Nutritional Management of the Surgical Patient

Contributors xv Section 1 Introduction 1 Chapter 1 Introduction 3 Section 2 Before and During Surgery 5 Chapter 2 Nutrition Screening and Assessment 7 Sara Smith Overview of Body Composition 8 Nutrition-Related Syndromes 8 Nutrition Screening 8 Nutrition Assessment 12 References 14 Chapter 3 Nutritional Considerations Prior to Surgery 17 Oonagh Griffin Malnutrition and Sarcopenia 18 Incidence 18 Impact of Malnutrition and Sarcopenia on Surgical Outcomes 19 Malnutrition 19 Sarcopenia and Sarcopenic Obesity 19 Pre-operative Nutritional Treatment Strategies 20 Carbohydrate Loading 20 Liver Shrinkage Diets 20 Priorities For Future Research 21 References 21 Chapter 4 Prehabilitation Programmes and Their Impact on Surgical Outcomes 25 Helen McNamara A Brief History of Prehabilitation 25 Defining Prehabilitation 26 Stratified Care and Prehabilitation 26 Enhanced Recovery After Surgery and Prehabilitation 27 Holistic and Person-Centred Approaches To Prehabilitation 27 Psychological Preparation 28 Prehabilitation to Support Behaviour Change 28 Frameworks for Prehabilitation 28 Prime Prehabilitation for Surgery at The Royal Surrey Hospital Foundation Trust 28 Interventions of Prime Prehabilitation 29 Group Programmes 29 One-to-One Consultations 29 Home Exercise Programmes 29 Friends and Family 29 Nutritional Support 29 Peer Support 30 Prime Outcome Data 30 Conclusion 30 References 31 Chapter 5 Enhanced Recovery after Surgery 33 Neil Bibby, Rebekah Lord, and Ashleigh Maske Early Oral Feeding 35 Nutritional Support and Oral Nutrition Supplements 36 Enteral Nutrition 36 Immuno-nutrition 37 References 40 Chapter 6 Surgical Terminology and Pre-operative Considerations: A Guide for Non-Surgeons 42 Rajiv Lahiri Surgical Descriptors 42 Key Suffixes in Surgical Terminology 42 Terms to Explain Positioning 43 Pre-operative Considerations 43 Prehabilitation 46 Assessing Surgical Risk 46 Emergency Patients 46 High-Risk Patients 47 Intra-operative Risk Assessment 47 Post-operative Complications 48 Fistula 48 Collections 48 Anastomotic Leak 48 Chyle Leak 49 Conclusion 49 Acknowledgements 49 References 49 Chapter 7 Operating on the Malnourished Patient 51 Katy O’Rourke and Chris Jones Anaemia 51 Electrolyte Abnormalities 53 Sodium 53 Potassium 55 Calcium 55 Magnesium 56 Phosphate 56 Refeeding Syndrome 57 Hyperglycaemia 60 Impact of Body Habitus on Anaesthesia 61 Obesity 61 Consequences of Obesity during Anaesthesia 61 The Underweight Patient 61 Consequences of Malnutrition during Anaesthesia 61 References 64 Section 3 Impact of Surgery 67 Chapter 8 Nutritional Management of the Surgical Patient in Critical Care 69 Nárbhla Donnelly and Anne Langan Metabolic Response to Stress 70 Feeding The Post-operative Surgical Patient in Critical Care 70 Enteral Nutrition 71 Parenteral Nutrition 72 Feeding While Receiving Inotrope and Vasopressor Support 72 Nutritional Targets 73 Determining Energy Targets 73 Protein Targets 74 Areas for Future Research/Questions Unanswered 75 Acknowledgements 79 References 79 Chapter 9 Nutritional Management of Patients Undergoing Head and Neck Cancer Surgery 83 Cathy Skea Head and Neck Cancers 83 Laryngeal Cancer 84 Hypopharyngeal Cancer 85 Oropharyngeal Cancer 85 Oral Cavity Cancer 85 General Nutritional Implications Following Surgical Intervention 85 Surgical Procedures 86 Glossectomy 86 Total Laryngectomy 86 Pharyngo-Laryngo-Oesophagectomy 86 Methods of Post-operative Nutritional Support 87 Early Oral Feeding 87 Enteral Feeding 87 Route of Delivery 87 Choice of Formulae 87 Parenteral Nutrition 87 Post-operative Complications and their Nutritional Management 88 Fistulae/Wound Breakdown 88 Dysphagia Due to Delayed Wound Healing Resulting in Dysphagia 88 Pseudo-epiglottis 88 Nasal Regurgitation/Gastro-oesophageal Reflux 88 Chylous Fistula (Chyle Leak) 89 Long-Term Management of Oesophageal Strictures 89 References 95 Chapter 10 Cardiothoracic Surgery and Nutrition 97 Rupal Patel and Ann-Marie Nixon Overview of Surgical Procedures 97 Cardiac 