Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity. Issue 7 (6th December 2013)

• Record Type: Journal Article
• Authors: Gerritsen, Arja; Wennink, Roos A. W.; Besselink, Marc G. H.; van Santvoort, Hjalmar C.; Tseng, Dorine S. J.; Steenhagen, Elles; Borel Rinkes, Inne H. M.; Molenaar, I. Quintus
• Is Part Of: HPB. Volume 16:Issue 7(2014:Jul.)
• Page Start: 656
• Page End: 664
• Publication Date: 2013-12-06
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12197
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12197-sec-0001" sec-type="section"> <title>Objective</title> <p>The aim of this study was to evaluate whether a change in the routine feeding strategy applied after pancreatoduodenectomy (PD) from nasojejunal tube (NJT) feeding to early oral feeding improved clinical outcomes.</p> </sec> <sec id="hpb12197-sec-0002" sec-type="section"> <title>Methods</title> <p>An observational cohort study was performed in 102 consecutive patients undergoing PD. In period 1 (<italic>n</italic> = 51, historical controls), the routine postoperative feeding strategy was NJT feeding. This was changed to a protocol of early oral feeding with on‐demand NJT feeding in period 2 (<italic>n</italic> = 51, consecutive prospective cohort). The primary outcome was time to resumption of adequate oral intake.</p> </sec> <sec id="hpb12197-sec-0003" sec-type="section"> <title>Results</title> <p>The baseline characteristics of study subjects in both periods were comparable. In period 1, 98% (<italic>n</italic> = 50) of patients received NJT feeding, whereas in period 2, 53% (<italic>n</italic> = 27) of patients did so [for delayed gastric empting (DGE) (<italic>n</italic> = 20) or preoperative malnutrition (<italic>n</italic> = 7)]. The time to resumption of adequate oral intake significantly decreased from 12 days in period 1 to 9 days in period 2 (<italic>P</italic> = 0.015), and the length of hospital stay shortened from 18 days in period 1 to 13 days in period 2 (<italic>P</italic> = 0.015). Overall, there were no differences in the incidences of complications of Clavien–Dindo Grade III or higher, DGE, pancreatic fistula, postoperative haemorrhage and mortality between the two periods.</p> </sec> <sec id="hpb12197-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The introduction of an early oral feeding strategy after PD reduced the time to resumption of adequate oral intake and length of hospital stay without negatively impacting postoperative morbidity.</p> </sec> </abstract>