A 62-year-old woman undergoes a pancreaticoduodenectomy for a pancreatic head cancer. A jejunostomy is placed to facilitate nutritional repletion as she is expected to have a prolonged recovery. What is the best method for delivering postoperative nutrition?
Early enteral nutrition is recommended in patients predicted to have a prolonged recovery after surgery. The misconception that the entire bowel does not function in the early postoperative period is still widely held. Intestinal motility and absorption studies have clarified the patterns by which bowel activity resumes. The stomach remains uncoordinated in its muscular activity and does not empty efficiently for about 24 hours after abdominal procedures. The small bowel functions normally within hours of surgery and is able to accept nutrients promptly, either by nasoduodenal or percutaneous jejunal feeding catheters or, after 24 hours, by gastric emptying. The colon is stimulated in large measure by the gastrocolic reflex but ordinarily is relatively inactive for 3 to 4 days. Well-nourished patients who undergo uncomplicated surgical procedures can tolerate up to 10 days without full nutritional suppo before significant problems with protein breakdown begin to occur. Enteral nutrition is preferred over parenteral nutrition because of decreased risks of nosocomial infections and catheter-related complications and increased benefit in preventing mucosal atrophy
Institution of enteral feeding the jejunostomy tube after return of bowel function as evidenced by passage of flatus or a bowel movemen
Institution of enteral feeding the jejunostomy tube within 24 hours postoperatively
Institution of supplemental enteral feeding the jejunostomy tube only if oral intake is inadequate after return of bowel function
Institution of a combination of immediate trophic (15 mL/h) enteral feeds the jejunostomy tube and parenteral nutrition to provide total nutritional suppo
Preoperative assessment and monitoring in anaesthesia