Outcome of Early Nutrition Support after Perforated Peptic Ulcer Repair
Keywords:
Peptic ulcer perforation, Perforated peptic ulcer repair, Early nutrition support, Early enteral feedingAbstract
Background: Early nutrition support (ENS) is safe and beneficial for patients undergoing elective upper gastrointestinal tract surgery. However, the value of ENS in perforated peptic repair remains inconclusive.
Objective: The aim of the present study was to investigate the safety, feasibility, and benefits of ENS in perforated peptic ulcer repair.
Methods: Patients with perforated peptic ulcer who underwent repair by simple closure with omental pedicle techniques were randomized into 2 groups. In the ENS group, patients were given an oral diet of congee at will after 24 hours after repair if gastric residual volume was less than 200 mL per 8 hours. In the traditional postoperative care (TPC) group, patients were given liquid diet progressing to congee at will only after 72 hours. The primary outcome was postoperative complications occurring within 30 days after surgery, including surgical site infection (SSI), hospital acquired pneumonia and postoperative repair leakage. Other outcomes included diet intolerance, time to achieve enteral nutrition in the ENS group and length of hospital stay.
Results: One hundred and ten patients were randomly assigned to TPC or ENS (55 patients per group). Baseline and intraoperative clinical characteristics were similar in both groups. Postoperative complications after surgery were seen in 4.6% of patients. The risk of postoperative complications was slightly higher in the TPC group (3 of 55 patients, 5.5 %) versus the ENS group (2 of 55 patients, 3.6%), but the difference was not statistically significant. Superficial SSI was the only postoperative complication. Neither hospital acquired pneumonia nor postoperative repair leakage were observed. Only one patient in the TPC group had diet intolerance, which was successfully managed conservatively. Time to achieve enteral nutrition in the ENS group was 40 hours (almost 2 days) after surgery. The length of hospital stay was similar for both groups.
Conclusions: ENS in patients who underwent perforated peptic ulcer repair appeared to be as safe as, if not clearly superior to, TPC.
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