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Early postoperative enteral feeding following major upper gastrointestinal surgery
M D McCarter1, M E Gomez, J M Daly
1Department of Surgery, New York Hospital-Cornell University Medical Center, New York, NY, USA.
Insights
Early jejunal feeding after major upper gastrointestinal surgery is safe and feasible. Patients tolerated the feeding well, receiving adequate nutrition despite mild gastrointestinal symptoms, supporting its use in recovery.
Area of Science:
- Gastroenterology
- Surgical Nutrition
- Clinical Nutrition
Background:
- Enteral feeding is often delayed post-major abdominal surgery.
- Early nutritional support is crucial for patient recovery and outcomes.
Purpose of the Study:
- To prospectively assess the feasibility and tolerance of early jejunal feeding.
- To evaluate early jejunal feeding following major upper gastrointestinal surgery.
Main Methods:
- 167 patients received jejunal feeding starting postoperative day 1.
- Formula rate advanced to target (25 kcal/kg/day) by postoperative day 4.
- Complications, calorie intake, and symptoms were monitored daily.
Main Results:
- No major complications or deaths occurred from jejunal tube placement or early feeding.
- Mild gastrointestinal symptoms (cramping, distention, nausea, diarrhea) occurred but were mostly mild.
- Patients achieved an average of 78% of their caloric goal by postoperative day 4.
Conclusions:
- Early jejunal feeding is safe and feasible in patients undergoing esophageal, gastric, or pancreatic resections.
- Predominantly mild gastrointestinal symptoms do not preclude successful nutritional support.
- This feeding strategy can be effectively implemented in the postoperative recovery phase.
Abstract:
For a variety of reasons, enteral feeding is frequently delayed following major abdominal surgery. The purpose of this study was to evaluate prospectively the feasibility and tolerance of early jejunal feeding following major upper gastrointestinal surgery. Beginning on postoperative day 1, patients (n = 167) received a full-strength enteral formula at the rate of 25 ml/hr through a jejunal feeding tube. Diets were advanced to the calculated target rate (25 kcal/kg/day) by postoperative day 4. Complications of tube feeding, calories received, and patient symptoms were recorded daily. There were no major complications or deaths resulting from placement of a jejunal tube or from early enteral feeding. Patients had abdominal symptoms such as cramping, distention, nausea, and diarrhea on 9%, 18%, 4%, and 24% of all feeding days, respectively. The majority of these symptoms, with the exception of diarrhea, were graded as mild. Patients undergoing surgery for pancreatic malignancy had significantly more diarrhea than patients undergoing esophagectomy or gastrectomy. Despite these differences in symptoms, patients received an average of 78% of their targeted caloric goal by postoperative day 4 and maintained this level throughout the study. Early enteral feeding for patients undergoing esophageal, gastric, or pancreatic resections is both safe and feasible despite the occurrence of predominantly mild gastrointestinal symptoms.