Randomized sequential trial of parenteral nutrition in healing of colonic anastomoses in man

Abstract

Adults who underwent elective colonic resection with anastomosis for both benign and malignant disease were randomly assigned to control or treated groups. Treated patients received daily 50 ml/kg of amino acid solution containing either 10 or 25 g/dl glucose by central or peripheral vein plus 500 ml of commercial soybean emulsion for 24 hours before operation and for 5 consecutive days after. Patients in both groups were examined by roentgenography after a water-soluble contrast enema, between 10 and 14 days after operation, and the integrity of the anastomosis was assessed radiologically without knowledge of the treatment given. Results were assessed by sequential analysis. After 21 pairs of subjects were entered,a boundary was crossed making the area favourable to treatment inaccessible, and the trial was terminated. Forty-seven patients were included in the trial: there were four anastomotic leaks in 23 control subjects and eight leaks in 24 treated subjects. The authors conclude that intensive perioperative parenteral nutrition in patients who undergo routine elective colonic resection does not improve the rate of healing of colonic anastomoses.