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HOSPITAL 103
DEPARTMENT OF ABDOMINAL SURGERY
EFFECTS OF EARLY ENTERAL FEEDING EFFECTS OF EARLY ENTERAL FEEDING
AFTER LAPAROSCOPIC DISTAL AFTER LAPAROSCOPIC DISTAL
GASTRECTOMY FOR GASTRIC CANCER GASTRECTOMY FOR GASTRIC CANCER
AT HOSPITAL 103AT HOSPITAL 103
Da Nang 2015Da Nang 2015
Tran Tuan Anh, Ho Chi Thanh
Nourishing plays an important role in treatment
Nourishing plays an important role in Surgery
BACKGROUND
The patient does not eat by mouth after surgery until flatus.
Intravenous feeding
• Costly
• Patients are hungry
• Undernourished
• Lack of water and electrolytes
so we conducted this researchso we conducted this research
BACKGROUND
TARGETS OF THE STUDY
Assess the safety and feasibility of early enteral feeding
after laparoscopic distal gastrectomy.
Assess the effects of early enteral feeding after
laparoscopic distal gastrectomy.
Materials and methodMaterials and method
* Materials:
- 90 patients, who underwent laparoscopic90 patients, who underwent laparoscopic distal distal
gastrectomy with D2 lymphadenectomy.gastrectomy with D2 lymphadenectomy.
- From 1/2010 to 6/2013.- From 1/2010 to 6/2013.
* Patients were divided into 2 groups: Patients were divided into 2 groups:
- - 45 patients with early enteral feedings through the 45 patients with early enteral feedings through the
naso-gastric tube naso-gastric tube
- 45 patients intravenous feeding. - 45 patients intravenous feeding.
* Method: Method: Controlled treatment and intervention.Controlled treatment and intervention.
Materials and methodMaterials and method
Criteria to choose the patients: - Patients who underwent laparoscopic distal
gastrectomy with D2 lymphadenectomy.- Patients must awake, completely spontaneously
breathe. - Sonde was placed through from nose to the
gastrointestinal anastomosis Exclusion criteria:-Patients didn’t underwent LADG, or LATG, or LADG combining with other organs.- After the operation, patients didn’t awake, breathe with machines.-Sonde was not through gastrointestinal anastomosis.
In the operating, sonde was placed through from nose to the gastrointestinal anastomosis
Materials and method
automatic pumpKANGAROO 924KANGAROO 924
Milk Ensure GoldMilk Ensure Gold
Materials and method
Intravenous feeding Intravenous feeding
Materials and method
Early feeding Early feeding
Materials and methodMaterials and method
Patient characteristics:- Age, gender and BMI.- Blood tests: Red blood cells, hemoglobin, protein- Abdominal condition before flatus.- Flatus time (hour).- Postoperative day. Complications:- Bleed.- Incision infection, pneumonia, residue abscess- Anastomotic leak, duodenum stump leak.
Mixing milk Ensure Gold.Mixing milk Ensure Gold.
- 53.5 g milk + 195 ml water = 200 ml milk.
Dosage and use.Dosage and use.
- First day : 20 ml/ hour = 400 ml/ day.
- Second day: 25 ml/ hour = 600 ml/ day.
Materials and method
Table 1: Characters of the patient before operation.
Results and discussionResults and discussion
CriteriaIntravenous feeding
(n = 45)Early Feeding
(n = 45)p
Age 55.86 ± 11.90 57.26 ± 11.42 p > 0.05
Gender (Man/Fel) 26/19 30/15 p> 0.05
BMI 20.22 ± 1.99 19.96 ± 1.95 p > 0.05
Blood test
Blood red (T/L) 4.30 ± 0.621 4.33 ± 0.58 p > 0.05
Hemoglobin (g/l) 122.33 ± 23.41 125.97 ± 9.56 p > 0.05
Protein (g/L) 71.60 ± 5.54 72.04 ± 7.00 p > 0.05
Table 2: Postoperative condition.
CriteriaIntravenous feeding
(n = 45)Early Feeding
(n = 45)p
Abdominal condition
Soft 34 (75.5%) 39 (86.6%) p > 0.05
Slightly bloating 8 (17.7%) 5 (11.1%) p > 0.05
Serious bloating 3 (6.67%) 1 (2.22%) p > 0.05
Vomit condition
Nausea 9 (20%) 6 (13.33%) p > 0.05
Vomit 0 0 p > 0.05
Results and discussionResults and discussion
Table 3: Complications
Results and discussionResults and discussion
CriteriaIntravenous feeding
(n = 45)Early Feeding
(n = 45)p
Anastomotic leakage
0 0
Duodenal stump leakage
0 0
Wound infection 0 1 (2.22%)Intra abdominal
abscess1 (2.22%) 0
Pneumonia 1 (2.22%) 0Total 2 (4.44%) 1(2.22%) p > 0.05
CriteriaIntravenous feeding
(n = 45)Early Feeding
(n = 45)p
Flatus (hour) 49.6 ± 7.9 49.1 ± 9.7 p > 0.05
Small meal (day)
3.2 ± 0.4 3.1 ± 0.4 p > 0.05
Postoperative day (day)
7.4 ±1.7 6.9 ± 1.6 p= 0.034
The differences of 2 groups have the significance with p=0.034Hur [7]: postoperative day: 8.03 and 9.97 day; p < 0.001Lee [9]: postoperative day: 9 and 12 day, p = 0.012
Results and discussionResults and discussion
Table 4: Postoperative recovery
Day of feedingQuantity (ml) Number of
patients Total (ml)
Day 1 400 42 16,800
Day 2 600 41 24,600
Day 3 600 2 1,200
Day 4 600 1 600
Total 43,200
Average of one patient was1,028.57 ml (1,028.57 Kcal)
The rate of early feeding was 93.3%Jo (2011) was 89%, Braga (2002) was 91%, Hur (2009) 92%
Results and discussionResults and discussion
Table 5: Results of early enteral feeding by sonde
Economic benefit in early enteral feeding by sonde
955 Kcal42.86 USD
15.048 USD 1,777 Kcal
1,028 Kcal by intravenous feeding = 46.095 USD
1,028 Kcal by early enteral feeding = 8.675 USD
1 patient safe was 37.43 USDTotal 42 patients safe was 1,571.98USD
1. Early enteral feeding by sonde after laparoscopic distal gastrectomy is safe, feasible and can be done.
2. Early enteral feeding helps patients to quickly recover and reduce treatment time.
ConclusionConclusion
1. Should be early fed in order to reduce postoperative malnutrition in general nourishing 1. Should be early fed in order to reduce postoperative malnutrition in general nourishing postoperative patients and gastrointestinal tract in particularpostoperative patients and gastrointestinal tract in particular..
2. There needs to expand research on early feeding in other gastrointestinal surgery to more There needs to expand research on early feeding in other gastrointestinal surgery to more exactly assess the effect of early enteral feeding.exactly assess the effect of early enteral feeding.
SuggestionsSuggestions
Thank you!Thank you!