97 Cardiopulmonary Bypass 98 Coronary Artery Bypass Grafting 98 Valve Replacement Surgery 98 Aortic Surgeries 98 Thoracic Surgery 98 Cardiothoracic Transplant 99 Nutritional Implications 99 Cardiac Surgery 99 Fluid Management 99 Thoracic Surgery 100 Cardiothoracic Transplant 100 Body Composition and Weight Management 100 Food Safety 100 Complications 100 Gut Ischaemia 100 Vocal Cord Palsy 101 Chylothorax 101 Parenteral Nutrition 102 Octreotide 102 Monitoring 102 Surgical and Radiological Interventions 102 Long-Term Management 102 Cardioprotective Diet and Weight 102 Cardiac Rehabilitation 102 Long-Term Post-Transplant Complications 103 Hypertension, Dyslipidaemia, and Diabetes 103 Chronic Kidney Disease 104 Osteoporosis and Vitamin D 104 Further Research 107 References 108 Chapter 11 Nutritional Management of the Surgical Patient: Oesophago-gastric Surgery 110 Charles Rayner and Fiona Huddy Common Operations and Their Anatomy 111 Oesophagectomy 111 Gastrectomy – Total or Subtotal 112 Nutritional Optimisation and Prehabilitation 112 Post-operative Nutrition Support 113 Dietary Reintroduction 114 Nutritional Management of Early Complications 114 Anastomotic Leak 114 Chyle Leak 115 Post-operative Ileus 115 Adjuvant Oncological Treatments 115 Nutritional Management of Late Complications 115 Poor Oral Intake and Anorexia 115 Dysphagia Due to Anastomotic Stricture 116 Dumping Syndrome 116 Malabsorptive Syndromes 117 Pancreatic Exocrine Insufficiency 117 Small Intestinal Bacterial Overgrowth 117 Bile Acid Malabsorption 117 Micronutrient Deficiencies 117 References 120 Chapter 12 Endoscopic Procedures and Their Implications for Nutrition 123 John S. Leeds Endoscopic Procedures 124 Endoscopic Retrograde Cholangiopancreatography 124 Endoscopic Ultrasound 124 Cyst Drainage and Necrosectomy 125 Biliary Access and Drainage 125 Facilitation of Endoscopy in Patients with Surgically Altered Anatomy 126 Endoscopic Ultrasound–Guided Gastroenterostomy 126 Oesophageal Stent 126 Endoscopic Insertion of Feeding Tubes 126 Duodenal Stent 127 Complications 127 Managing Duodenal Perforation 128 Long-Term Management 128 References 130 Chapter 13 Pancreatitis 132 Mary E. Phillips Types Of Pancreatitis 132 Acute Pancreatitis 132 Chronic Pancreatitis 133 Acute on Chronic Pancreatitis 133 Surgical Procedures for Acute Pancreatitis 133 Drainage of Collections/Necrosectomy 133 Embolisation 134 Laparoscopic Cholecystectomy 134 Other Surgical Procedures 134 Surgical Procedures for Chronic Pancreatitis 134 Nutritional Management of Acute Pancreatitis 134 Timing of Nutritional Intervention 134 Route of Feeding 134 Formulation of Enteral Feed 135 Probiotics 135 Oral Diet 135 Pancreatic Exocrine Insufficiency 135 Diabetes 136 Lifestyle Advice 136 Nutritional Management of Chronic Pancreatitis 136 Nutritional Assessment 136 Oral Diet 137 Tube Feeding 137 Pancreatic Exocrine Insufficiency 137 Diabetes 137 Lifestyle Advice and Long-Term Follow-Up 137 References 138 Chapter 14 Pancreatic Resection 141 Alessandro Parente, Sarah Powell-Brett, and Keith J. Roberts Overview of Surgical Procedures 141 Pancreatico-duodenectomy 142 Distal Pancreatectomy 142 Total Pancreatectomy 142 Central Pancreatectomy 142 Drainage Procedures 143 Impact of Pancreatic Resection on Nutrition 143 Pre-operative Malnutrition and Pancreatic Exocrine Insufficiency 143 Post-operative Pancreatic Exocrine Insufficiency 143 Consequences of Pancreatic Exocrine Insufficiency and Malnutrition Following Pancreatic Resection 144 Other Nutritional Considerations 145 Common Post-operative Complications and Their Nutritional Management 145 Post-Pancreatectomy Haemorrhage 145 Delayed Gastric Emptying 145 Post-operative Pancreatic Fistula 145 Bile Leak 146 Chyle Leak 146 Long-Term Management 146 Diabetes after Pancreatic Surgery 146 Pancreatic Enzyme Replacement Therapy 146 References 149 Chapter 15 Liver Resection 153 Nabeel Merali and Adam Frampton Liver Physiology and Anatomy 153 Pre-operative Care 154 Embolisation 154 Pre-operative Nutrition 154 Surgery 155 