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Abstract
Surgical nutrition is very important aspect in surgical field which can enhance the outcome of surgical procedures and specific surgical conditions.
Nutrition assessment must combine clinical evaluation with objective measurements of those body compartments the integrity of which is particularly relevant to clinical outcome. Sophisticated research techniques for body composition analysis are not available in the majority of institutions and a continued effort is still required to develop methods to quantify the different body compartments at the bedside. There is also a definite need for new functional parameters related to organs whose function is altered by food deprivation. Meanwhile, most nutritional assessment protocols will continue to implement simple measurements which, if correctly interpreted,may be very useful in guiding the indications and monitoring the efficacy of nutritional support.
Appropriate feeding of the surgical patient begins with accurate assessment of the patient’s nutritional requirements. Unfortunately, this is not a simple task .however, The Harris-Benedict equation is perhaps the most commonly used method of estimating a patient’s metabolic energy requirements. It calculates the estimated basal energy expenditure (BEE) in kcal/day.
When nutrition support is decided, techniques of support include entral (by mouth, transnasal, and tube enterostomy) and parentral (central, peripheral) routes. It depends on type of patient, indication for Nutrition support.
Although long the subject of debate and controversy, significant data now exists to support the use of enteral nutrition over total parenteral nutrition (TPN) in the care of the critically ill surgical patient. Every attempt should be made to feed patients enterally if the gastrointestinal tract is functional. However TPN is used when the intestines are obstructed, when the small intestine is not absorbing nutrients properly, or the bowels need to rest as in gastrointestinal fistula (abnormal connection).
Acute pancreatitis, short bowel syndrome, and enterocutaneous fistulas, are important diseases in which Nutrition support plays major role in determining the outcome of these cases.
Well-nourished patients with mild pancreatitis rarely require nutrition support. Routine use of PN is unnecessary, and may have a “net” negative effect in mild pancreatitis. The current studies of gastric feedings in pancreatitis have methodological limitations and raise concerns about the relatively high mortality rates of patients with severe pancreatitis fed into the stomach. There is insufficient data to conclude that gastric feeding is safe or effective in severe acute pancreatitis. In patients with severe pancreatitis, and those with existing malnutrition that require nutrition support, the weight of current evidence supports jejunal enteral nutrition as the preferred route of nutrition support.
The nutritional management of short bowel syndrome presents numerous challenges for physicians and other health care professionals. Nutrition support supplies bowel rest. In case of infants and children with short bowel syndrome however, with aggressive and timely medical nutrition therapy, most infants and children do well.
In intestinal fistulas, with promote nutrition support, Spontaneous closure is to be expected in the vast majority of low output EF. High output fistulas carry a worse prognosis and frequently require surgery for treating intrabdominal infection or closing the fistula.
In morbid obesity, unlike other weight-loss programs, the surgery process allows patients to experience greater self-control. An experienced dietitian can assist patients in establishing action plans of behavioral goals to achieve before surgery in preparation for the postoperative lifestyle. Full mastery of the new habit repertoire on the part of postoperative patients produces the best long-term results.
Finally, surgical nutrition, TPN and the surgical patient summarize the basic nutritional knowledge that should be an integral part of the educational background of all junior and senior surgeons involved in the management of complex diseases.