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Introduction: Pancraeticoduodenectomy (Whipple procedure) is still associated with a significant postoperative complication rate. There is evidence that early enteral nutrition support may reduce postoperative septic complications. However, the true value of early enteral nutrition support is still controversial. The aim of the present study was to investigate the postoperative outcome of Whipple patients with and without early enteral nutrition support.
Patients and Methods: By using a prospective institutional database, we identified 202 patients from 2001 through 2009 undergoing Whipple procedure. 121 patients matched the inclusion criteria such as non-pylorus preserving Whipple and assessment by a clinical dietitian within 48 hours post-operatively. 67 of 121 (55.4%) patients received early enteral nutrition support, whereas 54 of 121 (44.6%) patients had no early nutrition support (control group). Postoperative course, morbidity and mortality were recorded and analyzed.
Results: No significant differences were found in the postoperative course of the patients. Median length of hospital stay was 15 in the early nutrition support group compared to 14 days in the control group. Postoperative leak rate was 13.8% with and 14.8% without early enteral nutrition support (P=0.964). 11 (13.4%) patients in the early enteral support group developed postoperative organ failure compared to 9 (11%) in the control group. Overall mortality was 4.9%. There was no difference in mortality within the two groups (4% vs. 5%, P=0.881). 33 patients (33.3%) in the control group needed total parenteral nutrition initiation which was significant higher compared to the 9 patients (13.4%) in the early nutrition support group (P<0.05).
Conclusion: Early enteral nutrition support is not associated with lower rates of postoperative morbidity and mortality and does not enhance postoperative recovery after Whipple resection. However, TPN initation is less likely in the early enteral nurtrion support group and might be therefore usefull to reduce risks associated with TPN.