Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet

Crit Care Med. 1998 Jan;26(1):24-30. doi: 10.1097/00003246-199801000-00012.


Objective: To evaluate the impact of the route of administration of artificial nutrition and the composition of the diet on outcome.

Design: Prospective, randomized, clinical trial.

Setting: Department of surgery, university hospital.

Patients: One hundred sixty-six consecutive patients undergoing curative surgery for gastric or pancreatic cancer.

Interventions: At operation, the patients were randomized into three groups to receive: a) a standard enteral formula (control group; n = 55); b) the same enteral formula enriched with arginine, RNA, and omega-3 fatty acids (enriched group; n = 55); and c) total parenteral nutrition (TPN group; n = 56). The three regimens were isocaloric and isonitrogenous. Enteral nutrition was started within 12 hrs following surgery. The infusion rate was progressively increased to reach the nutritional goal (25 kcal/kg/day) on postoperative day 4.

Measurements and main results: Tolerance of enteral feeding, rate and severity of postoperative complications, and length of hospital stay were recorded. Early enteral infusion was well tolerated. Side effects were recorded in 22.7% of the patients, but only 6.3% did not reach the nutritional goal. The enriched group had a lower severity of infection than the parenteral group (4.0 vs. 8.6; p < .05). In subgroups of malnourished (n = 78) and homologous transfused patients (n = 42), the administration of the enriched formula significantly reduced both severity of infection and length of stay compared with the parenteral group (p < .05). Moreover, in transfused patients, the rate of septic complications was 20.0% in the enriched group, 38.4% in the control group, and 42.8% in the TPN group.

Conclusions: Early enteral feeding is a suitable alternative to TPN after major abdominal surgery. The use of the enriched diet appears to be more beneficial in malnourished and transfused patients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Diet*
  • Enteral Nutrition* / adverse effects
  • Enteral Nutrition* / methods
  • Female
  • Gastrectomy
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Nutrition Assessment*
  • Nutrition Disorders / prevention & control
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy
  • Parenteral Nutrition* / adverse effects
  • Parenteral Nutrition* / methods
  • Postoperative Complications / therapy
  • Prospective Studies
  • Stomach Neoplasms / surgery*
  • Treatment Outcome