Nutritional Delivery and Adequacy during Bile Reinfusion in Post-Surgical Patients

Abstract

Background: Bile acid and salts depletion from high output bile in post- gastrointestinal surgical patients can lead to fat malabsorption causing malnutrition, fat-soluble vitamin deficiencies, dehydration, acute kidney injury and electrolyte abnormalities. Bile reinfusion is a method for restoration of bile salts in the gut. However, there are no studies which describe feeding delivery and nutritional adequacy during bile reinfusion. Methods: Patients undergoing gastrointestinal surgery and who have high bile output >500ml were included. Patients were started on oral, tube feeding and/or parenteral nutrition. Results: Twenty post- gastrointestinal surgical patients with a mean age of 48±13.5years and body mass index of 23.94±4.0kg/m2 had high output bile and in whom reinfusion was initiated. An average volume of 531±438ml/day of bile was reinfused for 9±4.99days along with oral diet or tube feeding and/or parenteral nutrition. Of the 20patients, 2 were exclusively on tube feeding, 5 on tube feeding and oral, 7 on oral and supplemental parenteral nutrition, and 6 on tube feeding with supplemental parenteral nutrition. Adequacy of energy and protein were categorized as ≥70% and <70%. Adequacy of protein and energy of ≥70% was achieved among 13patients (p=0.004, p=0.012). Although the adequacy was not statistically significant due to the small sample size, 18patients were discharged in clinically good condition and 2patients did not survive. Conclusions: The improvement in the patient’s nutrition, as in this study, is probably a significant contributing factor towards a positive postoperative outcome. Clinical benefits of this technique include fluid and electrolyte balance and optimal utilization of remaining absorptive capacity for enteral and/or oral nutrition.