Abstract
Background: Delayed gastric emptying occurs in about 30% of patients undergoing pancreaticoduodenectomy. Tube feedings have been thought to exacerbate this problem. The main objective is to determine the effects of not performing enteral feedings via jejunostomy tube after pancreatic resection.
Methods: We conducted an IRB approved, clinical trial in patients undergoing pancreaticoduodenectomy or total pancreatectomy. Patients were randomized to either a jejunostomy feeding tube placed at the time of surgery with tube feedings started 48 hours later followed by an oral diet on postoperative day 5 (Group A), or no feeding tube and started on an oral diet on postoperative day 5 (Group B). Drainage from the nasogastric tube, need for parenteral nutrition, and days until discharge were compared. We used t-test or non-parametric Wilcoxon test for comparing the main variables using one-sided test with a 0.05 level of significance.
Results: Twenty-seven patients were included in the study: 15 in Group A, and 12 in Group B. The groups were similar in baseline characteristics except average age; 69 years in Group A vs 58 years in Group B (P=0.015). Comorbidities and indications for surgery were not significantly different between the two groups. In addition, 24 of 27 (89%) patients had cancer. The majority of patients had the nasogastric tube for 4 days with no significant difference seen in the output volumes between the two groups. Despite the enteral nutrition, 54% of the patients in Group A required parenteral nutrition compared to 25% in Group B (P=0.23). The average number of hospital days was 19.6 for Group A, and 9.1 for Group B (P=0.06).
Conclusions: Patients tend to do better on no enteral feedings via jejunostomy tube after pancreatic resection. This finding has been translated into practice at our institution and patients resume oral intake postoperatively without jejunostomy tube feedings.
- Received September 11, 2008.
