Newsletter

[ Vol. 11 No. 1 ] (January - April 2010 )
The adequate timing and choice of components for feeding patients with major surgical disease

Tsann-Long Hwang
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan 

Malnutrition has a deleterious effect on every major system in the body. In the malnourished patient, the postoperative frequency of complication is higher. Hypoproteinemia leads to delayed gastric emptying and prolonged ileus, a greater frequency of wound dehiscence, and an increased risk of wound infection. Prognostic Nutritional Index (PNI) is frequently used before operation for evaluation of the operative risk. The important issues of clinical nutrition for patients with major surgical diseased include: (1). Awareness of malnutrition, (2). Assessment of nutritional status, (3). Start feeding as early as possible, (4). Choice of adequate components of feeding diet, (5). Immunomodulation.

Providing preoperative nutritional support ensures that the patients remain nutritionally repleted to withstand surgical and adjuvant therapy. Feeding with immunomodulational diet for more than one week is highly recommended. Postoperative nutritional support is also important. Whenever possible, the gastrointestinal tract should be used. Early postoperative enteral feeding can be given via nasogastric tube or jejunostomy. It can be started from low speed of continuous glucose water drip. Transpyloric nasoduodenal feeding is also advised for the patient with delayed gastric emptying. Feeding diet can be chosen with elemental diet for those patients with prolonged fasting or patients with acute pancreatitis. Immunomodulation with glutamine dipeptide parenteral nutrition or enteral diet supplemented with arginine, glutamine plus w-3 fatty acid or only _-3 fatty acid enriched diet, can be used for patients with high risk for infection.

The complications of parenteral or enteral feeding should be kept in mind, the former include hyperglycemia, liver impairment, metabolic disorders or catheter sepsis; the later include abdominal distension, diarrhea, constipation or hypoglycemia. The complications are usually preventable or treatable, but we should be cautious. The nutritional support in abdominal is important, we should start it at the adequate timing, use the best formula, and prevent the complications as possible. Though the nutritional support cost is high, it is worthy because of the reduction of peri-operative complication and hospitalization day.

From   
PENSA 2009
“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 54