Wandel der enteralen Ernährung in der gastrointestinalen Chirurgie - das „Fast-track”-Rehabilitationskonzept

Zusammenfassung

In den letzten Jahren hat der Zuwachs an wissenschaftlichen Erkenntnissen zur perioperativen Pathophysiologie nach abdominalchirurgischen Operationen zur Entwicklung verschiedener perioperativer multimodaler Rehabilitationskonzepte geführt. Diese so genannten „Fast-track”-Rehabilitationskonzepte sollen eine raschere Genesung der Patienten und eine Reduktion der allgemeinen Komplikationen bewirken. Ein Eckpfeiler der „Fast-track”-Rehabilitation in der großen Abdominalchirurgie ist die frühzeitige orale Ernährung. Ermöglicht wird der rasche postoperative Kostaufbau durch den konsequenten Einsatz der thorakalen Periduralanalgesie, den Verzicht auf systemische Opiatgaben und die Verwendung einer systemischen nicht-opioidhaltigen Basisanalgesie. Ergänzt werden diese Maßnahmen durch die Verwendung minimalinvasiver Techniken oder modifizierter konventioneller Zugänge zur Abdominalhöhle, die perioperative Beschränkung der Infusionsmenge und eine rasche postoperative Mobilisation. Die pathophysiologischen Grundlagen der „Fast-track”-Rehabilitation und ihre Bedeutung im klinischen Alltag werden im nachfolgenden Artikel zusammengefasst und diskutiert.

Abstract

In recent years growing scientific knowlegde on the perioperative pathophysiology of abdominal surgery has led to the developement of perioperative multimodal rehabiliation programs. These “Fast-track”-Rehabilitation programs were created to improve reconvalescence of patients and reduce the incidence of general complications. One cornerstone of “Fast-track”-rehabilitation after major abdominal surgery is early oral feeding. Consequent utilization of thoracic epidural analgesia, avoidance of systemic opioids and systemic basal analgesia with non-opioid-analgetics, minimal invasive surgery or modified conventional approaches to the abdominal cavity, perioperative restriction of infusions and enforced postoperative mobilisation allow for early oral feeding even after major procedures. The pathophysiological basics or “Fast-track”-rehabilitation and their value in the clinical routine will be summarized and discussed in the following manuscript.

Schlüsselwörter

Postoperative enterale Ernährung - multimodale Behandlung - gastrointestinale Chirurgie - perioperative Therapie - „Fast-track”-Rehabilitation

Key words

Postoperative enteral feeding - multimodal treatment - gastrointestinal surgery - perioperative therapy - fast-track-rehabilitation

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