this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons , the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery .
The prescription of these recommendations can accelerate the postoperative recovery of patients su bmi tted to elective general surgery , with decrease in morbidity , length of stay and rehospitalization , and consequently , of costs
OBJECTIVE to present recommendations based on the ACERTO Project ( Acceleration of Total Post-Operative Recovery ) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures .
1997 Harry M. Vars Research Award. Does the route of feeding modify gut barrier function and clinical outcome in patients after major upper gastrointestinal surgery?
BACKGROUND Direct experimental evidence suggests that total enteral nutrition ( TEN ) reduces septic morbidity compared with bowel rest and total parenteral nutrition ( TPN ) and that mucosal support and maintenance of gut barrier function is a key mechanism . This effect is supported indirectly by clinical studies , but this question has not previously been investigated directly in the postoperative patient . This study examined the hypothesis that early enteral feeding after major upper gastrointestinal surgery may modulate gut barrier function and decrease the risk of major infective complications compared with bowel rest and parenteral nutrition . METHODS A r and omized clinical trial of 67 patients ( TPN = 34 ; TEN = 33 ) fed postoperatively for 7 days was performed . Thirty-day major morbidity and mortality were monitored . Intestinal permeability was measured using the lactulose/mannitol test preoperatively and on postoperative days 1 and 7 . Systemic anti-endotoxin core immunoglobulin G and M antibodies and serum albumin and C-reactive protein were quantified at these time points . RESULTS No clinical benefit was observed in patients fed enterally compared with the parenterally fed group . Intestinal permeability was increased on the 1st postoperative day in association with evidence of endotoxin exposure . By day 7 , enteral feeding compared with parenteral feeding had failed to significantly influence any of the gut barrier or systemic parameters . CONCLUSIONS This r and omized controlled trial of  TEN vs TPN after major upper gastrointestinal surgery failed to show a clinical benefit for the enteral route . Moreover , enteral nutrition did not modulate gut barrier function postoperatively
this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons , the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery .
The prescription of these recommendations can accelerate the postoperative recovery of patients su bmi tted to elective general surgery , with decrease in morbidity , length of stay and rehospitalization , and consequently , of costs
OBJECTIVE to present recommendations based on the ACERTO Project ( Acceleration of Total Post-Operative Recovery ) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures .