Abstract
Eighteen patients undergoing colorectal excision had gastrointestinal function preserved. Paralytic ileus was avoided by efficient exclusion of swallowed air by aspiration of the esophagus. Full strength elemental diet was delivered into the duodenum immediately postoperatively at 100-150 ml/ hour. Virtually stoichiometric digestion, absorption, and utilization of dietary protein was demonstrated in six patients, for whom 125I-albumin was added to the initial feedings. The 24-hour urine contained 94 ± 4% of the activity. The same group of patients had hourly determinations of nitrogen balance. Each had achieved positive protein balance by 5 ± 3 hours postoperatively.
The morning following surgery (17-24 hours postoperatively) the special nasogastric device was removed and intravenous feedings were discontinued, with transition to per os intake of elemental diet. Twelve patients had oral barium motility studies initiated at this time, with continued oral intake of elemental diet. On serial x-rays, each showed clinically adequate peristalsis, with prompt passage of the contrast agent out of the stomach, through intestine and colon. The barium traversed anastomoses to enter the rectum and exit in a spontaneous bowel movement within the second 24-hour period. Three patients were discharged within 48 hours of surgery (sigmoid resection, 2; right hemicolectomy, 1).
Paralytic ileus develops after the usual postoperative regimens. Clinically adequate gastrointestinal function can be preserved by a regimen that includes efficient exclusion of swallowed air. This study documents the immediate enteral absorption of full nutrition (ie, 3000 kcal/day) as elemental diet. The x-ray studies document preservation of even gastric and colonic function, permitting normal per os intake and discharge within 24-48 hours of major abdominal surgery.
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