[Malnutrition after biliopancreatic diversion--postoperative management and complications]. / Malnutrition nach biliopankreatischer Teilung--postoperative Maßnahmen und Komplikationen.

The biliopancreatic diversion is currently the maximum variant of bariatric surgery. It presents several opportunities of typical surgical complications, beside the risks generally prevailing in bariatric surgery. In addition, there is the procedure-immanent risk of development of nutritional deficiencies in the long-term process, at significant percentages. These deficiencies can, to a great extent, be avoided by consistent supplementation within the scope of a structured follow-up program; they can also be corrected by a substitution therapy. In the future, the risk of malnutrition can possibly be lowered by technically modified procedures with equal bariatric effectiveness. Considering the very good long-term results with regard to stable weight reduction in connection with a high recovery rate of the comorbidities, combined with a consistent postal-surgical management, the problem of malnutrition appears to be of minor importance. However, an appropriate compliance of the patient is also required.

Influence of nutritional treatment on the postoperative course in patients with gastric cancer.

PURPOSE: Malnutrition occurs in ca. 60% of all patients with gastric cancer. The obligatory standard for a curative radical oncological procedure is gastrectomy inclusive of regional lymph nodes. Nutritional treatment is expected to decrease possibilities of postoperative complications in patients subjected to curative surgery. The study is aimed at comparing treatment results in patients with gastric cancer subjected to radical surgery, nutritional and non-nutritional treatment respectively. MATERIAL AND METHODS: The study included 176 patients qualified for curative surgery of a total or subtotal gastrectomy. Analysed were 2 groups of patients: group I--not subjected to nutritional treatment, group II--subjected to nutritional treatment, both in the circumoperative period. The groups were compared in respect to: 1) age, 2) sex, 3) nutritional condition, 4) degree of clinical cancer development, 5) histopathological cancer type, 6) kind of surgical procedure performed, 7) antibiotic and antithrombotic prevention. All complications observed in the patients were divided into four kinds: surgical of a high or low risk and general of a high or low risk. RESULTS: Given the above-mentioned estimation parameters, no statistically significant differences between both groups were recorded. Of 176 patients, 27% showed surgical complications and 40% had general complications. No difference (p = 0.60) in the incidence of a high and low risk surgical complications between groups I and II in the circumoperative period was observed, a significant difference (p = 0.03) was recorded in the incidence of general complications. Low risk general complications (respiratory infections) were shown to occur significantly more often (p = 0.005) in patients receiving either parenteral or enteral nutrition after surgery. CONCLUSIONS: A significant part of the patients with a medium degree and a medium to heavy degree of malnutrition subjected to a curative gastrectomy can pass through the postoperative period without using either parenteral or enteral nutrition and with no violations of all the other principles of the postoperative procedure as well as without provoking any significant increase of surgical complications. In case surgical complications should occur and delay resuming natural feeding, it is necessary that parenteral and/or enteral nutritional treatment be undertaken according to clinical circumstances and condition of the patient concerned; such proceedings increase chances of cure.