Hu MM, Ding YL, Li J. Effectiveness of early enteral nutrition support in patients undergoing gastrointestinal perforation repair surgery within the enhanced recovery. World J Gastrointest Surg 2025; 17(5): 106384 [DOI: 10.4240/wjgs.v17.i5.106384]
Corresponding Author of This Article
Miao-Miao Hu, Associate Chief Nurse, Intensive Care Unit, Suzhou Hospital of Anhui Medical University, Suzhou Municipal Hospital of Anhui Province, No. 299 Bianhe Middle Road, Suzhou 234000, Anhui Province, China. 15505579783@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Miao-Miao Hu, Juan Li, Intensive Care Unit, Suzhou Hospital of Anhui Medical University, Suzhou Municipal Hospital of Anhui Province, Suzhou 234000, Anhui Province, China
Ya-Li Ding, Department of General Surgery, Suzhou Hospital of Anhui Medical University, Suzhou Municipal Hospital of Anhui Province, Suzhou 234000, Anhui Province, China
Author contributions: Hu MM designed and coordinated the study and wrote the manuscript; Ding YL performed the experiments, acquired, and analyzed the data; Li J interpreted the data; All authors approved the final version of the article. Hu MM and Ding YL contributed equally to this study as co-first authors.
Institutional review board statement: The study was reviewed and approved by the Suzhou Municipal Hospital of Anhui Province Institutional Review Board.
Informed consent statement: All study participants provided informed written consent before study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Miao-Miao Hu, Associate Chief Nurse, Intensive Care Unit, Suzhou Hospital of Anhui Medical University, Suzhou Municipal Hospital of Anhui Province, No. 299 Bianhe Middle Road, Suzhou 234000, Anhui Province, China. 15505579783@163.com
Received: February 26, 2025 Revised: March 17, 2025 Accepted: March 27, 2025 Published online: May 27, 2025 Processing time: 85 Days and 19.1 Hours
Abstract
BACKGROUND
Gastrointestinal (GI) perforation (GP) repair is a surgical procedure to promptly seal perforations in the GI tract to prevent further leakage. After surgery, patients often experience a high metabolic state due to trauma, infection, and postoperative stress. In the Enhanced Recovery After Surgery (ERAS) protocol, early enteral nutrition is a key strategy for promoting postoperative recovery. Compared with parenteral nutrition, enteral nutrition more effectively meets the physiological needs of the GI system, promotes the recovery of gut function, and reduces the risk of GI infections.
AIM
To evaluate the clinical efficacy of early enteral nutrition support in patients undergoing GP repair within the ERAS protocol.
METHODS
This retrospective study analyzed 66 patients who underwent GP repair. Patients were divided into a control group (n = 32), managed with a traditional nutritional regimen, primarily consisting of total parenteral nutrition; and an observation group (n = 34), which included those who received early enteral nutrition support as part of the ERAS protocol. This study examined the time to first postoperative flatus and bowel movement, changes in nutritional and immune function, inflammatory markers on postoperative days 1 and 5, and adverse reactions.
RESULTS
The observation group had significantly shorter times to the first postoperative flatus and bowel movement than the control group (P < 0.05). On postoperative day 5, the observation group demonstrated higher nutritional and immune function levels than the control group (P < 0.05), while C-reactive protein levels were significantly lower (P < 0.05). The overall incidence of adverse reactions in the observation group was 8.82% (3/34), which was lower than the 28.13% (9/32) observed in the control group (P < 0.05).
CONCLUSION
Early enteral nutritional support facilitates GI recovery after GP repair. It improves nutritional status, enhances immune function, and attenuates inflammatory responses while also demonstrating a favorable safety profile.
Core Tip: This retrospective study compared early enteral nutrition (Enhanced Recovery After Surgery [ERAS] protocol) with traditional parenteral nutrition in 66 patients undergoing gastrointestinal perforation repair. The observation group (n = 34) showed shorter times to first flatus and bowel movement, higher nutritional (prealbumin, albumin, hemoglobin) and immune markers (immunoglobulin A [IgA], IgM, IgG), and lower C-reactive protein levels on postoperative day 5 vs the control group (n = 32). Adverse reactions were lower in the observation group (8.82% vs 28.13%). Early enteral nutrition under ERAS improves recovery, nutritional status, immune function, and reduces inflammation with better safety.
