NUTRITION IN GASTROINTESTINAL SURGICAL PATIENTS

Abstract

Despite important advances in surgical care and minimized surgical trauma, postoperative complications are still of great concern. Nutritional depletion has been demonstrated to be a major determinant in the development of postoperative complications. Nutritional status of gastrointestinal surgical patients is an important issue, which need to be attended in particularly during the perioperative period. Fears of postoperative ileus and the integrity of the newly constructed anastomosis have led to the adoption of starvation with administration of intravenous fluids until the return of normal bowel sounds and passage of flatus. However, it has been shown that early postoperative enteral feeding is both beneficial and well-tolerated. Meta-analysis has shown that enteral feeding compared with parenteral nutrition is associated with fewer complications, reduced costs and a shorter hospital stay. Therefore it should be the preferred option whenever possible. Evidence to support preoperative nutrition is limited, but malnourished individuals fed for 7-10 days preoperatively may have improved surgical outcome. Prolong preoperative starvation is not essential, and the administration of preoperative carbohydrates is safe without the fear of increasing the risk of aspiration. Initially nutritional support was aimed at meeting the energy needs and providing proteins and other essential micronutrients, while now it is more directed at modulation of the immune functions, the so called immunonutrition. Multimodal strategies including minimal invasive surgery, adequate postoperative analgesia, nutritional care, and enforced mobilization resulted in reduction in postoperative complications and length of hospital stay.

Keywords

• nutrition
• gastrointestinal
• surgical