Cirurgia colorretal eletiva sem descompressão gástrica e com realimentação precoce

Habr-Gama, Angelita; Jacob, Carlos Eduardo; Sousa Júnior, Afonso Henrique Silva e; Alves, Paulo Roberto Arruda; Vieira, Maria José Femenias

doi:10.1590/S0100-69911998000500003

Resumos

Historicamente, as operações sobre o intestino grosso sempre foram cercadas por cuidados especiais, com o intuito de minimizar o potencial de complicações. Com isso, a realimentação oral era postergada. Este trabalho teve como objetivo documentar a retirada da sonda nasogástrica logo após o procedimento cirúrgico e a adoção da realimentação precoce. Foram acompanhados 105 pacientes submetidos a operações colorretais eletivas por via de acesso convencional. A média de idade foi de 59,9 anos com predomínio do sexo masculino. Oitenta e cinco doentes foram operados por afecção maligna. A operação mais realizada foi a retossigmoidectomia com anastomose colorretal. Água era permitida logo após o despertar do paciente, e dieta líquida era liberada no dia seguinte e feita a progressão conforme a aceitação, independentemente da presença de ruídos hidroaéreos ou eliminação de flatos. Em 14 pacientes (13,3%), interrompeu-se a dieta devido a ocorrência de náuseas ou vômitos. A mortalidade foi nula. Ocorreram complicações em 15 doentes (14,3%). Na série estudada, a retirada imediata da sondanasogástrica e realimentação precoce foi prática segura e bem tolerada pela maioria dos pacientes.

Cirurgia colorretal; Alimentação precoce; Íleo pós-operatório

After colorectal operations, oral feeding has been traditionally delayed to avoid an increase in the incidence of anastomotic leakage. The purpose of this paper is to prove that immediate nasogastric tube withdrawal and early oral feeding may be safe. One hundred and five patients submitted to open colorectal resection were included in this study. The mean age was 59,9 years, and mate accounted for 54%. Eight five patients were operated on for colorectal cancer. The most employed proceeding was anterior rectal were resection. Water and tea was allowed since the patient was awake. Juice and soup was offered in the next day with progression to general diet according to patient's acceptance. Fourteen patients (13%) presented nauseas and vomiting, and feeding was interrupted. There was no death in this series. Postoperative complications were noticed in 15 patients (14%). Our conclusion is that immediate nasogastric tube withdrawl and early oral feeding after elective colorectal surgery is safe and well tolerated by the majority of patients.

Colorectal surgery; Early feeding; Postoperative regimen

ARTIGOS ORIGINAIS

Cirurgia colorretal eletiva sem descompressão gástrica e com realimentação precoce

Early feeding and nasogastric tube withdrawl after elective colorectal surgery

Angelita Habr-Gama, TCBC-SP^I; Carlos Eduardo Jacob^IV; Afonso Henrique Silva e Sousa Júnior^III; Paulo Roberto Arruda Alves^III; Maria José Femenias Vieira^IV

^IProfessora Titular da Disciplina de Coloproctologia da Faculdade de Medicina da USP. Chefe do Departamento de Gastroenterologia da Faculdade de Medicina da USP. Cirurgiã do Hospital Alemão Oswaldo Cruz

^IIPós-Graduando do Departamento de Gastroenterologia da Faculdade de Medicina da USP. Cirurgião do Hospital Alemão Oswaldo Cruz

^IIIMédico Assistente Doutor da Disciplina de Coloproctologia da Faculdade de Medicina da USP. Cirurgião do Hospital Alemão Oswaldo Cruz

^IVDoutora em Medicina pela Universidade de São Paulo. Cirurgiã do Hospital Alemão Oswaldo Cruz

^{Endereço para correspondência} Endereço para correspondência: Dra. Angelita Habr-Gama Rua Tucumã, 401 Sala 71 01455-010 - São Paulo - SP

RESUMO

Historicamente, as operações sobre o intestino grosso sempre foram cercadas por cuidados especiais, com o intuito de minimizar o potencial de complicações. Com isso, a realimentação oral era postergada. Este trabalho teve como objetivo documentar a retirada da sonda nasogástrica logo após o procedimento cirúrgico e a adoção da realimentação precoce. Foram acompanhados 105 pacientes submetidos a operações colorretais eletivas por via de acesso convencional. A média de idade foi de 59,9 anos com predomínio do sexo masculino. Oitenta e cinco doentes foram operados por afecção maligna. A operação mais realizada foi a retossigmoidectomia com anastomose colorretal. Água era permitida logo após o despertar do paciente, e dieta líquida era liberada no dia seguinte e feita a progressão conforme a aceitação, independentemente da presença de ruídos hidroaéreos ou eliminação de flatos. Em 14 pacientes (13,3%), interrompeu-se a dieta devido a ocorrência de náuseas ou vômitos. A mortalidade foi nula. Ocorreram complicações em 15 doentes (14,3%). Na série estudada, a retirada imediata da sondanasogástrica e realimentação precoce foi prática segura e bem tolerada pela maioria dos pacientes.

Unitermos: Cirurgia colorretal; Alimentação precoce; Íleo pós-operatório.

ABSTRACT

After colorectal operations, oral feeding has been traditionally delayed to avoid an increase in the incidence of anastomotic leakage. The purpose of this paper is to prove that immediate nasogastric tube withdrawal and early oral feeding may be safe. One hundred and five patients submitted to open colorectal resection were included in this study. The mean age was 59,9 years, and mate accounted for 54%. Eight five patients were operated on for colorectal cancer. The most employed proceeding was anterior rectal were resection. Water and tea was allowed since the patient was awake. Juice and soup was offered in the next day with progression to general diet according to patient's acceptance. Fourteen patients (13%) presented nauseas and vomiting, and feeding was interrupted. There was no death in this series. Postoperative complications were noticed in 15 patients (14%). Our conclusion is that immediate nasogastric tube withdrawl and early oral feeding after elective colorectal surgery is safe and well tolerated by the majority of patients.

Key words: Colorectal surgery; Early feeding; Postoperative regimen.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 8/7/97

Aceito para publicação em 23/7/98

Trabalho realizado no Hospital Alemão Oswaldo Cruz - São Paulo - SP

1. Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 1995;222:73-77.
2. Bufo AJ, Feldman S, Daniels GA, et al. Early postoperative feeding. Dis Colon Rectum 1994;37:1.260-1.265.
3. Clevers GJ, Smout JP, VanDerschee EJ, et al. Myoeletric and motor activity of the stomach in the first days after abdominal surgery: evolution by electrogastrography and impedance gastrography. J Gastroenterol Hepatol 1991; 6: 253-259.
4. Smith J, Kelly KA, Weinshilboum RM. Pathophysioloy of postoperative ileus. Arch Surg 1977;112:203-209.
5. Habr-Gama A, Vieira MJ, Souza Jr AHS, et al. Preparo intestinal para cirurgia colorretal. Estudo prospectivo do uso de soluçăo eletrolítica contendo polietilenoglicol. ABDC Arq Bras Cir Dig Săo Paulo 1987; 2:3-8.
6. Habr-Gama A, Alves PRA, Vieira MJF, et al. Prophylatic short course of metronidazole and netilmicin used in two schemes for elective colorectal surgery. ABCD Arq Bras Cir Dig, Săo Paulo, 1992; 7:33-39.
7. Levin AL. A new gastroduodenal catheter. JAMA 1921 ;76:1.007-1.009.
8. Wangenstein OH, Paine JR. Treatment of acute intestinal obstrution by suction with the duodenal tube. JAMA 1933;101:1.532-1.539.
9. Wells C, Rawlinson K, Tinckler L. Postoperative gastrointestinal motility. Lancet 1964;1:4-10.
10. Gerber A. An appraisal of paralytic ileus and the necessity for postoperative gastrointestinal suction. Surg Gyn Obst 1963; 117:294-296.
11. Bauer JJ, Gelernt IM, Salky BA, et al. Is routine postoperative nasogastric descompression really necessary? Ann Surg 1985;201:233-236.
12. Berg R, Geigle CF, Faso JM. Omission of routine nasogastric descompression. Dis Colon Rectum 1978;21:98-100.
13. Ibrahim AA, Abfege D, Issiah IA. Is postoperative proximal descompression a necessary complement to elective colon resection? South Med J 1977;70:1.070-1.071.
14. Otchy DP, Wolff BG, van Heerden J, et al. Does lhe avoindance of nasogastric descompression following elective abdominal colorectal surgery affect the incidence of incisional hemia. Dis Colon Rectum 1995;38: 604-608.
15. Essenhigh DM. Gastric descompression after abdominal surgery. Br Med J 1973;1:189-190.
16. Hipócrates apud Hoover HC, Ryan JA, Anderson EJ, et al. Nutritional benefits of immediate postoperative jejunal feeding of an elemental diet. Am J Surg 1980;139:153-159.
17. Bistrian BR, Blackbum GL, Halowell E. Protein status of general surgical patients. JAMA 1974;230:858-860.
18. Delany HM, Demetriou AA, Teh E, et al. Effect of early postoperative nutrition support on skin wound and colon anastomosis healing.JPEN 1990;14:357-361.
19. Page CP, Ryan JA, Haff RC. Continual catheter administration of an elemental diet. Surg Gyn Obst 1976;142:184.
20. Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma - a prospective, randomized study. J Trauma 1986;26:874-881.
21. Deitch EA, Winterton J, Li M, Berg R. Tthe gut as a port of entry for bacteremia. Ann Surg 1987;205:681-690.
22. Daly JM, Vars HM, Dudrick SJ. Effects of protein depletion on strength of colonic anastomoses. Surg Gyn Obs 1972;134:15-21.
23. lrvin TT. Effects of malnutrition and hyperalimentation on wound healing. Surg Gyn Obs 1978;146:33.
24. Law NW, Ellis H. The effect of parenteral nutrition on the healing of abdominal wall wounds and colonic anastomoses in protein-mal nourished rats. Surgery 1990;107:449-454.
25. Ward MWN, Danzi M, Lewin MR, et al. The effects of subclinical malnutrition and refeeding on the healing of experimental colonic anastomoses. Br J Surg 1982;69:308-310.
26. Dubois A, Weise VK, Kopin IJ. Postoperative ileus in the rat. Physiopathology, etiology, and treatment. Ann Surg 1973;178:1.973.
27. Heimbach DM, Crout JR. Treatment of paralytic ileus with adrenergic neuronal blocking drugs. Surgery 1971;68:582.
28. Carmichael MJ, Weisbrodt NW, Copeland EM. Effect of abdominal surgery on intestinal myoeletric activity in the dog. Am J Surg 1977; 133:34-37.
29. Zaloga GP, Bortenschlager L, Black KW, et al. Immediate postoperative enteral feeding decreases weight loss and improves wound healing after abdominal surgery in rats. Crit Cure Med 1992;20:115-118.
30. Woods JH, Erickson L W, Condon LR. Postoperative ileus: a colonic problem. Surgery 1978;84:527-533.
31. Wolf BG, Pemberton JH, van Heerden JA, et al. Elective colon and rectal surgery without nasogastric descompression: a prospective, randomised trial. Ann Surg 1989;209:670-974.

Endereço para correspondência:

Dra. Angelita Habr-Gama

Rua Tucumã, 401 Sala 71

01455-010 - São Paulo - SP

Datas de Publicação

Publicação nesta coleção
17 Maio 2010
Data do Fascículo
Out 1998

Histórico

Aceito
23 Jul 1998
Recebido
08 Jul 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 1995;222:73-77.

[2] 2. Bufo AJ, Feldman S, Daniels GA, et al. Early postoperative feeding. Dis Colon Rectum 1994;37:1.260-1.265.

[3] 3. Clevers GJ, Smout JP, VanDerschee EJ, et al. Myoeletric and motor activity of the stomach in the first days after abdominal surgery: evolution by electrogastrography and impedance gastrography. J Gastroenterol Hepatol 1991; 6: 253-259.

[4] 4. Smith J, Kelly KA, Weinshilboum RM. Pathophysioloy of postoperative ileus. Arch Surg 1977;112:203-209.

[5] 5. Habr-Gama A, Vieira MJ, Souza Jr AHS, et al. Preparo intestinal para cirurgia colorretal. Estudo prospectivo do uso de soluçăo eletrolítica contendo polietilenoglicol. ABDC Arq Bras Cir Dig Săo Paulo 1987; 2:3-8.

[6] 6. Habr-Gama A, Alves PRA, Vieira MJF, et al. Prophylatic short course of metronidazole and netilmicin used in two schemes for elective colorectal surgery. ABCD Arq Bras Cir Dig, Săo Paulo, 1992; 7:33-39.

[7] 7. Levin AL. A new gastroduodenal catheter. JAMA 1921 ;76:1.007-1.009.

