Nutritional rehabilitation strategies in abdominal surgery

Major abdominal surgery imposes significant physiological and psychological stress on patients and can lead to associated changes with consequent morbidity. Postoperative rehabilitation aims to minimise the impacts of surgical stress and facilitate convalescence and return to normal function. This review aims to highlight recent research in abdominal surgery rehabilitation with a focus on nutrition and adjuvant exercise and best practice guidelines.

Emerging interventions for restoration of normal gastrointestinal function postoperatively include the use of transcutaneous electrical acupoint stimulation and probiotics. Oral nutritional supplements in the postoperative period mitigate body weight loss, and routine use is now recommended after colorectal operations. Where oral intake is insufficient, enteral or parenteral nutrition is indicated, with meta-analyses demonstrating potential benefit of early supplementary parenteral nutrition. Immunonutrition postoperatively has been shown to reduce surgical complications and to have benefits over and above standard nutritional therapy. The evidence for adjuvant contractile interventions in the postoperative period is marked by heterogeneity in patient populations and exercise type, and further evidence is required in this space.

The evidence base for postoperative rehabilitation is continually increasing, and recent international guidelines recommend several novel nutritional practices, notably the use of probiotics and immunonutrition.