Enteral vs total parenteral nutrition following major upper gastrointestinal surgery

A best evidence topic in surgery was written according to a structured protocol. The question addressed was in patients undergoing elective major upper gastrointestinal surgery requiring post-operative nutritional support, does enteral feeding as compared to total parenteral feeding confer any clinical benefits. Thirty-two papers were identified by a search of the Medline and Embase databases, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study group, relevant outcomes and results of these papers were tabulated. All seven of these papers were randomised controlled trials which demonstrated enteral nutrition to be associated with shorter hospital stay, lower incidence of severe or infectious complications, lower severity of complications and decreased cost as compared to parenteral nutrition. For patients undergoing elective major upper gastrointestinal surgery requiring post-operative nutritional support, enteral feeding should be considered as the most desirable form of post-operative feeding.