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Gastric emptying after elective abdominal aortic aneurysm surgery: the case for early postoperative enteral feeding
R Avrahami1, J D Cohen, M Haddad
1Department of Vascular Surgery, Rabin Medical Center, Petah Tiqva, Israel.
Insights
Gastric emptying returns to normal approximately 18 hours after abdominal aortic aneurysm (AAA) surgery. This finding supports early initiation of enteral nutrition on the second postoperative day to preserve gastrointestinal mucosa integrity.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Clinical Nutrition
Background:
- Early postoperative enteral nutrition is crucial for maintaining gastrointestinal mucosa integrity.
- Assessing gastric emptying is key to determining the optimal timing for initiating enteral feeding after major surgery.
Purpose of the Study:
- To evaluate gastric emptying function following elective abdominal aortic aneurysm (AAA) surgery.
- To inform the timing of early postoperative enteral nutrition in AAA patients.
Main Methods:
- The paracetamol absorption test was employed to measure gastric emptying in 13 patients.
- Measurements were taken at 6, 18, and 32 hours post-surgery.
- Normal gastric emptying was defined by a specific plasma paracetamol concentration curve threshold (AUC-60 > 600 mg/min/l).
Main Results:
- Median time to normal gastric emptying was 18 ± 7.7 hours.
- By 32 hours post-surgery, 92% of patients exhibited normal gastric emptying.
- Nasogastric tubes were removed around 3.2 days post-operation, with enteral feeding starting on day 4.
Conclusions:
- Gastric emptying normalizes by 18 hours after elective AAA surgery, as confirmed by the paracetamol absorption test.
- Enteral nutrition can be safely initiated on the second postoperative day.
- Early enteral feeding supports gastrointestinal mucosal health.
Objective:
To assess gastric emptying with a view to early postoperative enteral nutrition after elective abdominal aortic aneurysm (AAA) surgery.
Methods:
The paracetamol absorption test was used to assess gastric emptying in 13 consecutive patients at 6, 18 and 32 h following elective AAA surgery. All patients received postoperative analgesia with marcaine given via an epidural catheter during the first 48 postoperative hours. Normal emptying was defined as an area under the plasma paracetamol concentration curve at 60 min (AUC-60) of > 600 mg/min/l.
Results:
The median time to normal gastric emptying was 18 +/- 7.7 h. One patient (7.6%) had normal emptying at 6 h, nine (69%) at 18 h and 12 (92%) at 32 h. The nasogastric tubes were removed at a median of 3.2 days after surgery, and enteral feeding was commenced on day 4.
Conclusions:
Gastric emptying was normal 18 h post-AAA surgery as assessed by the paracetamol absorption test. In view of the importance of maintaining an intact gastrointestinal mucosa, enteral nutrition may be commenced on the second postoperative day.