Citation: Hu MM, Ding YL, Li J. Effectiveness of early enteral nutrition support in patients undergoing gastrointestinal perforation repair surgery within the enhanced recovery. World J Gastrointest Surg 2025; 17(5): 106384
Gastrointestinal (GI) perforation (GP) is characterized by full-thickness rupture of the stomach or intestinal wall, resulting in the leakage of gastric contents and gas into the peritoneal cavity. Clinically, patients commonly exhibit symptoms such as severe abdominal pain, vomiting, abdominal muscle rigidity, and tenderness[1]. If left untreated, GP can result in the contamination of normally sterile body cavities, such as the thoracic, abdominal, or pelvic cavities, with GI contents, leading to secondary infections and other severe complications[2]. Approximately 20%-30% of patients with GP develop secondary abdominal infections, and the mortality rate in cases of delayed surgical repair can be as high as 40%-50%[3].
GP repair is a well-established surgical intervention designed to promptly close perforations in the GI tract, effectively sealing defects and preventing further leakage of intraluminal contents into the peritoneal cavity[4]. However, following surgical repair, patients often experience a state of high metabolism and catabolism due to multiple factors such as trauma, infection, and postoperative stress. This leads to increased energy demands, while digestive system function is typically suppressed during this period[5]. In the absence of timely and effective nutritional intervention, patients are at risk of malnutrition and immune dysfunction, which can progress to severe complications, including multiple organ failure, thereby substantially impairing postoperative recovery[6]. Therefore, the early initiation of appropriate nutritional support, particularly enteral nutrition, is a crucial strategy for promoting postoperative recovery.
Enhanced Recovery After Surgery (ERAS) is an evidence-based comprehensive intervention model designed to accelerate recovery, reduce postoperative complications, and improve overall patient outcomes. This involves a multidimensional approach integrating preoperative optimization, anesthesia and analgesia, early mobilization, and early enteral nutrition[7]. Recent studies have reported the role of early enteral nutrition support within the ERAS protocol in promoting postoperative recovery[8-10]. Compared with parenteral nutrition, enteral nutrition more effectively meets the physiological needs of the GI system, facilitates the recovery of gut function, and significantly reduces the incidence of GI infections[11]. Li et al[12] reported that enteral nutrition within the ERAS protocol can directly stimulate the intestinal mucosa in postoperative patients, enhance intestinal barrier function, improve gut microbiota imbalance, and decrease the risk of pathogen colonization. Furthermore, early enteral nutrition intervention has been shown to lower the incidence of postoperative infections, peritonitis, and multiple organ failure by suppressing systemic inflammation and enhancing immune function, thereby effectively shortening hospital stay[13]. As a key component of the ERAS model, early enteral nutrition intervention offers a safe, effective, and practical approach to postoperative management after GI surgery.
Although the ERAS model has been widely studied in elective GI surgeries, such as tumor resection, its application in emergency procedures, particularly GP repair, remains unclear[14,15]. Current literature lacks systematic evaluations of ERAS effectiveness and safety in emergency surgical settings, and the suitability, tolerance, and long-term clinical benefits of early enteral nutrition in these patients remain unclear. Therefore, this study conducted a retrospective analysis to assess the impact of early enteral nutrition support within the ERAS framework on postoperative outcomes in patients undergoing GP repair. The findings aim to provide robust theoretical evidence and practical insights to optimize clinical decision-making in this critical area.
MATERIALS AND METHODS
Clinical data
This retrospective study included 66 patients who underwent GP repair at a tertiary hospital between February 2021 and December 2024. Of these, 32 received total parenteral nutrition (control group), while 34 patients received early enteral nutrition support (observation group). This study was approved by the hospital's ethics committee (Approval No. C2025001). Informed consent was obtained from all patients and their families, who voluntarily signed consent forms after being fully informed.
Inclusion and exclusion criteria
Inclusion criteria: (1) Patients who underwent GP repair surgery; (2) Aged between 20 and 95 years; (3) American Society of Anesthesiologists (ASA) score ≤ 2; (4) No prior history of abdominal surgery; (5) No diabetes, impaired glucose tolerance, or other related endocrine or metabolic disorders; and (6) Complete clinical data available.
Exclusion criteria: (1) Patients with evident malnutrition or severe anemia before surgery; (2) Patients diagnosed with psychiatric disorders; and (3) Patients with severe organ dysfunction or malignant tumors.
Methods
Both groups underwent postoperative follow-up for 30 days. If the patient's hospital stay was shorter than 30 days, follow-up and health management were performed through outpatient visits, phone calls, or WeChat.
Control group
Patients in the control group received traditional nutritional management, primarily based on total parenteral nutrition. Before surgery, healthcare providers educated patients and their families about the surgical procedure, expected treatment outcomes, potential postoperative complications, and postoperative management. On postoperative day 1, total parenteral nutrition was initiated via a central venous catheter with a daily infusion time of 12-16 hours, continuing until the day before discharge. Once the patient passed gas, oral intake of warm water was allowed. If no adverse reactions were noted, the diet was gradually progressed from liquid to semi-solid foods.
Observation group
Patients in the observation group received early enteral nutrition support under the ERAS protocol combined with parenteral nutrition.
(1) Prior to surgery, the surgical team and assigned nurses provided detailed ERAS protocol education. The educational content covered an overview of the disease and surgical procedures. Through targeted health education, the team helped patients and their families better understand the common misconceptions associated with the surgical process. This approach aimed to provide scientifically accurate information about the surgery, thereby reducing the patients' fear and anxiety; (2) During the surgery, a nasojejunal tube and gastric decompression tube were placed to facilitate enteral nutrition support. Under direct visualization, the nasojejunal tube was guided into the proximal jejunum, while the gastric decompression tube was positioned within the gastric lumen for postoperative gastric decompression. Parenteral nutritional support was routinely initiated on postoperative day 1. On postoperative day 2, if the patient exhibited no significant discomfort, 500 mL warmed glucose-saline solution was administered via enteral feeding to promote intestinal adaptation. If no adverse reactions were noted on postoperative day 3, an enteral nutrition suspension (National Drug Approval No. H20010285, Peptisorb; Nutricia Pharmaceutical (Wuxi) Co., Ltd., Jiangsu Province, China) was introduced via tube feeding at an infusion rate of 20 mL/hour. The nutrient solution was maintained at a temperature of 37-40 °C to ensure optimal absorption. The infusion rate was gradually increased based on the patient’s tolerance, with a target caloric intake of 25 kcal/kg per day. As permitted by the patient’s condition, small amounts of liquid food could be introduced, and if postoperative adaptation was satisfactory, the diet could be transitioned to semi-solid foods until discharge. The gradual increase in enteral nutrition was accompanied by a progressive decrease in the volume of intravenous fluids to facilitate the transition to full enteral feeding; and (3) Once the patient regained consciousness from anesthesia, typically 4-6 hours postoperatively, they were encouraged to begin out-of-bed activities. An individualized exercise plan was developed, tailored to the patient's age and physical endurance, with the exercise intensity adjusted to ensure that the patient experienced no shortness of breath or fatigue. In terms of postoperative pain management, detailed instructions on the use of a patient-controlled analgesia pump were provided to both patients and their families. The patients were guided to manage the timing of medication administration to ensure optimal pain control.
Evaluation indicators
Blood samples were collected from both patient groups preoperatively and on postoperative days 1, 3, and 5 after overnight fasting. Serum levels of prealbumin (PA), albumin (ALB), hemoglobin (Hb), immunoglobulin A (IgA), IgM, IgG, and C-reactive protein (CRP) were measured to assess changes. Furthermore, perioperative complications were closely monitored, including both surgery- and nutrition-related issues such as bloating, vomiting, diarrhea, and wound infections. The time to first flatus and time to first bowel movement were also recorded to evaluate postoperative recovery.