[8] 8. Wangenstein OH, Paine JR. Treatment of acute intestinal obstrution by suction with the duodenal tube. JAMA 1933;101:1.532-1.539.

[9] 9. Wells C, Rawlinson K, Tinckler L. Postoperative gastrointestinal motility. Lancet 1964;1:4-10.

[10] 10. Gerber A. An appraisal of paralytic ileus and the necessity for postoperative gastrointestinal suction. Surg Gyn Obst 1963; 117:294-296.

[11] 11. Bauer JJ, Gelernt IM, Salky BA, et al. Is routine postoperative nasogastric descompression really necessary? Ann Surg 1985;201:233-236.

[12] 12. Berg R, Geigle CF, Faso JM. Omission of routine nasogastric descompression. Dis Colon Rectum 1978;21:98-100.

[13] 13. Ibrahim AA, Abfege D, Issiah IA. Is postoperative proximal descompression a necessary complement to elective colon resection? South Med J 1977;70:1.070-1.071.

[14] 14. Otchy DP, Wolff BG, van Heerden J, et al. Does lhe avoindance of nasogastric descompression following elective abdominal colorectal surgery affect the incidence of incisional hemia. Dis Colon Rectum 1995;38: 604-608.

[15] 15. Essenhigh DM. Gastric descompression after abdominal surgery. Br Med J 1973;1:189-190.

[16] 16. Hipócrates apud Hoover HC, Ryan JA, Anderson EJ, et al. Nutritional benefits of immediate postoperative jejunal feeding of an elemental diet. Am J Surg 1980;139:153-159.

[17] 17. Bistrian BR, Blackbum GL, Halowell E. Protein status of general surgical patients. JAMA 1974;230:858-860.

[18] 18. Delany HM, Demetriou AA, Teh E, et al. Effect of early postoperative nutrition support on skin wound and colon anastomosis healing.JPEN 1990;14:357-361.

[19] 19. Page CP, Ryan JA, Haff RC. Continual catheter administration of an elemental diet. Surg Gyn Obst 1976;142:184.

[20] 20. Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma - a prospective, randomized study. J Trauma 1986;26:874-881.

[21] 21. Deitch EA, Winterton J, Li M, Berg R. Tthe gut as a port of entry for bacteremia. Ann Surg 1987;205:681-690.

[22] 22. Daly JM, Vars HM, Dudrick SJ. Effects of protein depletion on strength of colonic anastomoses. Surg Gyn Obs 1972;134:15-21.

[23] 23. lrvin TT. Effects of malnutrition and hyperalimentation on wound healing. Surg Gyn Obs 1978;146:33.

[24] 24. Law NW, Ellis H. The effect of parenteral nutrition on the healing of abdominal wall wounds and colonic anastomoses in protein-mal nourished rats. Surgery 1990;107:449-454.

[25] 25. Ward MWN, Danzi M, Lewin MR, et al. The effects of subclinical malnutrition and refeeding on the healing of experimental colonic anastomoses. Br J Surg 1982;69:308-310.

[26] 26. Dubois A, Weise VK, Kopin IJ. Postoperative ileus in the rat. Physiopathology, etiology, and treatment. Ann Surg 1973;178:1.973.

[27] 27. Heimbach DM, Crout JR. Treatment of paralytic ileus with adrenergic neuronal blocking drugs. Surgery 1971;68:582.

[28] 28. Carmichael MJ, Weisbrodt NW, Copeland EM. Effect of abdominal surgery on intestinal myoeletric activity in the dog. Am J Surg 1977; 133:34-37.

[29] 29. Zaloga GP, Bortenschlager L, Black KW, et al. Immediate postoperative enteral feeding decreases weight loss and improves wound healing after abdominal surgery in rats. Crit Cure Med 1992;20:115-118.

[30] 30. Woods JH, Erickson L W, Condon LR. Postoperative ileus: a colonic problem. Surgery 1978;84:527-533.

[31] 31. Wolf BG, Pemberton JH, van Heerden JA, et al. Elective colon and rectal surgery without nasogastric descompression: a prospective, randomised trial. Ann Surg 1989;209:670-974.

Brasil

Brasil

Cirurgia colorretal eletiva sem descompressão gástrica e com realimentação precoce

Early feeding and nasogastric tube withdrawl after elective colorectal surgery

Resumos

Endereço para correspondência:

Datas de Publicação

Histórico