[Enteral nutrition: past and future].
Perioperative nutrition has during the last century been transformed from a tool to provide calorie and nitrogen support to a tool to boost the immune system and increase resistance to complications. Despite all progress in medicine and surgery has perioperative morbidity, rate of infections, thrombosis and development of serosal adhesions remained the same as long as can be judged or at least during the last eighty years. Most prone to develop complications are persons above the age of 65 and persons with depressed immunity. About eighty percent of the immune system is localised in the gastrointestinal tract, which offers great opportunities for modulation through enterar nutrition. As the stomach has a tendency to develop postoperative paralysis, tube feeding is often necessary. Andresen demonstrated already in 1918 the advantages of enteral nutrition, which starts already on the table. Mulholland et al and Rhoads and co-workers demonstrated during the 1940s certain advantages of enteral tube feeding. Also works by Alexander, Fischer, Ryan and their co-workers supported the value of early enteral feeding, and suggested enteral feeding as an effective tool to boost the immune system. It was, however, works published in the early nineties by Moore et al and by Kudsk et al, which made surgeons more aware of the advantages of early enteral nutrition. Major surgery is known to have a high rate of complications. Uninterrupted perioperative nutrition, eg nutrition during the night before, during surgery and immediately after offers a strong tool to prevent complications. It is essential that the nutrition provides food also for the colon, e.g. fibres and healthy bacteria (probiotics) to ferment the fibre and boost the immune system.
Bengmark
S
S
Departamento de Hepatología y Cirugía, Facultad de Medicina, Universidad de Londres, RU. sbengmark@onetel.net.uk
Ortiz de Urbina
J J
JJ
D002149:Energy Intake; D004750:Enteral Nutrition / Q000266:history* / Q000295:instrumentation / Q000379:methods / Q000639:trends; D004867:Equipment Design; D005544:Forecasting; D049673:History, 20th Century; D006801:Humans; D007107:Immune System; D009751:Nutritional Requirements; D013514:Surgical Procedures, Operative / Q000009:adverse effects