Nutrition entérale pré et postopératoire en chirurgie réglée de l'adulte. Techniques, avantages et inconvénients

Abstract

This review examined the techniques for enteral nutrition (routes and methods of administration and choice of enteral diets) in the perioperative period of elective surgery in adults. Only few controlled studies have assessed the efficiency of techniques according to the indication of enteral feeding (pre or postoperative period, digestive or non-digestive surgery). The nasogastric tube remains the most appropriate method to deliver short-term enteral feeding during the preoperative period. Today percutaneous endoscopic gastrostomy is the preferred method of gastrostomy. It is indicated in long term enteral nutrition, for example in the perioperative period of cancer surgery of head and neck. In the postoperative period of digestive surgery, intrajejunal feeding is usually delivered by a surgical jejunostomy or by a nasojejunal tube. Controlled studies comparing these two methods are still lacking. An important limitation of intrajejunal feeding is the poor tolerance of enteral diet during the first postoperative days after major upper abdominal surgery. The choice of enteral diet in the perioperative period remains contreversial. There is no clinical evidence to support the hypothesis that the use of pre-digested diets in jejunostomy feeding has a better nutritional benefit and a better tolerance than polymeric diets. Small peptides offer some metabolic advantages, however the clinical superiority of these nutrients over polymeric diets is not definitively proven. Continuous administration of enteral nutrition is usually required in case of jejunal feeding. In the other cases, some data suggest that enteral nutrition is more efficient using an intermittent feeding regimen.