Perioperative nutritional support

Malnutrition is a common and often unrecognized problem which increases the risk of postoperative morbidity and mortality. To identify those at risk, all patients should be screened on admission to hospital using a validated reliable tool (e.g. the Malnutrition Universal Screening Tool, MUST). Minimal perioperative fasting, carbohydrate loading and early enteral feeding all reduce postoperative complications and enhance recovery. Refeeding syndrome needs to be diagnosed and treated prior to initiating feeding. Enteral is the preferred route of feeding as it provides nourishment directly to the gut. If parenteral nutrition (PN) is indicated then close monitoring and strict guidelines need to be followed to reduce the risk of metabolic complications and line sepsis. PN is an integral part of the management of high-output enterocutaneous fistulae (ECF). A high-output ileostomy causes malnutrition and electrolyte abnormalities. Alterations to diet and fluids alongside medical management are necessary to reduce the high-output stoma.