Statistical analyses
Statistical analyses were carried out using SPSS version 22.0 (IBM SPSS Statistics, Armonk, NY, United States). Normality of the data distribution was checked using the Kolmogorov–Smirnov test. For normally distributed continuous variables, data are presented as the mean ± SD, and comparisons between groups were made using the t-test. For non-normally distributed continuous variables, the data are presented as medians (M [P25, P75]), and the Mann-Whitney U test was used to assess differences between groups. Categorical data are presented as frequencies and percentages, with comparisons made using the χ2 test. P < 0.05 was considered statistically significant.
RESULTS
Comparison of basic data
There were no statistically significant differences in sex, age, body mass index, ASA score, duration of surgery, or location of GP between the two groups (P > 0.05; Table 1).
Table 1 Comparison of basic data, n (%)/mean ± SD.
Control group (n = 32)
Observation group (n = 34)
t/χ2
P value
Sex
0.391
0.532
Male
23 (71.88)
22 (64.71)
Female
9 (28.13)
12 (35.29)
Age
59.22 ± 10.88
57.21 ± 10.48
0.766
0.447
BMI (kg/m2)
22.83 ± 3.54
22.04 ± 2.62
1.033
0.306
ASA score
0.121
0.728
I
22 (68.75)
22 (64.71)
II
10 (31.25)
12 (35.29)
Surgical time (minute)
127.09 ± 21.26
129.79 ± 22.25
0.504
0.616
Gastrointestinal perforation location
0.507
0.776
Gastroduodenum
22 (68.75)
26 (76.47)
Small intestine
4 (12.50)
3 (8.82)
Large intestine
6 (18.75)
5 (14.71)
Comparison of recovery outcomes
Patients in the observation group experienced a shorter time to first flatus and first bowel movement than those in the control group (P < 0.05; Table 2).
Table 2 Comparison of recovery outcomes, mean ± SD.
Control group (n = 32)
Observation group (n = 34)
t value
P value
Time to first flatus (hour)
16.83 ± 3.38
14.62 ± 2.89
2.859
0.006
Time to first bowel movement (hour)
20.74 ± 3.90
17.75 ± 2.43
3.762
< 0.001
Comparison of nutritional function
On postoperative day 1, the PA, ALB, and Hb levels in both the control and observation groups were lower than their respective preoperative levels (P < 0.05). By postoperative day 5, the PA, ALB, and Hb levels in the observation group showed an increase compared with those on postoperative day 1 (P < 0.05) and were nearly restored to preoperative levels (P > 0.05). By contrast, no changes were observed in the PA, ALB, or Hb levels in the control group between postoperative days 5 and 1 (P > 0.05), and these levels remained lower than preoperative values (P < 0.05).
PA, ALB, or Hb levels were not different between the two groups either preoperatively or on postoperative day 1 (P > 0.05). However, on postoperative day 5, the PA, ALB, and Hb levels were higher in the observation group than in the control group (P < 0.05; Table 3).
Table 3 Comparison of nutritional function, M (P25, P75).
Comparison of immune function and inflammatory markers
On postoperative day 1, IgA, IgM, and IgG levels in both the control and observation groups were lower than the preoperative levels (P < 0.05), whereas CRP levels showed a marked increase (P < 0.05). By postoperative day 5, the observation group exhibited an increase in IgA, IgM, and IgG levels relative to those on postoperative day 1 (P < 0.05), surpassing the preoperative levels (P < 0.05). By contrast, IgA, IgM, and IgG levels in the control group remained unchanged between postoperative days 1 and 5 (P > 0.05) and remained lower than the preoperative levels (P < 0.05). Moreover, the CRP levels in both groups demonstrated a reduction on postoperative day 5 compared with both postoperative day 1 and preoperative levels (P < 0.05).
Preoperatively and on postoperative day 1, there were no differences in the IgA, IgM, IgG, or CRP levels between the two groups (P > 0.05). However, on postoperative day 5, the observation group exhibited higher IgA, IgM, and IgG levels than the control group (P < 0.05), whereas CRP levels were notably lower (P < 0.05; Table 4).
