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Marco Braga, MD; Luca Gianotti, MD, ScD; Andrea Cestari, MD; Andrea Vignali, MD; Fabio Pellegatta, MD; Alberto Dolci, MD; Valerio Di Carlo, MD

Arch Surg. 1996;131(12):1257-1265.

Abstract
Objective
To evaluate if the perioperative administration of a supplemented enteral formula modulates selective inflammatory and immune variables and gut function after surgery.

Design
Prospective, randomized, double-blind, clinical trial.

Setting
Department of surgery, university hospital.

Patients
Forty patients with neoplasm of the colorectum or stomach.

Intervention
Seven days before surgery, the patients drank I L/d of a control enteral formula (n=20) or the same formula enriched with arginine, RNA, and -3 fatty acids (n=20). Jejunal infusion with the same formulas was started 6 hours after operation and continued until day 7.

Main Outcome Measures
Immune response was determined by phagocytosis ability and respiratory burst of polymorphonuclear cells, and inflammatory response by plasma levels of C-reactive protein. Operative intestinal microperfusion, postoperative intestinal mucosa oxygen metabolism, and plasma intestinal isoenzyme of alkaline phosphatase were used as indicators of gut function. Plasma nitric oxide also was determined.

Results
In the enriched group, phagocytosis ability and respiratory burst after surgery was higher (P<.01) and C-reactive protein level was lower (P<.05) than in the control group. The enriched group had higher mean (±SD) intestinal microperfusion (180±46 vs 146 ± 59 perfusion units, P<.05), intestinal mucosa oxygen metabolism (pHi 7.39±0.2 vs pHi 7.33±0.1, P<.05), and 5-fold lower levels of intestinal isoenzyme of alkaline phosphatase (P<.05). Postoperative levels of nitric oxide were higher in the enriched group (P<.05, analysis of variance).

Conclusion
The perioperative administration of an enriched enteral formula significantly improved gut function and positively modulated postsurgical immunosuppressive and inflammatory responses.

Arch Surg. 1996;131:1257-1265

Author Affiliations
From the Departments of Surgery (Drs Braga, Gianotti, Cestari, Vignali, and Di Carlo) and Laboratory Medicine (Dr Dolci), and the Laboratory of Cardiovascular Pathophysiology (Dr Pellegatta), Scientific Institute S Raffaele Hospital, University of Milan, Milan, Italy.

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