Toshiaki Shichinohe1, Takeshi Sasaki2,3, Shuji Kitashiro2, Takayuki Morita4, Koichi Ono5, Naoto Senmaru6, Junichi Ikeda7, Tetsufumi Kojima8, Noriaki Kyogoku9, Hidehisa Yamada10, Nagato Sato11, Kentaro Kato12,4, Soichi Murakami12, Yuma Ebihara12,2, Yo Kurashima12, Eiji Tamoto12,8, Takehiro Noji12,5, Toru Nakamura12, Keisuke Okamura12,4, Takahiro Tsuchikawa12, Satoshi Hirano12. 1. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan. shichino@med.hokudai.ac.jp. 2. Department of Surgery, Sapporo Tonan Hospital KKR Medical Center, North-1, West-6, Chuou-ku, Sapporo, Hokkaido, Japan. 3. Department of Surgery, Japanese Red Cross Asahikawa Hospital, 1-1 Akebono, Asahikawa, Hokkaido, Japan. 4. Department of Surgery, Hokkaido Gastroenterology Hospital, Honcho 1-1, Higashi-ku, Sapporo, Hokkaido, Japan. 5. Department of Surgery, Obihiro-Kosei General Hospital, West-6, South-8, Obihiro, Hokkaido, Japan. 6. Department of Surgery, Steel Memorial Muroran Hospital, 1-45 Chiribetsu-cho, Muroran, Hokkaido, Japan. 7. Department of Surgery, Japanese Red Cross Kitami Hospital, North-6, East-2, Kitami, Hokkaido, Japan. 8. Department of Surgery, Hakodate Central General Hospital, 33-2, Honcho, Hakodate, Hokkaido, Japan. 9. Department of Surgery, Oji General Hospital, 3-4-8, Wakakusa-cho, Tomakomai, Hokkaido, Japan. 10. Department of Surgery, NTT East Sapporo Hospital, South-1, West-15, Chuou-ku, Sapporo, Hokkaido, Japan. 11. Department of Surgery, Kushiro City General Hospital, 1-12 Shunkodai, Kushiro, Hokkaido, Japan. 12. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
Abstract
PURPOSE: An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy. METHODS: Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever". RESULTS:A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group. CONCLUSIONS: The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake.
RCT Entities:
PURPOSE: An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy. METHODS:Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever". RESULTS: A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group. CONCLUSIONS: The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake.
Entities:
Keywords:
Elemental diet; Estimated minimum length of stay in hospital after surgery; Laparoscopic colectomy
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