ARTIFICIAL NUTRITION AFTER MAJOR ABDOMINAL-SURGERY - IMPACT OF ROUTE OF ADMINISTRATION AND COMPOSITION OF THE DIET

Objective: To evaluate the impact of the route of administration of ar tificial nutrition and the composition of the diet on outcome. Design: Prospective, randomized, clinical trial. Setting: Department of surge ry, university hospital. Patients: One hundred sixty-six consecutive p atients undergoing curative surgery for gastric or pancreatic cancer. Interventions: At operation, the patients were randomized into three g roups to receive: a) a standard enteral formula (control group; n = 55 ); b) the same enteral formula enriched with arginine, RNA, and omega- 3 fatty acids (enriched group; n = 55); and c) total parenteral nutrit ion (TPN group; n = 56). The three regimens were isocaloric and isonit rogenous. Enteral nutrition was started within 12 hrs following surger y. The infusion rate was progressively in creased to reach the nutriti onal goal (25 kcal/kg/day) on postoperative day 4. Measurements and Ma in Results: Tolerance of enteral feeding, rate and severity of postope rative complications, and length of hospital stay were recorded. Early enteral infusion was well tolerated. Side effects were recorded in 22 .7% of the patients, but only 6.3% did not reach the nutritional goal. The enriched group had a lower severity of infection than the parente ral group (4.0 vs. 8.6; p < .05). In subgroups of malnourished (n = 78 ) and homologous transfused patients (n = 42), the administration of t he enriched formula significantly reduced both severity of infection a nd length of stay compared with the parenteral group (p < .05). Moreov er, in transfused patients, the rate of septic complications was 20.0% in the enriched group, 38.4% in the control group, and 42.8% in the T PN group. Conclusions: Early enteral feeding is a suitable alternative to TPN after major abdominal surgery. The use of the enriched diet ap pears to be more beneficial in malnourished and transfused patients.