Role of nutrition in gastroenterological surgery

Abstract

Nutrition plays important roles in recovery after gastroenterological surgery. Severe surgical stress increases muscle breakdown and lipolysis, thereby accelerating wound healing and enhancing host defense against microbes. Malnourished patients have insufficient amounts of muscle and body fat. Therefore, they may not appropriately respond to surgical stress. Perioperative nutritional therapy maintaining nutritional status reduces postoperative complications and accelerates recovery after surgery, particularly for malnourished patients. In addition, perioperative oral or enteral nutrition is now recommended for preserving host defense mechanisms against microbes. Lack of enteral nutrition impairs gut and hepatic immunity, systemic mucosal defense and peritoneal host defense, even when nutrient amounts supplied by parenteral nutrition are adequate. Thus, surgeons should avoid no oral or enteral nutrition periods. Supplemental administration of specific nutrients such as glutamine, arginine and ω‐3 fatty acids is termed “immunonutrition”, and is expected to reduce the morbidity of infectious complications and length of hospital stay. Nutritional therapy is important even after discharge to maintain body weight and compensate for abnormalities in the digestion and absorption of nutrients. Understanding the significance of nutrition in gastroenterological patients leads to better outcomes.

The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy

“…It was reported that perioperative IN significantly reduced the risk of postoperative infectious complications by 50% [37]. It should be emphasized that, although WHO and Centers for Disease Control and Prevention guidelines for the prevention of surgical site infection did not refer to the significance of nutrition therapy in previous versions, the 2016 WHO guidelines listed IN as a method contributing to the prevention of surgical site infection [38].…”

“…The route of IN is also very important because it influences the host defense mechanism. Comparing enteral and parenteral routes, enteral nutrition (EN) is better than total parenteral nutrition (TPN) [37]. EN preserves and TPN reduces gut-associated lymphoid tissue cell number, gut immunoglobulin A (IgA) level, respiratory tract IgA level, hepatic mononuclear cell number, resident macrophage number, and exudative neutrophil number [37].…”

“…Comparing enteral and parenteral routes, enteral nutrition (EN) is better than total parenteral nutrition (TPN) [37]. EN preserves and TPN reduces gut-associated lymphoid tissue cell number, gut immunoglobulin A (IgA) level, respiratory tract IgA level, hepatic mononuclear cell number, resident macrophage number, and exudative neutrophil number [37]. EN significantly, and TPN poorly, influences resistance against viruses and bacteria, intracellular signaling activation, cytokine production, and nuclear factor-κB activation.…”

“…EN significantly, and TPN poorly, influences resistance against viruses and bacteria, intracellular signaling activation, cytokine production, and nuclear factor-κB activation. It is important that survival in portal bacteriemia and bacterial peritonitis is good for EN and poor for TPN [37].…”

“…Glutamine is a conditionally essential amino acid. In conditions of severe surgical stress, Gln production may not achieve the amount needed, leading to glutamine deficiency [37]. Glutamine is a common nitrogen donor for healing tissues damaged by surgery.…”