Early postoperative glutamine-supplemented parenteral nutrition versus enteral immunonutrition in cancer patients undergoing major gastrointestinal surgery.

PURPOSE: The aim of this study was to determine whether the type of postoperative feeding, glutamine-supplemented parenteral nutrition or enteral immunonutrition, can modify morbidity and outcome in malnourished cancer patients undergoing major surgery in the gastrointestinal tract. PATIENTS AND METHODS: Twenty-nine consecutive malnourished patients undergoing major elective surgery for carcinoma of the stomach (n=8), pancreas (n=8), liver (n=1), and colon (n=12), were randomly assigned to receive from the first postoperative day either enteral immunonutrition or glutamine-supplemented parenteral nutrition, for at least 5 consecutive days. Postoperative major and minor morbidity and mortality were recorded. Data analysis was done using the Fisher's exact test. RESULTS: Fifteen patients received glutamine-supplemented parenteral nutrition and 14 received enteral immunonutrition. The overall incidence of postoperative complications was 33.3% in the parenteral nutrition group versus 50% in the enteral nutrition group (p=0.2). Subdividing postoperative complications into different types, the rates of major complications were similar in both groups of patients (13.3 and 21.4% respectively, p=0.4). Similarly, there were no significant differences between the two groups considering minor postoperative noninfectious complications, infectious complications, and mortality. CONCLUSION: In malnourished cancer patients undergoing major gastrointestinal surgery, morbidity and mortality are not significantly influenced by the type of postoperative feeding.

Complications of splenic tissue reimplantation.

Splenic tissue reimplantation employing the omental implantation technique was applied in 23 patients undergoing splenectomy for traumatic or iatrogenic splenic injury. Four complications were encountered after autotransplantation (17.4%). Two of these consisted of small bowel obstruction due to postoperative adhesions and were successfully managed by lysis of the adhesions. The other two complications were aseptic necrosis of the splenic transplants and were treated with ablation of the autolysed transplants. A case of abnormal splenic tissue reimplantation in a male patient with unsuspected myelofibrosis is also discussed. He underwent an emergency laparotomy for rupture of a subcapsular splenic haematoma. It is concluded that splenic tissue implantation in the greater omentum is associated with important early morbidity and this should be taken into account whenever application of the method is considered.