Perioperative Enteral Nutrition

Infusing a diet enriched with arginine, omega-3 fatty acid, and RNA preoperatively and postopera-tively has resulted in a significant reduction in total but not major complications. In patients undergoing abdominal surgery, progressive postoperative oral supplementation without formal EN reduces complications and raises the question as to whether EN, total parenteral nutrition (TPN), or immuno-nutrition are even necessary for the majority of patients. Complications can be reduced by introducing early sip feeding of liquid diets without formal EN.

A small but provocative study from India raises the same questions about the routine use of EN. Sixty postoperative patients were randomized to either a standard ward diet or a diet with a home-made liquid supplement (10 patients per group). They were also stratified to mild, moderate, and severe malnutrition groups of 20 patients each. There was no mortality in the study and patients were discharged after approximately 10 days. The supplemented groups received significantly more energy and protein. However, only in the severely malnourished patients was there a difference in the incidence of complications—7/10 in the control and 4/10 in the supplemented group. In the mild malnutrition group, there were 1/10 complications in each arm and 2/10 in the moderate malnutrition group. This study suggests that a very modest oral intake of supplements reduced complications but did so only in the severely malnourished group. It is likely that the aggressive nutritional support, as is practiced currently, may not be necessary and may even be detrimental in some situations. Larger randomized trials of oral supplements should be considered.

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