Enteral versus parenteral nutrition in the preoperative period

The association between malnutrition and poor postoperative outcome suggests that preoperative nutritional support in surgical patients with malnutrition should have a beneficial effect on outcome. In addition, nutritional support through enteral nutrition (EN) has numerous advantages over parenteral nutrition (PN). We performed a systematic review of the literature (MEDLINE, Cochrane Database) published from 1980-2004, to compare the effect of preoperative PN versus preoperative EN on patient outcomes in terms of complications, mortality and length of hospital stay. No meta-analyses comparing the efficacy of EN versus PN in the preoperative period were found. Only two randomized controlled clinical trials that met the inclusion criteria were found. Both studies had methodological flaws and a small number of patients. Neither of these two studies demonstrated the superiority of one preoperative nutritional modality over the other. We performed a critical analysis of both studies. Differences in the method of nutritional evaluation used, the energy requirements covered with artificial nutrition, the nutritional formulas used, postoperative maintenance of total PN and the diagnoses of the patients included were found. New studies evaluating the efficacy of two comparable nutritional strategies through the enteral and parenteral routes are required (AU)