According to ESPEN 2023 guidelines for perioperative nutrition in elective major abdominal surgery, what is the preferred route and timing of nutritional support when oral intake is inadequate postoperatively?
- A Early oral/enteral nutrition initiated within 24 hours of surgery if no contraindications ✓
- B Total parenteral nutrition (TPN) started on day 1 postoperatively via central line
- C Peripheral parenteral nutrition for 5 days followed by oral diet
- D Delayed enteral nutrition starting on day 3 to allow anastomotic healing
Explanation
ESPEN 2023 perioperative nutrition guidelines strongly recommend early oral or enteral nutrition (within 24 hours postoperatively) as it is associated with lower complication rates, shorter hospital stay, and better functional outcomes compared to delayed nutrition or TPN. Early enteral feeding maintains gut barrier function, reduces bacterial translocation, and supports immune function. TPN is reserved for patients who cannot tolerate enteral nutrition (intestinal failure, major complications). Waiting for 'anastomotic healing' before feeding is not evidence-based—early oral feeding does not increase anastomotic leak rates.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.