Alimentação precoce no pós-operatório de cirurgias digestivas

Abstract

Objetivo: Avaliar os benefícios da alimentação precoce no pós-operatório de cirurgias digestivas. Métodos: Trata-se de uma revisão integrativa de literatura cujo tema foi pesquisado na base de dados da Scielo e Pubmed através dos descritores “alimentação no pós-operatório” e “postoperative feeding”, respectivamente, sendo incluídos artigos com pacientes maiores de 18 anos e sem restrição à data de publicação. Resultados: A revisão dos artigos selecionados evidenciou que o manejo tradicional da alimentação pós-operatória está ultrapassado e a formulação dos novos protocolos como Enhanced Recovery After Surgery (ERAS) e Aceleração da Recuperação Total Pós-Operatória (ACERTO) possibilitam uma mudança benéfica nessa conduta. A alimentação precoce no pós- operatório é responsável por acelerar a recuperação do paciente, bem como, por reduzir os custos hospitalares durante a internação do paciente. Esses benefícios são constatados tanto em cirurgias abertas quanto em videocirurgias. Outro aspecto importante é a região anatômica do procedimento, sendo as cirurgias colorretais as mais estudadas e com resultados positivos mais consistentes. Considerações Finais: A alimentação precoce no pós-operatório de cirurgias colorretais e cirurgias digestivas altas é segura, reduzindo a morbimortalidade e o tempo de internação hospitalar.

Benefits of fasting abbreviation and early refeeding of multimodal perioperative care protocols

“…1,5,21 Among the advantages of early refeeding in elective operations, includes the current understanding that the functional return of the gastrointestinal tract is faster than previously thought after surgical procedures, and the early release of the diet promotes regulation by hormones such as gastrin and motilin, whose functions restore digestive system functioning. 14 In this context, the importance of early refeeding is based on the records of cases in which prolonged fasting and, consequently, late refeeding generate changes in metabolism and a higher prevalence of complications in patients undergoing surgery. Delaying the start of refeeding promotes an increase in insulin resistance, which results in the intensification of the inflammatory response to surgical trauma directly proportional to the degree of operative stress.…”

“…Surgical trauma and increased fasting time alter the endocrine-metabolic response with increased insulin resistance and consumption of substrates, in addition to the immunosuppressive effect, making the patient susceptible to infections and predisposing to tissue repair and healing difficulties. 4,14 In order to minimize these effects, preoperative care protocols were instituted and, among the main recommendations, the use of beverages containing carbohydrates stands out. 4 Furthermore, the possibility of adding other energy sources such as proteins, vitamins, trace elements, and more recently whey protein, has been recommended in recent publications.…”

“…In this context, the increase in insulin resistance is of significant importance, as it is responsible for intensifying the inflammatory response to surgical trauma in a way that is directly proportional to the degree of surgical stress. 14 The result, then, is hyperglycemia, a marker with high sensitivity to the damage of operative trauma. 7,16 Thus, the main objective of the preoperative supplement containing carbohydrates is to enable the endogenous release of the insulin hormone, and to mimic the body's physiological response to food intake after the fasting period, 7 improving surgical recovery.…”