Nutritional support for patients in general surgery

Abstract

The modern stage of development of surgery, especially minimal invasive technologies, has significantly changed the surgeons' thoughts about the perioperative period. Until the end of the twentieth century, pre‑ and postoperative fasting was the most important requirement in planned surgery. It was believed that it could help to avoid complications both during surgery and in the early postoperative period. H. Kehlet in his fundamental work outlined the factors that allowed to accelerate the patient's recovery after surgery, namely: the absence of preoperative fasting. Objective — to evaluate the effectiveness of nutritional support for surgical patients within ERAS (Enhanced Recovery After Surgery) and ESPEN (European Society for Clinical Nutrition and Metabolism) protocols. Materials and methods. This research included both traditional laparoscopic cholecystectomy (177 cases) and single‑port transumbilical cholecystectomy (8); among laparoscopic bariatric interventions, the major part was represented by classical Roux‑Y gastric shunting (28), as well as sleeve gastrectomy (5) and mini‑gastric shunting (4); among 123 different laparoscopic hernioplasties, in 64 cases transabdominal preperitoneal (TAPP) was performed for bubonocele, intraperitoneal onlay mesh (IPOM) for postoperative ventral and umbilical hernias (59), laparoscopic crurography and fundoplication with and without alloplasty (33). For each type of surgery two groups we identified: control and experimental. Both groups were followed by ERAS protocols in addition to nutritional support. With the prior consent of patients before surgery: the experimental group received full perioperative nutritional support according to our local protocols using protein‑enriched sip feeding formula Nutridrink Protein, the control group followed the traditional scheme of fasting during 12 hours before surgery and received regular drinking water instead of protein mixtures at the first postoperative day. Results. We found statistically significant difference between control and experimental groups in assessing of two important parameters as hunger and weakness. The hunger after laparoscopic cholecystectomy was 1.5 times (p < 0.001), after laparoscopic hernia repair — 1.7 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.26 times (p < 0.001), after laparoscopic bariatric intervention — 1.43 times, and after laparoscopic colon intervention — 1.9 times lower in the experimental group. The weakness after laparoscopic cholecystectomy was 1.8 times (p < 0.001), after laparoscopic hernia repair — 1.31 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.68 times (p < 0.001), after laparoscopic bariatric intervention — 1.67 times (p < 0.001), and after laparoscopic colon intervention — 1.38 times (p = 0.006) stronger in the control group. Conclusions. Traditional long‑term preoperative fasting is inappropriate. Combined with other ERAS postulates, perioperative nutritional support for surgical patients has a great chance of success. In our research, early restoration of oral nutrition significantly decreases hunger and general weakness in the early postoperative period, which allows the patient quickly return to full life.