Postoperative enteral nutrition

Enteralna prehrana predstavlja unos hrane i/ili komercijalnih nutritivnih otopina putem hranidbenih sondi u želudac, dvanaesnik ili jejunum. Danas se sve više naglašava njena važnost za što bolji i brži oporavak pacijenata nakon operacije. Stara je dogma da pacijenti poslije operacija probavnog sustava ne smiju primati ništa na usta jer se tako poboljšava cijeljenje anastomoze i da probavni trakt nije u funkciji do pojave prvih zvukova peristaltike. Suprotno tome, dokazano je da je postoperativna primjena enteralne prehrane u prva 24 sata od operacije sigurna i čak pozitivno utječe na cijeljenje anastomoze, a funkcija gastrointestinalnog trakta vraća se ubrzo nakon operacije čak i u odsutnosti peristaltike. Također, enteralna prehrana sprječava translokaciju bakterija. U početku ovog rada upoznajemo se s terminom enteralne prehrane, njenim počecima, načinima primjene i vrstama pripravaka. Nadalje objašnjavamo važnost enteralnog puta primjene i koje su prednosti u odnosu na parenteralni put. Govorimo i o indikacijama, kontraindikacijama, kao i komplikacijama primjene enteralne prehrane. U idućim odlomcima navodimo važnost procjene stanja uhranjenosti kirurških pacijenata, kako pothranjenost može biti povezana s lošijim postoperativnim ishodima i koje su metode procjene nutritivnog statusa. Također govorimo o odgovoru tijela na kiruršku traumu koji može štetno utjecati na ishod. Svi ti negativni aspekti mogu se korigirati i ublažiti primjenom enteralne prehrane. Razvitak enteralne prehrane napreduje i u primjeni se javljaju pripravci pojačani imunonutrijentima koji dodatno moduliraju imunološki i metabolički odgovor koji se javlja uslijed stresa povezanog uz kiruršku traumu. Stoga nudimo pregled djelovanja glavnih imunonutrijenata i njihove primjene u kliničkoj praksi. Pri kraju rada sažimamo trenutne smjernice o enteralnoj prehrani i podatke iz literature koji govore o njenoj primjeni u kirurgiji probavnog sustava: resekcijama jednjaka, gastrektomijama, kirurgiji pankreasa, zatim kirurgiji donjeg dijela probavnog sustava te primjeni nakon transplantacije jetre. Zaključno, nema sumnje u sigurnost primjene postoperativne enteralne prehrane. Štoviše, njena se primjena pokazala korisnom u usporedbi s parenteralnom ili nikakvom nutritivnom potporom. Smanjuje stopu postoperativnih komplikacija, ponajprije infektivnih, skraćuje boravak u bolnici i naposljetku, smanjuje troškove liječenja.The enteral nutrition involves food intake or commercial nutritional solutions intake via feeding tubes into stomach, duodenum or jejunum. Today, there is an emphasis on the importance of enteral nutrition for the patient's optimal recovery after surgery. The old dogma says that patients should not receive anything by mouth after gastrointestinal surgery because it improves anastomosis healing. It also says that gastrointestinal tract does not return its function until the bowel sounds are positive. Unlike this, it has been proven that the use of enteral nutrition in the first 24 hours after surgery is safe and even has positive effects on anastomosis healing, and gastrointestinal tract function returns soon after surgery, even in the absence of peristalsis. Enteral nutrition prevents bacteria translocation as well. In the beginning of the thesis the term of enteral nutrition is introduced, its beginnings, the ways of administration and types of formulas. Next, the importance of the enteral route of administration and its advantages comparing to parenteral nutrition are explained. Also, indications, contraindications, as well as complications of the use of enteral nutrition are discussed. In the next two chapters the importance of nutritional assessment of surgical patients is suggested. The association of malnutrition and adverse postoperative outcomes is explained and the methods of nutritional risk assessment are mentioned. Then, the body response to surgical trauma which may adversely affect the outcome is dealt with. All those negative aspects may be corrected or mitigated with the use of enteral nutrition. The development of enteral nutrition has been improved and nowadays there is the use of immunoenhanced formulas which additionally modulate immune and metabolic stress response related to surgical trauma. Therefore, we offer the review of the main immunonutrients activity and its use in clinical practice. In the end of the thesis current guidelines on enteral nutrition and information from the literature which refer to its use in the gastrointestinal surgery are summarized: esophagus resections, gastrectomies, pancreas surgery, lower gastrointestinal tract surgery and the use after liver transplantation. In the conclusion, the safety of the use of postoperative enteral nutrition is indisputable. Moreover, it has shown the benefits compared to parenteral nutrition or conditions without nutritional support. It decreases the postoperative complications rate, primarily the infectious ones, it reduces the length of hospital stay and, ultimately, it reduces the treatment costs