HOSPITAL 103 DEPARTMENT OF ABDOMINAL SURGERY EFFECTS OF EARLY ENTERAL FEEDING AFTER LAPAROSCOPIC DISTAL GASTRECTOMY FOR GASTRIC CANCER AT HOSPITAL 103.

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.


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


Intravenous feeding Intravenous feeding


Early feeding Early feeding


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.


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.



(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


Table 3: Complications




(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



(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


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%


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!

HOSPITAL 103 DEPARTMENT OF ABDOMINAL SURGERY EFFECTS OF EARLY ENTERAL FEEDING AFTER LAPAROSCOPIC DISTAL GASTRECTOMY FOR GASTRIC CANCER AT HOSPITAL 103.

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