The main endpoint was the development of bacterial infection. Other analyzed parameters were the durations of antibiotic therapy and hospital stay, non-infectious complications, side effects of the nutrition, and onset of bowel movement. Routine parameters, nutritional parameters, and cellular immune status in the blood were measured preoperatively and on 1, 5, and 10 d postoperatively.


RESULTS
The incidence of infections was significantly lower (P = 0.01) in groups B and C with enteral nutrition containing fibers (10% each) than in group A (30%). Patients in group B received antibiotics for a significantly shorter time (P = 0.04) than did the patients in groups A and C. The length of hospital stay and the incidence of non-infectious complications did not differ significantly. Fibers and lactobacilli were well tolerated. There were no general benefits of living Lactobacillus as opposed to heat-killed Lactobacillus in the entire study population, but benefits were observed in the patients with gastric and pancreas resections, although no statistical analysis was done due to their small numbers.


CONCLUSIONS
Early enteral nutrition with fiber-containing solutions reduced the rate of postoperative infections in comparison with parenteral nutrition and fiber-free enteral formula. Addition of living Lactobacillus seemed to increase the benefits in patients with gastric and pancreatic resections.
Rayes
Nada
N
Department of Surgery, Charité, Campus Virchow, Augustenberger Platz 1, 13355 Berlin, Germany. nada.reyes@charite.de
Hansen
Sonja
S
Seehofer
Daniel
D
Müller
Andrea Raffaela
AR
Serke
Stefan
S
Bengmark
Stig
S
Neuhaus
Peter
P
D000368:Aged; D001835:Body Weight; D003672:Defecation; D004043:Dietary Fiber / Q000008:administration & dosage*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007109:Immunity; D007239:Infections / Q000453:epidemiology; D007778:Lactobacillus; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010288:Parenteral Nutrition; D011183:Postoperative Complications; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery