1. 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

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

3. 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

4. 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.

5. Materials and method Materials and method * Materials: 90 patients, who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy. - 90 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.

6. 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.

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

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

9. Intravenous feeding Materials and method Early feeding

10. 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.

11.  Mixing milk Ensure Gold. - 53.5 g milk + 195 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

12. 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 ± 11.9057.26 ± 11.42 p > 0.05 Gender (Man/Fel)26/1930/15 p> 0.05 BMI20.22 ± 1.9919.96 ± 1.95 p > 0.05 Blood test Blood red (T/L)4.30 ± 0.6214.33 ± 0.58 p > 0.05 Hemoglobin (g/l)122.33 ± 23.41125.97 ± 9.56 p > 0.05 Protein (g/L)71.60 ± 5.5472.04 ± 7.00 p > 0.05

13. 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

14. 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

15. Criteria Intravenous feeding (n = 45) Early Feeding (n = 45) p Flatus (hour) 49.6 ± 7.949.1 ± 9.7 p > 0.05 Small meal (day) 3.2 ± 0.43.1 ± 0.4 p > 0.05 Postoperative day (day) 7.4 ±1.76.9 ± 1.6 p= 0.034 The differences of 2 groups have the significance with p=0.034 Hur [7]: postoperative day: 8.03 and 9.97 day; p < 0.001 Lee [9]: postoperative day: 9 and 12 day, p = 0.012 Results and discussion Table 4: Postoperative recovery

16. Day of feeding Quantity (ml)Number of patients Total (ml) Day 14004216,800 Day 26004124,600 Day 360021,200 Day 46001 Total43,200 Average of one patient was1,028.57 ml (1,028.57 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

17. Economic benefit in early enteral feeding by sonde 955 Kcal 42.86 USD 15.048 USD 1,777 Kcal 1,028 Kcal by intravenous feeding = 46.095 USD 1,028 Kcal by early enteral feeding = 8.675 USD 1 patient safe was 37.43 USD Total 42 patients safe was 1,571.98USD

18. 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

19. 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

20. Thank you!