Preoperative Immunonutrition Suppresses Endotoxemia During Major Abdominal Surgery: A Randomized Controlled Trial

U. Giger; M. W. Büchler; J. Farhadi; D. Berger; H. Schneider; L. Krähenbühl

doi:10.1055/s-2004-824914

Aktuelle Ernährungsmedizin, Inhaltsverzeichnis

Preoperative Immunonutrition Suppresses Endotoxemia During Major Abdominal Surgery: A Randomized Controlled Trial

U Giger ¹, MW Büchler ⁵, J Farhadi ², D Berger ³, H Schneider ⁴, L Krähenbühl ¹

¹Department of General Surgery, Hôpital Cantonal Fribourg, Switzerland
²Department of Visceral and Transplantation Surgery, University of Berne, Switzerland
³Department of Visceral and Vascular Surgery, Stadtklinik, Baden-Baden, Germany
⁴HealthEcon AG, Basel, Switzerland
⁵Department of General Surgery, University of Heidelberg, Germany

Abstract

Aim: To compare immuno enriched formula with a standard feeding regiment regarding perioperative immune response and clinical outcome.

Patients and Material: 46 (31 male; 15 female) with upper gastro-intestinal cancer (pancreas, stomach) were randomized into three groups. Group I (14) received for 5 days preoperative and seven days postoperative Impact®. Group II (17) two days preoperative and seven days postoperative Impact plus ®. Control Group III (15) received only postoperative Impact® for seven days. The rate of postoperative infections, ICU stay and hospital stay were recorded.

Results: The lowest infection rate was observed in group I and II. (14%; 29%). The highest in group III (67%). No significant difference was observed between the three groups regarding non-infectious complications (43%; 47% and 67%). ICU and hospital stay were significant increased for group III compared to group I and II. Perioperative endotoxin levels were significant lower in group I and II (max. 0.1 EU/ml) compared to group III (max 0.3 EU/ml).

Conclusions: Preoperative immunonutrition offers a significant better perioperative outcome regarding perioperative immune response and endotoxemia. Clinical outcome may also be positively affected with preoperative immunonutrition.