Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jan 2010
[Recent changes in perioperative nutritional support in patients undergoing thoracoscopic esophagectomy].
The advent of thoracoscopic esophagectomy (TSE) has enabled early patient recovery in association with changes in perioperative nutritional support. This article reviews recent changes in the perioperative nutritional support for patients undergoing TSE. TSE associated with a laparoscopic procedure facilitates the recovery of gastrointestinal motility and function while decreasing the incidence of vocal cord paralysis and/or difficulties in swallowing due to accurate mediastinal lymph node dissection. ⋯ Although TSE is associated with less surgical invasiveness, nutritional support still plays an important role in perioperative care to prevent postoperative complications and contribute to the early recovery of nutritional status. Moreover, since TSE is now performed to treat advanced esophageal cancer, patients are frequently malnourished preoperatively and therefore in the group at high risk for postoperative complications. The early start of oral feeding after the evaluation of swallowing function, selecting the appropriate route for enteral nutrition, and sufficient calorie intake during the perioperative period are essential to prevent postoperative pulmonary and/or infectious complications and consequently to improve patient quality of life.
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Nihon Geka Gakkai zasshi · Jan 2010
[Current practices of perioperative nutritional therapy in colorectal surgery].
Earlier oral intake after colorectal surgery can be achieved effectively with laparoscopic procedures. "Fast track" or "enhanced recovery after surgery" programs have attempted to reduce the physiologic stress of surgery. Perioperative care in such programs includes drinking a carbohydrate-rich beverage 2 hours before surgery and oral liquid intake on the day of surgery. Early restoration of gastrointestinal function can reduce postoperative complications and the length of hospital stays.
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Pancreatoduodenectomy is one of the most invasive and complex procedures in gastrointestinal surgery. Perioperative nutritional management, particularly enteral nutrition, is essential for patients undergoing pancreatoduodenectomy to attenuate postoperative complications and avoid progression of malnutrition due to surgical stress. Early enteral nutrition including immunonutrition via catheter jejunostomy is recommended from the viewpoint of protection from postoperative complications. ⋯ A fat-restricted diet is preferable if pancreatic exocrine function is disturbed due to accompanying or chronic pancreatitis and the deterioration of the remnant pancreatic preserve. Aggressive administration of commercially available pancreatic exocrine enzymes is recommended to prevent malabsorption of dietary lipids in the subacute and chronic stages after pancreatoduodenectomy. Oral supplementation of n-3 polyunsaturated fatty acids can be used in postoperative pancreatic cancer patients.