[Perioperative enteral nutrition]

Area of Science:

• Surgical Nutrition
• Immunonutrition
• Gastrointestinal Physiology

Context:

• Surgical trauma triggers an exaggerated cytokine response, increasing intestinal permeability, bacterial translocation, and infection risk.
• Parenteral nutrition fails to provide luminal nutrients essential for maintaining enterocyte function and the gut barrier.
• Enteral nutrition offers a safer, cheaper alternative that actively modulates the immune response and preserves gastrointestinal integrity.

Purpose:

• To reduce the impact of cytokines and infectious complications in surgical patients.
• To maintain the gut barrier effect and modulate the cytokine response through luminal nutrient delivery.
• To investigate the benefits of uninterrupted enteral nutrition before, during, and after surgery.

Summary:

• Enteral nutrition provides fuel directly to enterocytes, preserving the gut barrier and modulating the cytokine response, unlike parenteral nutrition.
• Studies show enteral nutrition modulates interleukin-6 response, hastens bowel function recovery, and reduces hospital stay after hepatic resection.
• Aggressive enteral nutrition in severe pancreatitis controlled the disease without septic complications, highlighting its role in preserving mucosal immunity.

Impact:

• Reduced infection rates and hospital stays in surgical patients receiving optimized enteral nutrition.
• Preservation of the gut barrier, mucus layer, and mucosal immunological status through continuous supply of immuno-nutrients like glutamine and fiber.
• Potential for improved outcomes in surgical infections by incorporating probiotics into enteral nutrition to enhance the colonic microenvironment.