Laparoscopic Placement of Feeding Tubes

Abstract

Under normal circumstances, oral intake of carbohydrates, proteins, and fats is sufficient to meet daily caloric requirements. Upper gastrointestinal cancer, mental obtundation or retardation, multiple trauma, and sepsis are special conditions that make it impossible to obtain an adequate amount of nutrients by mouth. Short-term parenteral nutrition is necessary in instances such as enterocutaneous fistulas and short bowel syndrome; however, patients with functional gastrointestinal tracts should be fed enterally. Enterai feeding locally stimulates enterocyte growth and enhances intestinal immune function. Most enterai formulas provide glutamine, which is the principle enterocyte nutrient. Standard total parenteral nutrition (TPN) solutions do not contain glutamine as it is unstable in solution. Even with optimal parenteral nutrition, enterocyte atrophy is well documented. Animal studies demonstrate impaired mucosal immunity when TPN is compared with enterai feeding.¹ The combination of mucosal atrophy and decreased local immunity may predispose for bacterial translocation and sepsis. In a study of trauma patients, septic complications were decreased when enterai nutrition was compared with parenteral nutrition.²