Impact of elemental diet on early recovery after laparoscopic colectomy: findings of a randomized controlled trial.
OBJECTIVE
An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy.


METHODS
Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever".


RESULTS
A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group.


CONCLUSIONS
The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake.
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan. shichino@med.hokudai.ac.jp.
Toshiaki
T
Shichinohe
Department of Surgery, Sapporo Tonan Hospital KKR Medical Center, North-1, West-6, Chuou-ku, Sapporo, Hokkaido, Japan.|Department of Surgery, Japanese Red Cross Asahikawa Hospital, 1-1 Akebono, Asahikawa, Hokkaido, Japan.
Takeshi
T
Sasaki
Department of Surgery, Sapporo Tonan Hospital KKR Medical Center, North-1, West-6, Chuou-ku, Sapporo, Hokkaido, Japan.
Shuji
S
Kitashiro
Department of Surgery, Hokkaido Gastroenterology Hospital, Honcho 1-1, Higashi-ku, Sapporo, Hokkaido, Japan.
Takayuki
T
Morita
Department of Surgery, Obihiro-Kosei General Hospital, West-6, South-8, Obihiro, Hokkaido, Japan.
Koichi
K
Ono
Department of Surgery, Steel Memorial Muroran Hospital, 1-45 Chiribetsu-cho, Muroran, Hokkaido, Japan.
Naoto
N
Senmaru
Department of Surgery, Japanese Red Cross Kitami Hospital, North-6, East-2, Kitami, Hokkaido, Japan.
Junichi
J
Ikeda
Department of Surgery, Hakodate Central General Hospital, 33-2, Honcho, Hakodate, Hokkaido, Japan.
Tetsufumi
T
Kojima
Department of Surgery, Oji General Hospital, 3-4-8, Wakakusa-cho, Tomakomai, Hokkaido, Japan.
Noriaki
N
Kyogoku
Department of Surgery, NTT East Sapporo Hospital, South-1, West-15, Chuou-ku, Sapporo, Hokkaido, Japan.
Hidehisa
H
Yamada
Department of Surgery, Kushiro City General Hospital, 1-12 Shunkodai, Kushiro, Hokkaido, Japan.
Nagato
N
Sato
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.|Department of Surgery, Hokkaido Gastroenterology Hospital, Honcho 1-1, Higashi-ku, Sapporo, Hokkaido, Japan.
Kentaro
K
Kato
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
Soichi
S
Murakami
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.|Department of Surgery, Sapporo Tonan Hospital KKR Medical Center, North-1, West-6, Chuou-ku, Sapporo, Hokkaido, Japan.
Yuma
Y
Ebihara
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
Yo
Y
Kurashima
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.|Department of Surgery, Hakodate Central General Hospital, 33-2, Honcho, Hakodate, Hokkaido, Japan.
Eiji
E
Tamoto
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.|Department of Surgery, Obihiro-Kosei General Hospital, West-6, South-8, Obihiro, Hokkaido, Japan.
Takehiro
T
Noji
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
Toru
T
Nakamura
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.|Department of Surgery, Hokkaido Gastroenterology Hospital, Honcho 1-1, Higashi-ku, Sapporo, Hokkaido, Japan.
Keisuke
K
Okamura
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
Takahiro
T
Tsuchikawa
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
Satoshi
S
Hirano
D000368:Aged; D000596:Amino Acids / Q000032:analysis; D003082:Colectomy / Q000009:adverse effects* / Q000534:rehabilitation*; D005260:Female; D005526:Food, Formulated / Q000032:analysis; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000534:rehabilitation*; D007902:Length of Stay; D008286:Malabsorption Syndromes / Q000178:diet therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000178:diet therapy* / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
D000596:Amino Acids
Elemental diet; Estimated minimum length of stay in hospital after surgery; Laparoscopic colectomy