References

Herbert G, Perry R, Andersen HK Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev.. 2018; 10 https://doi.org/10.1002/14651858.CD004080.pub3

Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia and early oral nutrition and mobilisation. Lancet. 1995; 345:(8952)763-764 https://doi.org/10.1016/s0140-6736(95)90643-6

Burton B, Nicholson G, Hall G. Endocrine and metabolic response to surgery. Continuing Educ Anesthesia Crit Care Pain. 2004; 4:(5)144-147 https://doi.org/10.1093/bjaceaccp/mkh040

Catchpole BN. Smooth muscle and the surgeon. Aust N Z J Surg.. 1989; 59:(3)199-208 https://doi.org/10.1111/j.1445-2197.1989.tb01502.x

McSorley ST, Horgan PG, McMillan DC. The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Crit Rev Oncol Haematol.. 2016; 101:139-150 https://doi.org/10.1016/j.critrevonc.2016.03.011

Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma—reduced septic morbidity. J Trauma.. 1989; 29:(7)916-922 https://doi.org/10.1097/00005373-198907000-00003

Schroeder D, Gillanders L, Mahr K, Hill GL. Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. J Parenter Enteral Nutr.. 1991; 15:(4)376-383 https://doi.org/10.1177/0148607191015004376

Soop M, Nygren J, Thorell A Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clin Nutr.. 2004; 23:(4)733-741 https://doi.org/10.1016/j.clnu.2003.12.007

Zhuang CL, Ye XZ, Zhang CJ Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: a meta-analysis of randomized clinical trials. Digestive Surg.. 2013; 30:225-232 https://doi.org/10.1159/000353136

Nutrition
Service improvement

Early enteral nutrition after lower gastrointestinal surgery: impact on hospital stay and complications

02 July 2020
Cochrane Corner
02 July 2020
Volume 25 · Issue 7

Historically, patients were kept fasted after most gastro-intestinal surgeries (Catchpole, 1985). Towards the end of the 20th century, however, several investigators hypothesised that immediate enteral nutrition was feasible and resulted in an improved wound healing response (Schroeder et al, 1991). For example, Moore et al (1989) demonstrated that early enteral feeding was well tolerated in patients with severe abdominal trauma and reduced septic complications. Most studies unequivocally showed that early enteral feeding led to a shorter length of hospital stay and decreased incidence of complications (Zhuang at al, 2013).

It is known that the immediate postoperative period is associated with the stress response, which stimulates neuroendocrine, metabolic and inflammatory responses (McSorley et al, 2016). The neuroendocrine response includes secretion of pituitary hormones and release of catecholamines and cortisols from the adrenal gland. Norepinephrine is released from the nerve endings of the sympathetic nervous system. Insulin secretion decreases and there is transient resistance to insulin, leading to hyperglycaemia immediately following surgery. Further, there is decreased insulin release and increased glucagon secretion from the pancreas as a response to surgery. This response leads to increased levels of glucose in the plasma, protein breakdown and lipolysis-that is, a catabolic state. Additionally, the inflammatory response to tissue injury leads to the release of interleukin-1, tumour necrosis factor-alpha and, later, interleukin-6 from macrophages and monocytes, leading to what is known as systemic acute phase response (Burton et al, 2004).

Register now to continue reading

Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month

Register
Or continue by

Signing in with your registered email address