Indications for Surgery 155 Contraindications to Surgery 155 Operative Description 155 Post-operative Care 156 Post-operative Nutritional Support 156 Post-operative Complications 156 Ascites 156 Ileus 156 Haemorrhage 157 Bile Leak 157 Bile Reinfusion 157 Liver Failure 157 Small-for-Size Syndrome 158 Conclusion 158 References 160 Chapter 16 Nutritional Management of the Urological Surgical Patient 162 Gregory J. Nason, Wissam Abou Chedid, Matthew J.A. Perry, and Krishna Patil Overview Of Surgical Procedure 162 Enhanced Recovery after Surgery and Prehabilitation 163 Impact On Nutrition 164 Pre-operative Nutritional Support 164 Post-operative Nutrition 165 Common Post-operative Complications and Their Nutritional Management 165 Ileus 165 Metabolic Acidosis 165 Areas for Future Research 166 References 166 Chapter 17 Colorectal Surgery 169 Mary E. Phillips and Jeremy R. Huddy Presentation and Aetiology 169 Colorectal Cancer 170 Inflammatory Bowel Disease 170 Other Colorectal Conditions 173 Small Bowel Conditions 173 Surgical Procedures 174 Nutritional Management in the Peri-operative Setting 174 Stoma Management 174 High-Output Stoma 175 Low-Residue Diet 175 Ileus 175 Short Bowel Syndrome 175 Long-Term Complications 176 Kidney Stones 176 Bile Acid Malabsorption 176 Low Anterior Resection Syndrome 176 Pouchitis 176 Conclusion 176 References 176 Chapter 18 Nutritional Management of Gynaecological Cancer Patients 178 Thanuya Mahendran, Maria Ashworth, Mary E. Phillips, and Jayanta Chatterjee Dietary Contribution to Gynaecological Malignancies 178 Pre-operative Malnutrition 179 Pre-operative Nutritional Support 179 Immuno-nutrition 180 Overview Of Surgical Procedures 181 Endometrial Cancer 181 Cervical Cancer 181 Ovarian Cancer 181 Primary Debulking Surgery 181 Interval Debulking Surgery 181 Primary or Interval Debulking Surgery with Bowel Resection and Stoma Formation 182 Bowel Obstruction and Palliative Resection 182 Post-operative Complications and Impact on Nutrition 182 Chyle Leak 183 Short Bowel Syndrome 183 Conclusion 183 References 184 Chapter 19 Major Trauma and Surgery 187 Jennifer Wetherden and Evanna Leavy Physiological Response to Injury 188 Routes of Nutrition 188 Nutritional Requirements 189 Overview of Trauma Injuries and Surgeries 189 Patient and Injury Characteristics 189 Types of Injury 189 Types of Surgery 190 Abdominal Trauma 190 Maxillofacial Trauma 191 Chest Trauma and Thoracic Surgery 191 Orthopaedic Surgery 191 Common Post-operative Complications and Their Nutritional Management 192 Paralytic Ileus 192 Nutritional Losses 192 Long-Term Nutritional Barriers and Complications 192 Impaired Mobility 192 Weight Management 193 Micronutrients and Wound Healing 193 Areas For Future Research 193 References 196 Section 4 Consequences of Surgery 199 Chapter 20 Bowel Obstruction and Dysfunction in Benign and Malignant Disease 201 Lindsey Allan and Naomi Westran Paralytic Ileus 201 Diagnosis and Incidence 201 Causes and Risk Factors 202 Management 203 Bowel Obstruction 203 Causes and Incidence 203 Diagnosis 204 Surgical Management 204 Nutritional Management 204 Areas for Future Research 206 References 206 Chapter 21 Intestinal Failure and Rehabilitation 210 Alison Culkin Management 211 Sepsis 211 Nutrition Assessment 211 Nutrition Support 212 Fluid and Electrolytes 213 Parenteral Nutrition 213 Enteral Nutrition 213 Oral Nutrition 214 Anatomy 215 Surgical Management 215 Prehabilitation 215 Long-Term Nutritional Consequences 215 Renal Issues 215 Intestinal Failure–Associated Liver Disease 216 Micronutrient Deficiencies 216 Areas for Future Research 216 References 218 Chapter 22 Nutritional Biochemistry in the Post-operative Patient 220 Callum Livingstone Trace Elements 221 Zinc (Zn) 221 Copper (Cu) 225 Selenium (Se) 226 Manganese (Mn) 226 Iron (Fe) 227 Vitamins 227 Thiamine (Vitamin B1) 231 Vitamin B12 (Cyanocobalamin) 231 Folate 231 Vitamin A 232 Vitamin D 232 Vitamin E 233 Conclusion 234 References 235 Section 5 Consolidate Your Learning 239 Chapter 23 Test Yourself 241 Index 245