Table 4 Comparison of immune function, M (P25, P75).
In either group, there were no cases of postoperative death, severe abdominal infections, or any other serious adverse reactions. The incidence of adverse reactions in the control group was 28.13% (9/32), including three cases of abdominal distension, two cases of vomiting, two cases of diarrhea, and two cases of incisional infection. By contrast, the incidence of adverse reactions in the observation group was lower at 8.82% (3/34), comprising one case each of abdominal distension, vomiting, and incisional infection. The postoperative incidence of adverse reactions was lower in the observation group than in the control group (P < 0.05; Table 5).
GP is a common clinical emergency, primarily treated with surgical repair[16]. However, patients typically experience notable postoperative trauma, extended recovery periods, and a hypermetabolic state[17]. Failure to provide timely and effective nutritional support may increase complications, which can critically affect patient prognosis[18]. Malnutrition is frequently observed in patients following GP repair surgery[19]. Therefore, an appropriate nutritional intervention strategy is critical to ensure survival, support organ function, and facilitate postoperative recovery. In the present study, patients in the observation group, who received early enteral nutrition support under the ERAS protocol, demonstrated substantially better outcomes than those in the control group, who received traditional total parenteral nutrition support. These outcomes included improvements in PG function, nutritional status, immune function, inflammatory response, and fewer adverse reactions.
The findings of this study demonstrated that patients in the observation group experienced substantially shorter GI recovery times, along with substantial improvements in nutritional parameters, such as PA, ALB, and Hb, than those in the control group. Unlike parenteral nutrition, it directly provides the necessary metabolic energy through the GI tract, aligning more closely with physiological processes[6,20]. Nutrients absorbed through the intestines improve the patient's nutritional status and enhance prognosis[21]. Moreover, the timing of nutritional support is crucial[22]. Fell et al[23] showed that small intestine function recovers approximately 12 hours after surgery, providing early postoperative initiation of enteral nutrition.
Preoperative intra-abdominal infections and stress responses induced by surgical trauma commonly lead to impaired immune function and heightened inflammatory responses postoperatively[24]. Furthermore, an imbalance between oxidative and antioxidant defenses, or oxidative stress, can trigger neutrophil infiltration and stimulate the production of reactive free radicals[25]. These factors are key contributors to postoperative malnutrition, infection, and delayed recovery. Therefore, inflammatory mediators and immune function are closely associated with the recovery trajectory of patients[26]. The findings of this study demonstrate that irrespective of whether patients received traditional total parenteral nutrition or early enteral nutrition under the ERAS protocol, they exhibited a notable increase in inflammatory markers and a notable decline in immune markers on postoperative day 1 compared with preoperative levels. These results indicate that surgical trauma significantly increases the systemic inflammatory response while suppressing immune function. These results align with those of Zhao and Yu[27], who noted that an increase in acute postoperative inflammation and oxidative stress is closely associated with several adverse outcomes, including immunosuppression, increased risk of infection, and delayed recovery. Additionally, Lu et al[28] further emphasized that postoperative immune suppression is not only linked to a higher incidence of infections but is also associated with prolonged hospital stays and an increased risk of complications.
