Immunonutrition in Elective Gastrointestinal Surgery Patients

Abstract

Background: previous trials have shown that perioperative immunonutrition could protect patients from infectious complications after gastrointestinal cancer operations. the purpose of this study was to determine whether perioperative immunonutrition decreases postoperative morbidity,especially infection complications, mortality and length of hospital stay in patients undergoing major gastrointestinal tract surgery.Methods: one hundred patients with ap lanned elective operation for benign or malignant gastrointestinal illness were randomized into two groups: group 1) oral supplementation for five days before and five days after surgery with 900 mL/day of aformula enriched with arginine, gamma-3-fatty acid and rna +liquid diet ad libitum on one and two postoperative day and then solid food (immunonutrition group; n=50) or group 2) no artificial nutrition before and after surgery,onone and two postoperativeday intravenous solution of 5% glucoseand electrolytes and then normal diet (conventional group; n=50).Results: the groups were comparable for all key baseline and surgical characteristics. there were nine (18%) infectious complications in both groups. overall complication rates were 28% (n =14) in the immunonutrition group and 24% (n =12) in the conventional group. No significant difference between the groups was found in complication rates, mortality or length of hospital stay.Conclusion: routine perioperative immunonutrition to the patients undergoing major gastrointestinal surgery is not beneficial.

Immunonutrition in Patients Undergoing Major Upper Gastrointestinal Surgery: A Prospective Double-Blind Randomised Controlled Study

“…These findings have been confirmed in patient undergoing oesophagectomy (12) for oesophageal cancer, however other reports suggest peri-operative immunonutrition for patients undergoing major gastrointestinal surgery not to be beneficial (13) in terms of complication rates or length of hospital stay. These clinical trials tended to be on heterogeneous patient groups and involved different combinations of feed.…”

Pre-operative nutrition and carbohydrate loading

“…A further trial using the same supplement for 5 d pre-and post-operatively found no significant differences in infectious complications, mortality or length of stay when compared with a group receiving no nutrition support (20) .…”

Efeito da suplementação dietética de arginina na cicatrização das anastomoses colônicas em ratos

“…O conceito implica em indicar-se adequadamente cada imunonutriente, tais como glutamina, selênio, óleo de peixe (ácidos graxos -3) e arginina, a cada situação clínica, entre elas desnutrição, queimaduras, trauma, pacientes em estado crítico ou em síndrome de estresse respiratório agudo. Basearam sua argumentação no fato que os diversos estudos apresentados até o momento incorrem em erros metodológicos diversos, como seleção inadequada da amostra para estudo, uso de produtos para o estudo que associam diversos imunonutrientes 2,4,13,17,28,35,38,43 . Nesta linha de raciocínio, alguns autores estão buscando limitar o foco da amostra.…”