Elsevier

Nutrition

Volume 17, Issue 2, February 2001, Pages 91-94
Nutrition

Applied nutritional investigation
Jejunal feeding, even when instituted late, improves outcomes in patients with severe pancreatitis and peritonitis

https://doi.org/10.1016/S0899-9007(00)00508-6Get rights and content

Abstract

This study assessed the feasibility and effectiveness of jejunal feeding (JF) after surgery due to secondary peritonitis or failed conservative therapy of severe pancreatitis. Of 60 patients, 30 were randomly assigned to receive postoperative JF and the remaining 30 constituted the control group. Acute Physiology and Chronic Health Evaluation II, nutritional intake, systemic inflammatory response syndrome, and outcomes were measured. Patients in JF group received the daily mean of 1294.6 (362.6) kcal including 830.6 (372.7.0) kcal enterally, versus 472.8 (155.8) kcal daily in the control group (P < 0.0001). There were fewer complications in the JF patients, with no significant difference; length of stay in the intensive care unit and in the hospital did not differ. The frequency of systemic inflammatory response syndrome was similar in both groups, but outcomes differed. The first surgical intervention resulted in 3.3% of relaparotomies in JF patients, caused by unresolved peritonitis, versus 26.7% in the control subjects (P = 0.03). Recovery of bowel transit took significantly less time in the JF patients (mean: 54.6 h versus 76.8 h in control subjects, P = 0.01). JF resulted in 3.3% mortality as opposed to 23.3% in the control group (P = 0.05). In conclusion, JF is feasible and effective in postoperative treatment of patients due to secondary peritonitis or severe pancreatitis. Improved bowel and peritoneal function could be the main impact of JF.

Introduction

Enteral nutrition has been referred to as the most physiologic type of nutritional support in the critically ill.1 Early enteral nutrition has been described as a rational and acceptable option of supporting critically ill patients after major abdominal surgery and in patients with acute pancreatitis.2, 3, 4, 5 However, a discrepancy still exists between the number of patients in the intensive care unit (ICU) who could benefit from enteral nutrition and those who actually receive this treatment modality.6 Gut dysfunction is often claimed to be the main reason interfering with the prescribed or calculated goal of enteral feeding.7 In contrast, other reports have indicated that early enteral nutrition helps to maintain intestinal integrity and can also prevent or shorten the presence of postoperative ileus.8 The advantage of early enteral nutrition is most probably the immunomodulatory effect, which is achieved through the attenuation of the acute-phase response.2 Whether early postoperative enteral nutrition is a rational treatment modality in patients after surgery due to secondary peritonitis or severe pancreatitis is still under debate. The aim of this study was to assess the feasibility and effectiveness of jejunal feeding (JF) in patients after surgery due to secondary peritonitis or failed conservative therapy of severe pancreatitis (SP) in the early phase of the disease.

Section snippets

Methods

A prospective randomized study was carried out among patients with secondary peritonitis or SP who underwent surgery between January 1997 and April 1999 in the Riga 7th Clinical Hospital. Sixty patients were included in the study: 30 were selected for postoperative JF (group A) and the remaining 30 constituted the control group (group B). The severity of pancreatitis was defined according to the Atlanta classification system for acute pancreatitis,9 including systemic physiologic derangement

Results

All SP patients underwent laparotomy in the acute phase of the disease due to the deterioration of the clinical course or obscure diagnose before the phase of sequestration.

The mean age of patients was 50.2 y (15 to 78 y) in group A and 52.7 y (22 to 76 y) in group B. There were 24 men and 6 women in group A and 21 men and 9 women in group B. Group A consisted of 21 patients operated on because of progressive SP (complicated by peritonitis in 12 cases); 17 patients with SP underwent surgery

Discussion

Catabolic state and protein-calorie malnutrition can lead to malfunction of all organ systems including the immune, respiratory, and gastrointestinal systems, thus worsening surgical outcomes after major gastrointestinal surgery and prolonging length of hospital stay.1, 8, 13, 14 Malnourished patients are often unrecognized15, 16; however, total parenteral nutrition is used mainly during the postoperative period, especially in patients with abdominal emergencies despite the septic,

Summary

JF is a feasible and effective postoperative treatment of patients after surgery due to secondary peritonitis or SP. Improved bowel and peritoneal function could be the main impact of JF. Further study is necessary for a better understanding of the gut feeding effect in this category of patients.

Acknowledgements

The authors acknowledge the help and cooperation of. V. Cera, MD (Chief of Toxicology, ICU), and A. Apsitis, MD (Chief of ICU); Amaija, Ltd., the manufacturer of Nutricia products in Latvia, for supplying the feeding formula; and U. Berkis, MScMath, for assistance in the statistical analysis.

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