Comparison of postoperative early enteral nutrition and parenteral nutrition in infants with congenitalcholedochal cyst

Abstract

Objective To evaluate the application and clinical effectiveness of early enteral nutrition (EEN) used after operation in infants with congenital choledochal cyst (CCC). Methods This randomised controlled trial enrolled 68 patients receiving choledochal cyst excision plus biliary reconstruction (Roux-en-Y anastomosis) for CCC in Department of General Surgery of Affiliated Nanjing Children's Hospital of Nanjing Medical University between January 2014 and December 2015.The infants were randomly divided into EEN group(n=34)and total parenteral nutrition (TPN) group(n=34). The EEN group received enteral nutrition 48 hours after surgery, while the TPN group was given conventional parenteral nutrition after surgery. The body mass, prealbumin, retinol binding protein, hemoglobin, immunoglobulin and lymphocyte count were compared between the two groups on day 1 after admission and day 7 after operation. The time of first defecation, the time of gastric tube removal, the amount of gastrointestinal drainage, and the incidence of complications after surgery were also compared between the two groups. Results A total of 68 infants completed the clinical observation. There were no significant differences in the preoperative body mass, height, disease distribution, and nutritional indexes between the two groups. Compared with the TPN group, the time of first defecation [(69.20±9.37)hours vs. (84.73±5.12)hours], the time of gastric tuberemoval [(110.48±5.47)hours vs.(134.90±6.97)hours], and the amount of gastrointestinal drainage [(202.31±32.89)ml vs.(258.70±25.52)ml] were all shorter/lower in the EEN group (all P 0.05). After a follow-up period of 3 to 24 months, we found that the patients in both groups had good recovery and nutritional status. Conclusion EEN after surgery for CCC in infants is a reliable, safe, and effective technique and may be beneficial for the recovery of gastrointestinal function, the improvement of nutritional status and immunity, and the outcome after surgery. Key words: Choledochal cyst; Enteral nutrition; Parenteral nutrition; Infant