Majeed H Alwan

Basrah Journal of Surgery مجلة البصرة الجراحية
ISSN: 16833589 Year: 2009 Volume: 15 Issue: 2 Pages: 10-15
Publisher: Basrah University جامعة البصرة


Despite important advances in surgical care and minimized surgical trauma, postoperativecomplications are still of great concern. Nutritional depletion has been demonstrated to be amajor determinant in the development of postoperative complications. Nutritional status ofgastrointestinal surgical patients is an important issue, which need to be attended in particularlyduring the perioperative period.Fears of postoperative ileus and the integrity of the newly constructed anastomosis have led tothe adoption of starvation with administration of intravenous fluids until the return of normalbowel sounds and passage of flatus. However, it has been shown that early postoperativeenteral feeding is both beneficial and well-tolerated.Meta-analysis has shown that enteral feeding compared with parenteral nutrition is associatedwith fewer complications, reduced costs and a shorter hospital stay. Therefore it should be thepreferred option whenever possible.Evidence to support preoperative nutrition is limited, but malnourished individuals fed for 7-10days preoperatively may have improved surgical outcome.Prolong preoperative starvation is not essential, and the administration of preoperativecarbohydrates is safe without the fear of increasing the risk of aspiration.Initially nutritional support was aimed at meeting the energy needs and providing proteins andother essential micronutrients, while now it is more directed at modulation of the immunefunctions, the so called immunonutrition.Multimodal strategies including minimal invasive surgery, adequate postoperative analgesia,nutritional care, and enforced mobilization resulted in reduction in postoperative complicationsand length of hospital stay.