Systematic review of five feeding routes after pancreatoduodenectomy

Gerritsen, Arja; Besselink, Marc G.; Gouma, Dirk J.; Steenhagen, Elles; Rinkes, Inne H.M. Borel; Molenaar, I. Quintus

doi:10.1002/bjs.9049

Cited by 98 publications

(58 citation statements)

References 40 publications

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“…[80][81][82] . The oral route should be the first option for early feedback, even after large procedures 83 . The current trend in the postoperative period is to avoid prolonged fasting and to abandon the classic oral diet from liquid to pasty and finally solid and to allow an oral precocious diet at will 81,84 .…”

Section: Methodsmentioning

confidence: 99%

ACERTO guidelines of perioperative nutritional interventions in elective general surgery

De-Aguilar-Nascimento

Salomão

Waitzberg

et al. 2017

Rev. Col. Bras. Cir.

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Objective: to present recommendations based on the ACERTO Project (Acceleration of Total Post-Operative Recovery) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures. Methods: review of relevant literature from 2006 to 2016, based on a search conducted in the main databases, with the purpose of answering guiding questions previously formulated by specialists, within each theme of this guideline. We preferably used randomized controlled trials, systematic reviews and meta-analyzes but also selected some cohort studies. We contextualized each recommendation-guiding question to determine the quality of the evidence and the strength of this recommendation (GRADE). This material was sent to authors using an open online questionnaire. After receiving the answers, we formalized the consensus for each recommendation of this guideline. Results: the level of evidence and the degree of recommendation for each item is presented in text form, followed by a summary of the evidence found. Conclusion: this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons, the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery. The prescription of these recommendations can accelerate the postoperative recovery of patients submitted to elective general surgery, with decrease in morbidity, length of stay and rehospitalization, and consequently, of costs.

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Section: Methodsmentioning

confidence: 99%

ACERTO guidelines of perioperative nutritional interventions in elective general surgery

De-Aguilar-Nascimento

Salomão

Waitzberg

et al. 2017

Rev. Col. Bras. Cir.

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show abstract

“…This was a multidisciplinary procedure, undertaken by the physician assistants, senior nurses, 'key' nurses and medical staff. [20][21][22][23][24][25][26][27] Instead of a traditional 'day-to-day-care' plan for the surgical ward, an 'hour-to-hour' care plan had to be developed, including the PACU and ICU care. It was important to identify potential barriers and facilitators in these settings, in order to tailor the implementation strategy.…”

Section: Development Of the Cpmentioning

confidence: 99%

“…Our protocol prescribes that if the gastric tube can be removed, the patients need to start with oral/enteral feeding, and TPN needs to stop as soon as the oral intake of the patients is above 1000 kcal. 22,23,[35][36][37] TPN should be started on day 3 if patients had a MUST score of 1 and enteral feeding had not been started on day 3. All patients with a gastroparesis without signs of sepsis or ileus on day 7 will be given a naso-jejunal tube by the gastroenterologist through the gastrojejunostomy and start enteral feeding.…”

Section: Development Of the Cpmentioning

confidence: 99%

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Kolk

Boogaard

Becking-Verhaar

et al. 2017

Journal of Gastrointestinal Surgery

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Introduction Medical and nursing protocols in perioperative care for pancreaticoduodenectomy are mainly mono-disciplinary, limiting their integration and transparency in a continuous health care system. The aims of this study were to evaluate adherence to a multidisciplinary clinical pathway for all pancreaticoduodenectomy patients during their entire hospital stay and to determine if the use of this clinical pathway is associated with beneficial effects on clinical end points. Materials and Methods A prospective cohort study was conducted in 95 pancreaticoduodenectomy patients treated according to a clinical pathway, including a variance report, compared to a historical control group (n = 52) with a traditional treatment regime. Results Process evaluation of the clinical pathway group revealed that protocol adherence throughout all units was above 80%. Major complications according to Clavien-Dindo classification grade ≥3 decreased from 27 to 13%; p = 0.02. Hospital length of stay was significantly shorter in the clinical pathway group, median 10 days ], compared with the control group, median 13 days ; p = 0.02. Conclusion The use of a clinical pathway in pancreaticoduodenectomy patients was associated with high protocol adherence, improved outcome and shorter hospital length of stay. Variance report analysis and protocol adherence with a Prepare-ActReflect Cycle are essential in surveillance of outcome.

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“…Since the oral route was not inferior to, and in some cases resulted in better outcomes, than the enteral or parenteral route, oral feeding should be considered as the preferred route after PD. 14 …”

Section: Small Bowel Necrosismentioning

confidence: 99%

Pancreas cancer with Whipple’s operation

Blaauw

2015

South African Journal of Clinical Nutrition

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Systematic review of five feeding routes after pancreatoduodenectomy

Abstract: There is no evidence to support routine enteral or parenteral feeding after PD. An oral diet may be considered as the preferred routine feeding strategy after PD.

Cited by 98 publications

References 40 publications

ACERTO guidelines of perioperative nutritional interventions in elective general surgery

ACERTO guidelines of perioperative nutritional interventions in elective general surgery

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Pancreas cancer with Whipple’s operation

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