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5. ESPEN practical guideline: Clinical nutrition in surgery

Author

Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., Laviano, A., Ljungqvist, O., Lobo, D.N., Martindale, R.G., Waitzberg, D., Bischoff, S.C., and Singer, P.

Subjects
Bariatric surgery, ERAS, Nutritional therapy, Organ transplantation, Perioperative nutrition, Prehabilitation, Surgery
Abstract

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.

Published
2021

6. ESPEN guideline: Clinical nutrition in surgery

Author

Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., Laviano, A., Ljungqvist, O., Lobo, D.N., Martindale, R., Waitzberg, D.L., Bischoff, S.C., and Singer, P.

Subjects
Digestive System Surgical Procedures, Gastrointestinal Diseases/diet therapy, Gastrointestinal Diseases/surgery, Gastrointestinal Tract/surgery, Humans, Malnutrition/prevention & control, Meta-Analysis as Topic, Nutrition Policy, Nutritional Status, Nutritional Support, Observational Studies as Topic, Perioperative Care, Postoperative Complications/prevention & control, Randomized Controlled Trials as Topic, Risk Factors, ERAS, Enteral nutrition, Parenteral nutrition, Perioperative nutrition, Prehabilitation, Surgery
Abstract

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: • integration of nutrition into the overall management of the patient • avoidance of long periods of preoperative fasting • re-establishment of oral feeding as early as possible after surgery • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.

Published
2017

23. European Society of Coloproctology consensus on the surgical management of intestinal failure in adults.

Author

Vaizey, C. J., Maeda, Y., Barbosa, E., Bozzetti, F., Calvo, J., Irtun, Ø., Jeppesen, P. B., Klek, S., Panisic‐Sekeljic, M., Papaconstantinou, I., Pascher, A., Panis, Y., Wallace, W. D., Carlson, G., and Boermeester, M.

Subjects
COLON diseases, INTESTINAL diseases, SURGERY, PATIENT selection, RISK assessment, MANAGEMENT
Abstract

Intestinal failure ( IF) is a debilitating condition of inadequate nutrition due to an anatomical and/or physiological deficit of the intestine. Surgical management of patients with acute and chronic IF requires expertise to deal with technical challenges and make correct decisions. Dedicated IF units have expertise in patient selection, operative risk assessment and multidisciplinary support such as nutritional input and interventional radiology, which dramatically improve the morbidity and mortality of this complex condition and can beneficially affect the continuing dependence on parenteral nutritional support. Currently there is little guidance to bridge the gap between general surgeons and specialist IF surgeons. Fifteen European experts took part in a consensus process to develop guidance to support surgeons in the management of patients with IF. Based on a systematic literature review, statements were prepared for a modified Delphi process. The evidence for each statement was graded using Oxford Centre for Evidence-Based Medicine Levels of Evidence. The current paper contains the statements reflecting the position and practice of leading European experts in IF encompassing the general definition of IF surgery and organization of an IF unit, strategies to prevent IF, management of acute IF, management of wound, fistula and stoma, rehabilitation, intestinal and abdominal reconstruction, criteria for referral to a specialist unit and intestinal transplantation. [ABSTRACT FROM AUTHOR]

Published
2016
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25. MON-PP013: The Reimbursement Does not Imply the Use of Clinical Nutrition Results From an International, World-Wide Survey

Author

Klek, S., Abdulqudos Abosaleh, D., Amestoy, A., Baik, H.W., Baptista, G., Barazzoni, R., Chourdakis, M., Fukushima, R., Hartono, J., Jayawardena, R., Garcia, R.J., Krznaric, Z., Nyulasi, I., Parallada, G., Perez Francisco, L., Panisic-Sekeljic, M., Perman, M., Prins, A., Isabel Martinez del Rio Requejo, I.M., Reddy, R., Singer, P., Sioson, M., Ukleja, A., Vartanian, C., Velasco Fuentes, N., Linetzky Waitzberg, D., Zoungrana, S.L., and Galas, A.

