[The need for a specific postoperative, total parenteral nutrition therapy after various intra-abdominal procedures]

119 metabolically healthy surgical patients, who had to undergo elective intraabdominal surgery, were separated into upper -- cholecystectomy, gastric resection -- and lower -- colonic and sigma surgery -- intraabdominal procedures and divided into 8 groups with different infusion regimes. During the early postoperative period patients with upper abdominal surgery had significantly higher postoperative enzyme changes compared with patients with lower abdominal surgery. Patients with cholecystectomy had the significantly highest postoperative enzyme changes. On postoperative day 6 the enzyme changes showed a significant dependence from the duration of total parenteral nutrition, the chosen calorie-nitrogen-ratio, and the chosen energy substrate, xylitol or glucose. We could show a significant negative correlation between the extent of the stimulation of hepatic lipid synthesis and the protein parameters. Of all chosen infusion regimens xylitol in a dose of 0.11 g/kg BW X h together with the high amino acid infusion rate of 1.76 g/kg BW X day had the most favourable effect on the extent of stimulation of hepatic lipid synthesis, the late postoperative enzyme changes and the synthesis rate of visceral proteins. This study could demonstrate, that different intraabdominal surgical procedures need a more specific nutritional therapy.