SURGICAL TREATMENT OF BOWEL DISEASES WITH NUTRITIONAL SUPPORT

Abstract

Introduction: Diseases affecting the gastrointestinal tract and requiring surgical intervention represent a significant clinical challenge, not only due to the technical complexity of the procedures, but also due to the profound metabolic and nutritional impact they impose on patients. Conditions such as Crohn's disease, ulcerative colitis, neoplasms and intestinal obstructions often result in a pre-existing state of malnutrition, characterized by poor food intake, poor nutrient absorption and a chronic inflammatory state. This scenario of nutritional depletion, combined with the intense catabolic stress of the surgery itself, has historically been associated with increased morbidity and mortality, with higher rates of infectious complications, anastomotic failures and longer recovery times, highlighting the importance of strategies to mitigate these risks. Objective: The objective of this systematic literature review was to evaluate the available scientific evidence on the impact and effectiveness of perioperative nutritional support on the prognosis of patients undergoing surgical treatment for intestinal diseases. Methodology: The study was conducted according to the PRISMA checklist guidelines, with a systematic search in the PubMed, Scielo and Web of Science databases for articles published in the last ten years. The descriptors used were: "Bowel Surgery", "Nutritional Therapy", "Malnutrition", "Postoperative Complications" and "Prognosis". The following inclusion criteria were defined: (1) studies that evaluated the use of nutritional support (enteral or parenteral) in intestinal surgical patients; (2) articles that reported clinical outcomes such as complication rates or length of hospital stay; and (3) clinical trials or cohort studies. The exclusion criteria were: (1) studies in pediatric populations; (2) case reports or review articles; and (3) studies that did not differentiate nutritional support from other interventions. Results: The results found in the literature consistently demonstrated that perioperative nutritional support played a fundamental role in improving outcomes. Preoperative nutritional optimization in malnourished patients, through enteral or, in selected cases, parenteral nutritional therapy, was associated with a significant reduction in infectious and non-infectious complications. In the postoperative period, the early introduction of enteral nutrition, whenever possible, was shown to be beneficial for maintaining the integrity of the intestinal barrier, modulating the inflammatory response and reducing the length of hospital stay, being superior to parenteral nutrition in most scenarios. Conclusion: Based on the evidence analyzed, it was concluded that nutritional support was not merely a supportive treatment, but rather an integral and essential part of surgical therapy for intestinal diseases. The identification and proactive management of malnutrition in the perioperative period, with the application of individualized nutritional therapy, proved to be effective strategies for reducing morbidity, accelerating recovery and improving the overall prognosis of patients, consolidating nutrition as a fundamental pillar of modern surgical care.