Nutritional depletion has been demonstrated to be a major determinant of the development of\r\npost-operative complications. Gastrointestinal surgery patients are at risk of nutritional depletion\r\nfrom inadequate nutritional intake, surgical stress and the subsequent increase in metabolic rate.\r\nFears of postoperative ileus and the integrity of the newly constructed anastomosis have led to\r\ntreatment typically entailing starvation with administration of intravenous fluids until the passage of\r\nflatus. However, it has since been shown that prompt postoperative enteral feeding is both effective\r\nand well tolerated. Enteral feeding is also associated with specific clinical benefits such as reduced\r\nincidence of postoperative infectious complications and an improved wound healing response.\r\nFurther research is required to determine whether enteral nutrition is also associated with\r\nmodulation of gut function.\r\nStudies have indicated that significant reductions in morbidity and mortality associated with\r\nperioperative Total Parenteral Nutrition (TPN) are limited to severely malnourished patients with\r\ngastrointestinal malignancy. Meta-analyses have shown that enteral nutrition is associated with\r\nfewer septic complications compared with parenteral feeding, reduced costs and a shorter hospital\r\nstay, so should be the preferred option whenever possible.\r\nEvidence to support pre-operative nutrition support is limited, but suggests that if malnourished\r\nindividuals are adequately fed for at least 7ââ?¬â??10 days preoperatively then surgical outcome can be\r\nimproved.\r\nOngoing research continues to explore the potential benefits of the action of glutamine on the gut\r\nand immune system for gastrointestinal surgery patients. To date it has been demonstrated that\r\nglutamine-enriched parenteral nutrition results in reduced length of stay and reduced costs in\r\nelective abdominal surgery patients. Further research is required to determine whether the routine\r\nsupplementation of glutamine is warranted.\r\nA limitation for targeted nutritional support is the lack of a standardised, validated definition of\r\nnutritional depletion. This would enable nutrition support to be more readily targeted to those\r\nsurgical patients most likely to derive significant clinical benefit in terms of improved post-operative\r\noutcome.
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