Traditional management of patients post-operatively involved a period of nil by mouth. Over the past decade the use of enteral nutrition post-operatively via a feeding jejunostomy has gained popularity. The use of feeding jejunostomy has been associated with increased risk of complications(Reference Al-Shehri, Makarewicz and Freeman1, Reference Gerndt and Orringer2); i.e. abdominal pain, distension, nausea and vomiting. In some cases fatal complications have been reported(Reference Lawlor, Inculet and Malthaner3–Reference Schloerb, Wood and Casillan6).
Several factors have been suggested as responsible for these complications, including initial volume and rate of enteral nutrition (EN), rate of increase of EN, type of tube used and method of insertion. It appears from the literature that ‘aggressive’ feeding is not advocated(Reference Lawlor, Inculet and Malthaner3–Reference Schloerb, Wood and Casillan6).
The aim of the present study was to determine the tolerance and feasibility of EN delivered in the first post-operative week in patients who had undergone major upper gastrointestinal surgery for malignancy. The study duration was 36 months and formed part of a larger randomised controlled trial. All patients received a jejunostomy (Freka surgical jejunostomy set; Frenius Kabi Ltd, Runcorn, Cheshire, UK) inserted by one of four surgeons at laparotomy. Fifty-five patients were analysed in the study.
Nine patients (16.3%) had their enteral feeding stopped in the first post-operative week; the reasons included chylothorax, possible chest infection, pain and oozing laparotomy wound. All patients were restarted on early EN within 36 h of stopping. The results from the present study illustrate that EN is essentially well tolerated in this patient group. Thus, these results should support the use of routine EN in patients undergoing major upper gastrointestinal resection.
