In severely ill patients the metabolic responses to tissue damage may be sufficient to cause diminution of muscle mass and plasma proteins, to impair the immune response to infection, and to delay the healing of wounds, especially anastomoses. It has been difficult to show the effect of nutritional therapy, partly because of unwillingness to use ‘placebo’ treatment. However, in one controlled trial postoperative morbidity and infection after elective surgery for colonic carcinoma were significantly reduced by 10 days’ intensive pre-operative enteral feeding,1 and in a second,2 postoperative morbidity and length of stay in hospital were reduced in patients receiving intensive and immediate postoperative enteral feeding. This article discusses the use of enteral feeds peri-operatively and in the malnourished.
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