Health Care Professionals Group

Abdominoperineal resection and nutritional requirements.. Health care professionals please help?

Abdominoperineal resection. After the surgery, how does the patient recieve adequate nutrients? How long are they nil by mouth after the procedure and is it possible or common for these patients to recieve TPN to allow the bowel to rest? Or dextrose? Thanks in advanced. :)

Public Comments

1. My hubby just had 20% of his stomach removed and 40% of his liver and he was on IV fluids for 10 days the intestinal tract has to rest and start working again before you can take anything by mouth.
2. After an APR (usually for a rectal cancer or low-lying diverticulosis) the main concern is healing and proper functioning of the bowel. If the patient has received a colostomy bag with the APR, then eating can begin as soon as the patient begins to have functional bowels (usually measured by when they begin to "pass gas"). If the patient has had a re-anastomosis (i.e. a segment of rectum/colon removed and then put back together immeidately) then it may take a little bit longer - but not by much. Typically patients will eating within a week following an APR, and usually much earlier. Interestingly, there has been some data to suggest that patients should be encouraged to begin eating immediatly after surgery - although I have never actually seen this in practice, and I think most surgeons would still be a bit nervous about doing this. In Canada, patients who are not eating after surgery receive IV fluids with normal saleine +/- some dextrose. TPN is not used unless there are other reasons for an extended period of not eating. With respect to your nutritional requirements, they are really not any different than before (assuming thatyou only had some rectum/large bowel removed - and no small bowel, stomach, etc). It is important to note that this is very different from a stomach resection (total or subtotal gastrectomy) as a previous respondent indicated because in such a case there will be specific absorption losses. One thing that may occur following APR is a softening of stools or even more loose stools because less water is reabsorbed in the large bowel. Ironically, one of the things that canbe helpful for this is a stool bulking agent with high fibre such as metamucil. Hope this helps.