Perioperative Nutrition for Surgical

Patient Post Laparotomy

Aida Yulia Amany 1

 Case

A male 48 y.o came to the ER with abdominal pain,

bloating, distended stomach, flatulence (-) Peristaltic
sound decrease, peritoneal sign (+).
Past History : recurrent abdominal pain in epigastric
region.
Laparatomy was conducted towards this patient on
the next day and gaster perforation was found as the
cause of peritonitis in this patient

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 Nutrition and Surgery

Malnutrition may compound the severity of

complications related to a surgical procedure
A well-nourished patient usually tolerates major
surgery better than a severely malnourished
patient
Malnutrition is associated with a high incidence of
operative complications and death.

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 Goals of Perioperative Nutrition
Support

Surgical mortality
Surgical complications and infection
Catabolic state and restore anabolism
Support the depleted patient throughout the
catabolic phase of recovery
Hospital LOS
Speed the healing/recovery process
Ensure the prompt return of GI function to
resume standard oral intake as soon as possible

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*ESPEN : European Society for Parenteral & Enteral Nutrition
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ERAS = Enhanced Recovery After Surgery
 Traditional vs Current Guidelines
of ERAS*
Curtailed fasting and preoperative carbohydrate
loading, fasting for a minimum of 8 hours before a
general anaesthetic

Recommendation: Patients should be fasted for 6

hours to solids but they should be allowed small
amounts of clear free fluids for up to 2 hours before
induction of general anaesthesia.

*ERAS = Enhanced Recovery After Surgery

 Traditional vs Current
Guidelines of ERAS*

Oral feeding delayed for 24-48 hours after surgery /

wait for return of bowel sounds or passage flatus

Recommendation: Patients should be allowed oral

fluids as tolerated on the day of the surgery and
built up to an oral diet over the next 24 hours. In
addition, a clear carbohydrate rich drink should be
administered orally the night before surgery and 3
hours prior to induction of anaesthesia.

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*ERAS = Enhanced Recovery After Surgery
 Traditional vs Current
Guidelines of ERAS*
routine infusion of large volumes of crystalloid
is indicated because patient was hypovolaemic
due to prolonged fasting (nil by mouth after
midnight).

Recommendation: The management of fluid therapy

uses an algorithm to maximize cardiovascular
contractility using bolus of colloid as the
intervention with the help of Oesophegeal Dopler
Ultrasound

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*ERAS = Enhanced Recovery After Surgery
 Modes of Nutritions
Administration

Enteral

Parenteral

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Modes of Nutritions Administration

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 Modes of Nutritions Administration
Enteral nutrition
Oral supplements
N/G tube feeding
Gastrostomy tube feeding
Per-cutaneous
Open surgical
Jejunostomy tube feeding
Laparoscopy/open surgery

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 Modes of Nutritions Administration

Parenteral nutrition
Defined as nutrients provided
intravenously.
Component s of PN mixtures :
Protein (amino acids)
Carboydrates (dextrose) ,
Fats (Long-chain fatty acids),
Sterile water, electrolytes,
vitamins

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 Indications for Parenteral Nutrition
Support
Malnourished patient expected to be unable to eat
> 5-7 days AND enteral nutrition is
contraindicated
Enteral nutrition is contraindicated or severe GI
dysfunction is present
Paralytic ileus, mesenteric ischemia, small
bowel obstruction, enteric fistula distal to
enteral access sites

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Dangers of Over and Under Feeding

Risks associated with over-feeding:

Hyperglycemia
Hepatic dysfunction from fatty infiltration
Respiratory acidosis from increased CO2
production
Refeeding syndrome

Risks associated with under-feeding:

Decreased respiratory muscle function
Impaired immune function
Increased infection
Weight loss and malnutrition
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Refeeding Syndrome

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 References

Jacob Danny. 2006. First Exposure General Surgery. Lange.

De Jong. 2005. Buku ajar Ilmu Bedah. ECG
H Michael. 2009. Guidelines For Implementation Of
Enhanced Recovery Protocols. Association of Surgeons of
Great Britain and Ireland.
Ward Nicola. 2004. Nutrition support to patients undergoing
gastrointestinal surgery. Nutrition Journal. Accessed from
http://www.nutritionj.com/content/2/1/18
M Doherty. 2012. Intraoperative fluids: how much is too
much?. British Journal of Anesthesia. Accessed from
http://bja.oxfordjournals.org/content/early/2012/05/31/bj
a.aes171.full

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Thank You..
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