Zusammenfassung
Mit dem Ziel, die postoperative Erholung des chirurgischen Patienten zu verbessern, hat das sogenannte ERAS- oder Fast-Track-Konzept eine Revolution in der Chirurgie eingeleitet. Das Konzept wird aus der ernährungsmedizinischen Sicht dargestellt, Probleme des postoperativen Kostaufbaus und die medikamentösen Optionen zur Behandlung der gastrointestinalen Dysmotilität werden diskutiert.
Abstract
In order to enhance recovery after surgery a multidisciplinary approach, the so-called ERAS- or Fast-Track-concept can be considered a surgical revolution. From a nutritional point of view this concept is presented and discussed with regard to special problems of early postoperative oral nutritional food uptake and medical treatment options to overcome gastrointestinal dysmotility.
Schlüsselwörter
Fast-Track-Chirurgie - postoperative Darmatonie - postoperativer Kostaufbau
Key words
Fast-Track-surgery - postoperative ileus - postoperative oral food intake
Literatur
-
1
Bisgaard T, Kehlet H.
Early oral feeding after elective abdominal surgery – what are the issues?.
Nutrition.
2002;
18
944-948
-
2
Ljungqvist O, Nygren J, Thorell A.
Modulation of post-operative insulin resistance by pre-operative carbohydrate loading.
Proc Nutr Soc.
2002;
61
329-336
-
3
Weimann A, Braga M, Harsanyi L. et al .
ESPEN Guidelines on Enteral Nutrition: Surgery including Organ Transplantation.
Clin Nutr.
2006;
25
224-244
-
4
Fearon K C, Ljungqvist O, Meyenfeldt M von. et al .
Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection.
Clin Nutr.
2005;
24
466-477
-
5
Hasenberg T, Rittler P, Post S. et al .
Umfrage zur perioperativen Therapie bei elektiven Kolonresektionen in Deutschland 2006.
Chirurg.
2007;
78
818-826
-
6
Türler A, Schnurr C, Nakao A. et al .
Endogenous endotoxin participates in causing a panenteric inflammatory ileus after colonic surgery.
Ann Surg.
2007;
245
734-744
-
7
Kuo C P, Jo S W, Chen K M. et al .
Comparison of the effects of thoracic epidural analgesia and i. v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery.
Br J Anaesth.
2006;
97
640-646
-
8
Han Geurts I J, Hop W C, Kok N F. et al .
Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery.
Br J Surg.
2007;
94
555-561
-
9
Soop M, Nygren J, Thorell A. et al .
Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery.
Br J Surg.
2004;
91
1138-1145
-
10
Carrère N, Seulin P, Julio C H. et al .
Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial.
World J Surg.
2007;
31
122-127
-
11
Holte K, Foss N B, Andersen J. et al .
Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study.
Br J Anaesth.
2007;
99
500-508
-
12
Stewart D, Waxman K.
Management of postoperative ileus.
Am J Ther.
2007;
14
561-566
-
13
Herbert M K, Holzer P.
Standardized concept of the treatment of gastrointestinal dismotility in critically ill patients – current status and future options.
Clin Nutr.
2008;
27
25-41
-
14
MacLaren R, Kiser T H, Fish D N. et al .
Erythromycin vs Metoclopramide for facilitating gastric emptying and tolerance to intragastric nutrition in critically ill patients.
JPEN.
2008;
32
412-419
-
15 Büchler M W, Seiler C M, Monson J R. et al .Clinical trial: alvimopan for the management of postoperative ileus after abdominal surgery: results of an international randomised, double-blind, multicentre, placebo-controlled clinical study. Aliment Pharmacol Ther 2008; Mar 28, Epub ahead of print
-
16
Matros E, Rocha F, Zinner M. et al .
Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo-controlled trial.
J Am Coll Surg.
2006;
202
773-778
-
17
Chan M K, Law W L.
Use of chewing gum in reducing postoperative ileus after elective colorectal resection: a systematic review.
Dis Colon Rectum.
2007;
50
2149-2157
-
18
Weimann A, Ebener C, Hausser L. et al .
Leitlinie Parenterale Ernährung: Chirurgie und Transplantation.
Aktuel Ernaehr Med.
2007;
32
S114-S123
-
19 DGEM-S3-Leitlinie, Kurzfassung. Stuttgart; Thieme 2008: 50
-
20
Hartig W, Weimann A.
Der postoperative Kostaufbau chirurgischer Patienten.
Aktuel Ernaehr Med.
2000;
25
298-304
-
21
Ryan A M, Rowley S P, Healy L A. et al .
Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit.
Clin Nutr.
2006;
25
386-393
-
22
Smedley F, Bowling T, James M. et al .
Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care.
Br J Surg.
2004;
91
983-990
Prof. Dr. Arved Weimann
Klinik für Allgemein- und Visceralchirurgie, Klinikum St. Georg gGmbH
Delitzscher Str. 141
04129 Leipzig
Telefon: 0341/909-2200
Fax: 0341/909-2234
eMail: Arved.Weimann@sanktgeorg.de
