Early peroral feeding after pancreaticoduodenecomy
Objective. To analyze the various ways for enteral feeding after pancreaticoduodenectomy.
Materials and methods. There were investigated the results of pancreaticoduodenectomy, performed in 78 patients, suffering tumors of pancreatic head and periampullary zone, in whom various methods of nutritive support, in 2003 - 2017 yrs were applied. For comparative analysis the patients were divided into two groups: the first - 39 patients, perioperative treatment of whom was conducted in accordance to the ERAS program, and the second - 39 patients, who were treated using a standard method. In patients of the first group the effects of a peroral way of nutrition were compared, as well as combined peroral and enteral nutrition via microjejunostomy. There were studied the terms of restoration of peroral feeding, the gastrostasis rate, the nutrition calorage during 7 postoperative days, levels of general protein and albumin on the first, third and seventh postoperative day.
Results. In 33 (84.6%) patients of the first group the peroral nutrition restoration have occurred in complete order to the protocol. The gastrostasis rate in patients of the first group was essentially lesser, than in patients of the second group. In the first group this complication have occurred in 6 (15.4%) patients, in the second group - in 14 (35.9%) patients (p = 0.009). Dynamics of level of general protein and albumin of the blood in postoperative period did not depend on method and energetic estimate of the nutrition.
Conclusion. Application of peroral feeding, in accordance to the concept of the program for accelerated restoration of the patients, survived after pancreaticododenectomy, constitutes an optimal way for the nutrient support of an organism and permits to reduce the gastrostasis rate trustworthily.
Williamsson C, Karlsson N, Sturesson C, Lindell G, Andersson R, Tingstedt B. Impact of a fast-track surgery programme for pancreaticoduodenectomy. Br J Surg. 2015;102(9):1133-41. doi: 10.1002/bjs.9856.
Afaneh C, Gerszberg D, Slattery E, Seres DS, Chabot JA, Kluger MD. Pancreatic cancer surgery and nutrition management: a review of the current literature. Hepatobiliary Surg Nutr. 2015;4(1):59-71. doi: 10.3978/j.issn.2304-3881.2014.08.07.
Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schäfer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2013;37(2):240-58. doi: 10.1007/s00268-012-1771-1.
Buscemi S, Damiano G, Palumbo VD, Spinelli G, Ficarella S, Lo Monte G, et al. Enteral nutrition in pancreaticoduodenectomy: a literature review. Nutrients. 2015;7(5):3154-65. doi: 10.3390/nu7053154.
Pinevich DL, Sukonko OG, Polyakov SL, Smirnov VM, Minich AA. The principles of "enhanced recovery after surgery. Zdravookhranenie. 2014;(5):34-48. [In Russian].
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623-50. doi: 10.1016/j.clnu.2017.02.013.
Parmar AD, Sheffield KM, Vargas GM, Pitt HA, Kilbane EM, Hall BL, Riall TS. Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB (Oxford). 2013;15(10):763-72. doi: 10.1111/hpb.12129.
Eshuis WJ, van Eijck CH, Gerhards MF, Coene PP, de Hingh IH, Karsten TM, et al. Antecolic versus retrocolic route of the gastroenteric anastomosis after pancreatoduodenectomy: a randomized controlled trial. Ann Surg. 2014;259(1):45-51. doi: 10.1097/SLA.0b013e3182a6f529.
Atema JJ, Eshuis WJ, Busch OR, van Gulik TM, Gouma DJ. Association of preoperative symptoms of gastric outlet obstruction with delayed gastric emptying after pancreatoduodenectomy. Surgery. 2013;154(3):583-8. doi: 10.1016/j.surg.2013.04.006.
Welsch T, Borm M, Degrate L, Hinz U, Büchler MW, Wente MN. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg. 2010;97(7):1043-50. doi: 10.1002/bjs.7071.
Gerritsen A, Wennink RA, Besselink MG, van Santvoort HC, Tseng DS, Steenhagen E, et al. Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity. HPB (Oxford). 2014;16(7):656-64. doi: 10.1111/hpb.12197.
Padussis JC, Zani S, Blazer DG, Tyler DS, Pappas TN, Scarborough JE. Feeding jejunostomy during Whipple is associated with increased morbidity. J Surg Res. 2014;187(2):361-6. doi: 10.1016/j.jss.2012.10.010.
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braun- schweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nnutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40(2):159-211. doi: 10.1177/0148607115621863.
Robertson N, Gallacher P, Peel N, Garden O, Duxbury M, Lassen K, et al. Implementation of an enhanced recovery programme following pancreaticoduodenectomy. HPB (Oxford). 2012;14(10):700-8. doi: 10.1111/j.1477-2574.2012.00521.x.
Dai J, Jiang Y, Fu D. Reducing postoperative complications and improving clinical outcome: Enhanced recovery after surgery in pancreaticoduodenectomy - A retrospective cohort study. Int J Surg. 2017;39:176-81. doi: 10.1016/j.ijsu.2017.01.089.
Aoyama T, Kazama K, Murakawa M, Yamaoku K, Atsumi Y, Shiozawa M, et al. An institutional experience of introducing an Enhanced Recovery After Surgery (ERAS) program for pancreaticoduodenectomy. Int Surg. 2016;101(11,12):542-9. doi: 10.9738/INTSURG-D-16-00002.1.
Daniel SK, Thornblade LW, Mann GN, Park JO, Pillarisetty VG. Standardization of perioperative care facilitates safe discharge by postoperative day five after pancreaticoduodenectomy. PLoS One. 2018;13(12): e0209608. doi: 10.1371/journal.pone.0209608.
Walters DM, McGarey P, LaPar DJ, Strong A, Good E, Adams RB, et al. A 6-day clinical pathway after a pancreaticoduodenectomy is feasible, safe and efficient. HPB (Oxford). 2013;15(9): 668-73. doi: 10.1111/hpb.12016.
Braga M, Pecorelli N, Ariotti R, Capretti G, Greco M, Balzano G, et al. Enhanced Recovery After Surgery Pathway in Patients Undergoing Pancreaticoduodenectomy. World J Surg. 2014;38(11): 2960-6. doi:10.1007/s00268-014-2653-5.
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