Junya Fukuzawa1, Hideo Terashima, Nobuhiro Ohkohchi. 1. Department of Surgery, Advanced Biomedical Applications, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Abstract
BACKGROUND: The benefits of early postoperative oral feeding following colonic anastomosis have previously been demonstrated. However, early postoperative oral feeding in patients with upper gastrointestinal surgery has been avoided because of concerns regarding anastomotic leakage. We investigated whether early postoperative oral feeding was advantageous for upper gastrointestinal anastomosis in comparison to parenteral feeding with a fasting period. MATERIALS AND METHODS: Male Sprague-Dawley rats were subjected to the same surgical manipulation, i.e., venous catheterization, gastrostomy, and proximal jejunal anastomosis. Rats were divided into two groups: the enteral nutrition (EN) group, which received nutrients via gastrostomy as a substitute for oral feeding, and the total parental nutrition (TPN) group, which was fed via a venous catheter. Identical nutritional solutions were administered to the two groups immediately after surgery. The anastomotic bursting pressure (ABP) and the content of hydroxyproline in the anastomotic tissue were measured 5 days postoperatively. RESULTS: The ABP in the EN group was significantly higher than that in the TPN group (214.6 +/- 42 versus 149.5 +/- 49 mmHg; p < 0.01). The hydroxyproline content in the EN group was also significantly higher (63.5 +/- 10 versus 50.5 +/- 12 micromol/g dry tissue; p < 0.01). CONCLUSIONS: Early enteral feeding via gastrostomy accelerated jejunal anastomotic healing in comparison to parenteral feeding. This study clearly indicates that early oral feeding after upper gastrointestinal surgery leads to prompt anastomotic healing.
BACKGROUND: The benefits of early postoperative oral feeding following colonic anastomosis have previously been demonstrated. However, early postoperative oral feeding in patients with upper gastrointestinal surgery has been avoided because of concerns regarding anastomotic leakage. We investigated whether early postoperative oral feeding was advantageous for upper gastrointestinal anastomosis in comparison to parenteral feeding with a fasting period. MATERIALS AND METHODS: Male Sprague-Dawley rats were subjected to the same surgical manipulation, i.e., venous catheterization, gastrostomy, and proximal jejunal anastomosis. Rats were divided into two groups: the enteral nutrition (EN) group, which received nutrients via gastrostomy as a substitute for oral feeding, and the total parental nutrition (TPN) group, which was fed via a venous catheter. Identical nutritional solutions were administered to the two groups immediately after surgery. The anastomotic bursting pressure (ABP) and the content of hydroxyproline in the anastomotic tissue were measured 5 days postoperatively. RESULTS: The ABP in the EN group was significantly higher than that in the TPN group (214.6 +/- 42 versus 149.5 +/- 49 mmHg; p < 0.01). The hydroxyproline content in the EN group was also significantly higher (63.5 +/- 10 versus 50.5 +/- 12 micromol/g dry tissue; p < 0.01). CONCLUSIONS: Early enteral feeding via gastrostomy accelerated jejunal anastomotic healing in comparison to parenteral feeding. This study clearly indicates that early oral feeding after upper gastrointestinal surgery leads to prompt anastomotic healing.
Authors: James J Tomasek; Giulio Gabbiani; Boris Hinz; Christine Chaponnier; Robert A Brown Journal: Nat Rev Mol Cell Biol Date: 2002-05 Impact factor: 94.444
Authors: K G Kreymann; M M Berger; N E P Deutz; M Hiesmayr; P Jolliet; G Kazandjiev; G Nitenberg; G van den Berghe; J Wernerman; C Ebner; W Hartl; C Heymann; C Spies Journal: Clin Nutr Date: 2006-05-11 Impact factor: 7.324
Authors: Kenneth G Walker; Stephen W Bell; Matthew J F X Rickard; Daniel Mehanna; Owen F Dent; Pierre H Chapuis; E Leslie Bokey Journal: Ann Surg Date: 2004-08 Impact factor: 12.969
Authors: Jin Chen Hu; Li Xin Jiang; Li Cai; Hai Tao Zheng; San Yuan Hu; Hong Bing Chen; Guo Chang Wu; Yi Fei Zhang; Zhong Chuan Lv Journal: J Gastrointest Surg Date: 2012-08-02 Impact factor: 3.452
Authors: Georgia Herbert; Rachel Perry; Henning Keinke Andersen; Charlotte Atkinson; Christopher Penfold; Stephen J Lewis; Andrew R Ness; Steven Thomas Journal: Cochrane Database Syst Rev Date: 2019-07-22
Authors: Teus J Weijs; Grard A P Nieuwenhuijzen; Jelle P Ruurda; Ewout A Kouwenhoven; Camiel Rosman; Meindert Sosef; Richard V Hillegersberg; Misha D P Luyer Journal: BMJ Open Date: 2014-06-06 Impact factor: 2.692
Authors: Georgia Herbert; Rachel Perry; Henning Keinke Andersen; Charlotte Atkinson; Christopher Penfold; Stephen J Lewis; Andrew R Ness; Steven Thomas Journal: Cochrane Database Syst Rev Date: 2018-10-24