In the observation group, the levels of inflammatory markers on postoperative day 5 were substantially lower than preoperative levels, whereas immune markers were notably higher, and these outcomes were substantially better than those of the control group. This finding strongly supports the positive role of early enteral nutrition under the ERAS protocol in promoting postoperative recovery. First, early enteral nutrition plays a crucial role in postoperative recovery by not only supplying essential nutrients to maintain intestinal barrier integrity but also modulating immune cell activity, thereby enhancing the body's immune defense[29]. Chen et al[13] found that enteral nutrition with dietary fiber, amino acids, and immune-modulating factors can activate T cells, B cells, and macrophages, thereby improving postoperative immune function. Additionally, dietary fiber, essential amino acids, and immune-modulating factors in eternal nutrients support immune system function and overall health. Furthermore, specific bioactive nutrients in enteral nutrition contribute to the activation of gut-associated immune pathways, reinforcing intestinal immune barrier function and enhancing systemic immune adaptability. Poggioli et al[30] reported that omega-3 fatty acids and short-chain fatty acids regulate T cells and promote anti-inflammatory immune responses, and homeostasis. Furthermore, early enteral nutrition helps modulate the intestinal microflora, thereby reducing the incidence of enterogenic infections and consequently mitigating postoperative inflammatory responses[31]. Bar-Yoseph et al[32] found that early enteral nutrition effectively prevents dysbiosis, inhibits the translocation of intestinal toxins into the bloodstream, and reduces the levels of inflammatory markers. Maintaining intestinal barrier function and restoring gut health play critical roles in reducing oxidative stress[33]. Rousseau and Martindale[34] observed that early enteral nutrition in ERAS speeds immune recovery, enhances gut microbiota, and improves intestinal permeability, reducing the production and excessive accumulation of free radicals, thus alleviating oxidative stress and facilitating faster postoperative recovery.
This study revealed that the incidence of adverse reactions in the observation group was substantially lower than that in the control group, suggesting that early enteral nutrition under the ERAS protocol is safe after GP repair. This difference may result from gut microbiota imbalance, intestinal barrier dysfunction, and prolonged lack of enteral nutritional stimulation. The gut microbiota plays a pivotal role in regulating GI function, immune homeostasis, and host defense against infections. Prolonged absence of enteral nutrition disrupts microbial balance, reduces beneficial bacteria such as Bifidobacterium and Lactobacillus, and promotes pathogen overgrowth[35]. This microbial dysbiosis may contribute to heightened inflammatory responses, impairing intestinal barrier integrity and increasing the risk of postoperative GI complications[36]. Research suggests that nutritional deprivation weakens intestinal epithelial cell proliferation, compromises barrier function, and elevates intestinal permeability, leading to bacterial translocation and exacerbated inflammatory reactions[37]. These pathophysiological alterations could partly explain the higher incidence of postoperative complications observed in the control group. However, some studies suggest that early initiation of enteral nutrition may occasionally cause intestinal dysfunction or mild GI discomfort in certain patients[38]. This may be attributed to the slower recovery of intestinal function or individual patient variations[39]. Therefore, when implementing early enteral nutrition, it is critical to perform a thorough evaluation and close monitoring of the clinical status of the patient to prevent potential complications.
CONCLUSION
Early enteral nutrition support under the ERAS protocol is safe for patients undergoing GP repair. It improves GI function and nutritional status, reduces postoperative inflammatory responses, and enhances immune function, thereby facilitating postoperative recovery. However, this study had several limitations. First, it is a single-center study with a relatively small sample size, which may introduce selection bias and limit the generalizability of the findings. Future research should incorporate multi-center prospective cohort studies with larger sample sizes to enhance the study’s reliability and external validity. Second, the follow-up duration was relatively short, preventing a comprehensive assessment of the long-term effects. Future studies should extend the follow-up period and integrate long-term survival, nutritional status, and functional recovery metrics to further validate its long-term safety and clinical benefits. Additionally, this study did not distinguish between different perforation sites, despite the potential influence of anatomical and pathological variations on nutritional tolerance, intestinal function recovery, and overall prognosis. Future research should include subgroup analyses to refine site-specific nutritional strategies, enhancing clinical applicability.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade C, Grade C
P-Reviewer: Oderberg IM; Seo KI S-Editor: Lin C L-Editor: Filipodia P-Editor: Zhao YQ
Gao X, Liu Y, Zhang L, Zhou D, Tian F, Gao T, Tian H, Hu H, Gong F, Guo D, Zhou J, Gu Y, Lian B, Xue Z, Jia Z, Chen Z, Wang Y, Jin G, Wang K, Zhou Y, Chi Q, Yang H, Li M, Yu J, Qin H, Tang Y, Wu X, Li G, Li N, Li J, Pichard C, Wang X. Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery: A Randomized Clinical Trial.JAMA Surg. 2022;157:384-393.
[RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)][Cited by in Crossref: 24][Cited by in RCA: 51][Article Influence: 17.0][Reference Citation Analysis (0)]
Dong J, Lei Y, Wan Y, Dong P, Wang Y, Liu K, Zhang X. Enhanced recovery after surgery from 1997 to 2022: a bibliometric and visual analysis.Updates Surg. 2024;76:1131-1150.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 1][Reference Citation Analysis (0)]
De Luca R, Gianotti L, Pedrazzoli P, Brunetti O, Rizzo A, Sandini M, Paiella S, Pecorelli N, Pugliese L, Pietrabissa A, Zerbi A, Salvia R, Boggi U, Casirati A, Falconi M, Caccialanza R. Immunonutrition and prehabilitation in pancreatic cancer surgery: A new concept in the era of ERAS® and neoadjuvant treatment.Eur J Surg Oncol. 2023;49:542-549.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 41][Cited by in RCA: 34][Article Influence: 17.0][Reference Citation Analysis (0)]
Talebi S, Zeraattalab-Motlagh S, Vajdi M, Nielsen SM, Talebi A, Ghavami A, Moradi S, Sadeghi E, Ranjbar M, Habibi S, Sadeghi S, Mohammadi H. Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta-analyses of randomized trials.Nutr Clin Pract. 2023;38:564-579.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 3][Reference Citation Analysis (0)]
Sindler DL, Mátrai P, Szakó L, Berki D, Berke G, Csontos A, Papp C, Hegyi P, Papp A. Faster recovery and bowel movement after early oral feeding compared to late oral feeding after upper GI tumor resections: a meta-analysis.Front Surg. 2023;10:1092303.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 4][Reference Citation Analysis (0)]
Costa G, Fransvea P, Lepre L, Liotta G, Mazzoni G, Biloslavo A, Bianchi V, Occhionorelli S, Costa A, Sganga G; FACS on behalf of the IGo-GIPS study group. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach.Surg Endosc. 2023;37:5137-5149.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 9][Cited by in RCA: 8][Article Influence: 4.0][Reference Citation Analysis (0)]
Lian H, Chen W, Yu J, Lv W, Pan W, Li Y, Gao J, Huang H. Intestinal Nutrition Played a Vital Important Role in an Intestinal Perforation Patient with Chronic Constipation: A Case Report.Altern Ther Health Med. 2023;29:40-43.
[PubMed] [DOI]
Xu X, Zhang B, Tan M, Fan X, Chen Q, Xu Z, Tang Y, Han L. Clinical application of early postoperative nutritional support in patients with high-risk valvular heart disease.Shock. 2024;62:522-528.
[RCA] [PubMed] [DOI] [Full Text][Reference Citation Analysis (0)]
Zhao H, Yu H. Postoperative Effects of Cinobufacini Capsules on Pain Reduction, Mitigation of Oxidative Stress, Immune Modulation, and Inflammatory Response in Differentiated Thyroid Cancer.Altern Ther Health Med. 2024;30:346-350.
[PubMed] [DOI]
Lu XT, Duan RR, Qin XY, Huang WH, Ding SS, Zhang J, Wang CA. [Effect of percutaneous acupoint electrical stimulation on immune function and postoperative recovery in patients with total knee arthroplasty].Zhongguo Gu Shang. 2024;37:1213-1218.
[RCA] [PubMed] [DOI] [Full Text][Reference Citation Analysis (0)]
Häcker D, Siebert K, Smith BJ, Köhler N, Riva A, Mahapatra A, Heimes H, Nie J, Metwaly A, Hölz H, Manz Q, De Zen F, Heetmeyer J, Socas K, Le Thi G, Meng C, Kleigrewe K, Pauling JK, Neuhaus K, List M, Pollard KS, Schwerd T, Haller D. Exclusive enteral nutrition initiates individual protective microbiome changes to induce remission in pediatric Crohn's disease.Cell Host Microbe. 2024;32:2019-2034.e8.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 5][Reference Citation Analysis (0)]
