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Malnutrition is a common and serious problem in intensive care units. Negative energy balance has been associated with increased morbidity and mortality in critically ill patients. The increased incidence of complications attributable to malnutrition correlates with increased length of hospital stay and overall health care costs. Although early enteral nutrition is the preferred method of feeding critically ill patients, enteral nutrition alone often fails to supply adequate calories and nutrients to critically ill patients, who are frequently hypermetabolic. Supplementation of insufficient enteral nutrition with parenteral nutrition may optimize nutritional support and avert negative energy balance in critically ill patients, thereby improving outcomes.

postoperative enteral feeding (EN) has been proposed as the novel method for nutritional support after surgery. Nevertheless, pancreatic surgeons often prefer postoperative TPN because of concerns about the possible adverse effects of early feeding and increased risk of anastomotic leak especially pancreaticojejunostomy site. The aim of this study was to evaluate whether early postoperative enteral feeding reduced the incidence of complications and length of hospital stay in patients following pancreaticoduodenectomy Methods: Between May 2007 and March 2008, 21 patients who underwent PD for a periamullary disease at Yongdong Severance Hospital of Yonsei University College of Medicine and randomized to enteral feeding or TPN. Enteral feeding and TPN begun on postoperative 1, and advanced to a goal of 25 kcal/kg per day. Both group started to have an oral diet after stool passing. Complications was diagnosed according to the criteria developed by the International Study Group Results: Patients demographics, nutritional state, and operative factors were similar between the groups. Comparison of length of hospital stay and time to normal intake of soft diet were shorter in the EN group, but there was no statistical significance. Postoperative surgery related complication (anastomosis leak, delated gastric empting) was similar between both group, however the rate of infections complications (wound infection, pneumonia, UTI, etc) was lower in EN group. Conclusion: The postoperative early enteral feeding is safe and well-tolerated and it s could give the beneficial opportunity for patients who have underwent PD for a periampullary disease.