Enteral Nutritional Support for Major Surgery of the Digestive Organs

Narihide Goseki, Yuzuru Hara, Togo Aoi, Takeshi Nagahama, Yasuyuki Dobashi, Tokichi Gen, Tohru Kawamura, Hiroshi Nakamura, Tohru Takiguchi, Mitsuo Endo

The First Department of Surgery, Tokyo Medical and Dental University School of Medicine

For the postoperative nutritional management, enteral nutrition (EN) was performed for 13 patients who received hepatectomy (segmentectomy or lobectomy), 9 with esophageal varices who received Hassab's operation with or without esophageal transsection under laparotomy, 12 who received pancreato-duodenectomy and 24 with esophageal cancer who received subtotal esophagectomy under thoracolaparotomy. Constant and continuous infusion of enteral nutrient was performed at20 kcal/20 ml/hr (480 kcal/day) from the third day after the operation via the enteral feeding tube, then the dose was increased by 20 kcal/20 ml/hr daily, and from the fifth post-operative day, 80 kcal/80 ml/hr (1920 kcal/day) was given. For the pancreato-duodenectomy patients, EN was applied in combination with intravenous hyperalimentation (IVH), and to the other patients without IVH. All patients were examined for changes in various nutritional parameters. Branched-chain amino acids (BCAA)-enriched enteral nutrient (BCAA-EN) containing 32.6% BCAA was administered to 6 patients with esophageal carcinoma to determine the nutritional effects. In every patient, nitrogen balance became positive within a week, and an inverse correlation with 3-methylhistidine urinary excretion was observed. Rapid turn-over proteins such as retinolbinding protein, prealbumin and transferrin recovered rapidly except for liver cirrhosis cases, which showed a slight delay. BCAA-EN was suggested to be effective clinically in esophageal cancer patients who received subtotal esophagectomy under thoraco-laparotomy.

Key words
enteral nutrition, postoperative nutritional support, branched chain amino acids enriched enteral nutrient

Reprint requests
Narihide Goseki The First Department of Surgery, Tokyo Medical and Dental University School of Medicine
1-5-45 Yushima, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
December 9, 1992

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