Réalimentation précoce et chirurgie digestive

Abstract

Malnutrition is often unsuspected and is today well-recognized as a potential cause of increased morbidity. The aim of this review was to assess the influence of early postoperative nutrition in digestive surgery. Review of the literature has shown eight prospective randomized studies that have compared early oral feeding versus standard feeding after elective colorectal surgery. Early oral feeding was tolerated by the majority of the patients. Furthermore, early oral feeding was not associated with increased mortality and morbidity rates. Fast-track rehabilitation (i.e. early oral feeding, epidural analgesia and early mobilization), accelerate today recovery after colorectal surgery, leading to in-hospital stay reduction. In upper-GI surgery, a randomized trial has shown that early postoperative enteral nutrition reduced postoperative infectious complications. Furthermore, 15 studies have compared postoperative enteral (by nasogastric suction or by percutaneous jejunostomy) versus total parenteral nutrition. Postoperative enteral nutrition was tolerated by 80% of the patients and was not associated with increased mortality and morbidity rates. Although, postoperative in-hospital stay was similar between both procedures, postoperative enteral nutrition was cheaper than total parenteral nutrition. In conclusion, currently available data show that early postoperative nutrition such as oral nutrition after elective colorectal surgery or enteral nutrition after upper intestinal surgery was not associated with increased mortality or morbidity rates. Thus, early postoperative nutrition should be proposed in patients after elective digestive surgery.