Published
2015
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27. SUN-PP013: Reimbursement Affects Prescription of Enteral and Parenteral Nutrition? Results from European Multicenter Survey

Author

Klek, S., Chourdakis, M., Bischoff, S., Dubrov, S., Forbes, A., Galas, A., Genton, L., Gundogdu, H., Irtun, O., Jagmane, I., Jirka, A., Jakobson-Forbes, T., Kennedy, N., Klimasauskas, A., Khoroshilov, I., Leon-Sanz, M., Muscaritoli, M., Panisic-Sekeljic, M., Poulia, K.A., Schneider, S., Siljamäki-Ojansuu, U., Uyar, M., Wanten, G., and Krznaric, Z.

Published
2015
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39. Home enteral nutrition in children--2010 nationwide survey of the Polish Society for Clinical Nutrition of Children.

Author

Szlagatys-Sidorkiewicz A, Popinska K, Toporowska-Kowalska E, Borkowska A, Sibilska M, Gebora-Kowalska B, Klek S, Hapyn E, Kierkus J, Grzybowska-Chlebowczyk U, Wiecek S, Daukszewicz A, Jakubczyk M, Lembas-Sznabel M, Wilczynski M, Zagodon I, Matras P, Zmarzly A, Ksiyk J, and Szlagatys-Sidorkiewicz, Agnieszka

Abstract

Published epidemiologic data on the administration rates of enteral/parenteral home nutrition is very limited. The aim of this first nationwide study was to assess the availability of pediatric home enteral nutrition (HEN) services in Poland. The questionnaire was sent to all regional centers providing pediatric HEN services in Poland (n = 14). The analysis included the number of pediatric patients who received HEN in 2010, their demographic characteristics and geographical distribution. Furthermore, the distributions of indications and methods of enteral nutrition administration were analyzed, along with the reasons of withdrawal from the HEN program. The number and fraction of children receiving HEN increased in 2010, from 433 (11.34 per 1 million inhabitants) on January 1st to 525 (13.75) on December 31st. Marked differences were observed in geographical distribution of this parameter, from zero to up to 30 pediatric patients per 1 million inhabitants. Median age of patients was 6 years (range: 9 months-18 years). In most cases, HEN was prescribed due to neurological disorders (n = 337, 64.2%), and administered by means of gastrostomy (n = 450, 85.71%). This study revealed the dynamic development of pediatric HEN services in Poland but also documented their potential regional shortages. [ABSTRACT FROM AUTHOR]

Published
2012
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45. Standard and immunomodulating enteral nutrition in patients after extended gastrointestinal surgery -- a prospective, randomized, controlled clinical trial.

Author

Klek S, Kulig J, Sierzega M, Szczepanek K, Szybinski P, Scislo L, Walewska E, Kubisz A, and Szczepanik AM

Abstract

BACKGROUND & AIM: The immunomodulating enteral diets are intended to reduce the incidence of postoperative complications in surgical patients. The aim of the study was to assess the clinical effect of such nutrition. MATERIALS AND METHODS: Between June 2004 and September 2007 196 well-nourished patients undergoing resection for pancreatic and gastric cancer were randomized in double-blind manner to receive postoperative enteral nutrition with immunostimulating diet (IMEN group) or standard oligopeptic diet (SEN group). Outcome measures were: number and type of complications, length of hospital stay, mortality, treatment tolerance, liver and kidney function. RESULTS: One hundred and ninety six patients were initially enrolled, finally 183 patients (91 SEN, 92 IMEN group; 69 F, 114 M, median age 61.2) were analyzed. Median postoperative hospital stay was 12.4 days (SD 5.9) in SEN and 12.9 days (SD 8.0) in IMEN group (p=0.42). Complications were observed in 21 patients (23.1%) in SEN and 23 (25.2%) in IMEN group (p>0.05). Four (4.4%) patients in SEN group and 4 (4.4%) in IMEN had surgical complications (p>0.05). There were no differences in liver and kidney function, visceral protein turnover and treatment tolerance. CONCLUSION: Results of our study showed no benefit of immunomodulating enteral nutrition over standard enteral nutrition in patients after major gastrointestinal surgery. The Trial was registered in Clinical Trials Database--number: NCT00576940. [ABSTRACT FROM AUTHOR]

Published
2008
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