Optimised Recovery With Accelerated Nutrition and GI Enhancement

A Randomised Controlled Trial of Optimised Surgical Recovery: the Potential Synergy Between Enhanced Gastrointestinal Motility and Oral Nutritional/ Metabolic Support

Factors which delay recovery following uncomplicated abdominal surgery include uncontrolled pain, intolerance of diet and poor mobility. Enhanced recovery after Surgery (ERAS) programmes are perioperative care pathways that address systematically these issues (i.e. improved dynamic pain relief, optimised nutritional care and enforced mobilisation) to promote a faster recovery and a shorter stay. The key treatments that improve outcome within an ERAS programme are not known. Moreover there are few acceptable, objective endpoints to assess key outcome variables such as return of GI function. This randomised trial will assess the potential synergy between early recovery of GI function (laxation) and early postoperative oral nutritional support(with associated preoperative preconditioning using carbohydrate/fluid loading). The main overall outcome targets being improved recovery of gastrointestinal function, postoperative nutritional status and physical function. It will validate the use of a novel, objective technique to measure gastric motility (surrogate for GI function). Such refinement of ERAS should result in shorter hospital stay and better use of limited health care resource.

Inclusion Criteria:

• Patients undergoing hepatic resection for benign or malignant conditions
• Able to understand the nature of the study and what will be required of them.
• Men and non-pregnant, non-lactating women
• BMI 18 - 30

Exclusion Criteria:

• Inability to give written, informed consent
• Patients with dementia or neurological impairment
• Patients with pre-existing condition limiting mobility
• Planned bile duct excision
• Repeat or staged procedures
• Central extended resections
• Underlying cirrhotic liver disease
• Jaundice (Bilirubin > 50 μmol/L)