| Research Abstract |
For nutritional management during the early phase of the post operative period for pylorus-preserving pancreatoduodenectomy (PPPD), parenteral nutrition (TPN) has been mainly employed. Currently, however, enteral dieting (ED) has attracted much attention as an effective measure to prevent the translocation of bacteria. In this randomized, controlled study to evaluate ED and TPN as means for post-operative nutritional management, we compared patients supported by either ED or TPN during the postoperative period following PPPD, especially looking at the incidence of post operative complications and the level of cytokines in the blood, and obtained interesting results.
[Subjects]
The subjects included forty-two patients who had received PPPD from April 1999 to March 2001.
[Methods]
(1) The type of feeding to be employed during the post operative period was determined as follows : the subject was assigned randomly to either the ED or TPN group immediately after PPPD by the ballot-in-envelop me
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thod.
(2) Nutrition was given through the following routes: for the ED group22 patients), a nutritional tube with a size of 8 Fr. was inserted from the closed end of the jejunum that was elevated during reconstruction into the elevated jejunum body; and for the TPN group(20 patients), an FVH catheter was inserted into the subclavian vein to remain there immediately after the abdomen was sutured upon completion of the surgery.
(3) post-operative nutritional management proceeded as follows. For the ED group, the patient was administered 50 ml of tea two times on postoperative Day 1, 200 ml of easily digestible nutritional supplement (1 kcal/ml) on Day 2, 400 ml on Day 3, 600 ml on Day 4,800 ml on Day 5, 1200 ml on Day 6, and 1600 ml on Day 7. From Day 8 onward, the enteral feeding proceeded in combination with normal oral feeding. Feeding proceeded in a similar manner for the TPN group in terms of the daily increase in calorie intake.
(4) The level of cytokine (IL-6) in the blood was measured before surgery, and on post-surgery Day 1, Day 8, Day 15 and Day 22. The incidence of post operative complications was also followed. The ED and TPN groups were compared for their change in cytokine levels in the blood over time and for the incidence of post operative complications, to evaluate which feeding method is a better means of nutritional management during the early phase of the post operative period for patients receiving PPPD.
[Results]
(l) With regard to the incidence of complications, there were 4 cases in the ED group (one with lymphorrhea, one with minor leakage through the pancreatojejunal anastomosis and two with delayed gastric empty) and six in the TPN group (one with pneumonia, one with minor leakage through the pancreatojejunal anastomosis, two with delayed gastric empty and two with infection through the IVH catheter). There was no significant difference in the incidence of complications between the two groups.
(2) For the ED group, the average level of cytokine (IL-6) in the blood was 5.8 (pg/ml) before surgery, and 107.0 on postoperative Day 1, 34.4 on Day 8, 21.1 on Day 15 and 12.0 on Day 22. For the TPN group, the corresponding values were 5.9 (pg/ml), 106.0, 46.9 80.1, 32.8 and 12.8, respectively. The average level of cytokine in the blood was significantly higher m the TPN group as compared with the ED group (p < 0 05).
[Conclusion]
It was concluded that, based on the incidence of post operative complications and on the postoperative change in cytokine levels in the blood, enteral feeding is better than parenteral feeding as a means for nutritional management of PPPD patients during their early postoperative period. Less
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