HOSPITAL 103 DEPARTMENT OF ABDOMINAL SURGERY EFFECTS OF EARLY ENTERAL FEEDING AFTER LAPAROSCOPIC DISTAL GASTRECTOMY FOR GASTRIC CANCER AT HOSPITAL 103 Da Nang 2015 Tran Tuan Anh, Ho Chi Thanh

Nourishing plays an important role in treatment Nourishing plays an important role in Surgery Surgical GOOD Nourishing GOOD RESULT GOOD BACKGROUND

The patient does not eat by mouth after surgery until flatus. Intravenous feeding Costly Patients are hungry Undernourished Lack of water and electrolytes so we conducted this research BACKGROUND

TARGETS OF THE STUDY  Assess the safety and feasibility of early enteral feeding after laparoscopic distal gastrectomy.  Assess the effects of early enteral feeding after laparoscopic distal gastrectomy.

Materials and method Materials and method * Materials: 90 patients, who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy patients, who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy. - From 1/2010 to 6/2013. Patients were divided into 2 groups: * Patients were divided into 2 groups: - 45 patients with early enteral feedings through the naso-gastric tube - 45 patients intravenous feeding. Method: Controlled treatment and intervention. * Method: Controlled treatment and intervention.

Materials and method Materials and method  Criteria to choose the patients: - Patients who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy. - Patients must awake, completely spontaneously breathe. - Sonde was placed through from nose to the gastrointestinal anastomosis  Exclusion criteria: -Patients didn’t underwent LADG, or LATG, or LADG combining with other organs. - After the operation, patients didn’t awake, breathe with machines. -Sonde was not through gastrointestinal anastomosis.

In the operating, sonde was placed through from nose to the gastrointestinal anastomosis Materials and method

automatic pump KANGAROO 924 Milk Ensure Gold Milk Ensure Gold Materials and method

Intravenous feeding Materials and method Early feeding

Materials and method Materials and method  Patient characteristics: - Age, gender and BMI. - Blood tests: Red blood cells, hemoglobin, protein - Abdominal condition before flatus. - Flatus time (hour). - Postoperative day.  Complications: - Bleed. - Incision infection, pneumonia, residue abscess - Anastomotic leak, duodenum stump leak.

 Mixing milk Ensure Gold g milk ml water = 200 ml milk.  Dosage and use. - First day : 20 ml/ hour = 400 ml/ day. - Second day: 25 ml/ hour = 600 ml/ day. Materials and method

Table 1: Characters of the patient before operation. Results and discussion Results and discussion Criteria Intravenous feeding (n = 45) Early Feeding (n = 45) p Age55.86 ± ± p > 0.05 Gender (Man/Fel)26/1930/15 p> 0.05 BMI20.22 ± ± 1.95 p > 0.05 Blood test Blood red (T/L)4.30 ± ± 0.58 p > 0.05 Hemoglobin (g/l) ± ± 9.56 p > 0.05 Protein (g/L)71.60 ± ± 7.00 p > 0.05

Table 2: Postoperative condition. Criteria Intravenous feeding (n = 45) Early Feeding (n = 45) p Abdominal condition Soft 34 (75.5%)39 (86.6%) p > 0.05 Slightly bloating 8 (17.7%)5 (11.1%) p > 0.05 Serious bloating 3 (6.67%)1 (2.22%) p > 0.05 Vomit condition Nausea 9 (20%)6 (13.33%) p > 0.05 Vomit 00 p > 0.05 Results and discussion

Table 3: Complications Results and discussion Criteria Intravenous feeding (n = 45) Early Feeding (n = 45) p Anastomotic leakage 00 Duodenal stump leakage 00 Wound infection 01 (2.22%) Intra abdominal abscess 1 (2.22%)0 Pneumonia 1 (2.22%)0 Total 2 (4.44%)1(2.22%) p > 0.05

Criteria Intravenous feeding (n = 45) Early Feeding (n = 45) p Flatus (hour) 49.6 ± ± 9.7 p > 0.05 Small meal (day) 3.2 ± ± 0.4 p > 0.05 Postoperative day (day) 7.4 ± ± 1.6 p= The differences of 2 groups have the significance with p=0.034 Hur [7]: postoperative day: 8.03 and 9.97 day; p < Lee [9]: postoperative day: 9 and 12 day, p = Results and discussion Table 4: Postoperative recovery

Day of feeding Quantity (ml)Number of patients Total (ml) Day ,800 Day ,600 Day ,200 Day Total43,200 Average of one patient was1, ml (1, Kcal) The rate of early feeding was 93.3% Jo (2011) was 89%, Braga (2002) was 91%, Hur (2009) 92% Results and discussion Table 5: Results of early enteral feeding by sonde

Economic benefit in early enteral feeding by sonde 955 Kcal USD USD 1,777 Kcal 1,028 Kcal by intravenous feeding = USD 1,028 Kcal by early enteral feeding = USD 1 patient safe was USD Total 42 patients safe was 1,571.98USD

1. Early enteral feeding by sonde after laparoscopic distal gastrectomy is safe, feasible and can be done. 2. Early enteral feeding helps patients to quickly recover and reduce treatment time.Conclusion

1. Should be early fed in order to reduce postoperative malnutrition in general nourishing postoperative patients and gastrointestinal tract in particular. There needs to expand research on early feeding in other gastrointestinal surgery to more exactly assess the effect of early enteral feeding. 2. There needs to expand research on early feeding in other gastrointestinal surgery to more exactly assess the effect of early enteral feeding.Suggestions

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