[Postoperative disease].

Abstract

Post-operative disease, which is well known clinically, is characterised in the laboratory and metabolically by a succession of two stages=an initial short stage, lasting a few days, marked by intensive catabolism and, after a change, there is a second phase, much longer, lasting several weeks, anabolic in nature, during which are reconstituted the reserves lost during the first phase. The mechanism of post-operative disease enters into the general field of post-aggressive reaction bringing into play an adrenocorticoid process. But a whole series of factors, included in the agression without neuro-endocrine background, cause diffuse metabolic disturbances in the organism with their own appearance of severity. Occurring at the same time as the operation, they may also occur in the pre and postoperative periods. In order to minimise and shorten the post-operative disease, it is important to combat as far as possible, these different specific factors by good preparation, correct anesthetic and surgical techniques and the prevention and treatment of complications. One should also pay attention to nutritional problems. When, before operation, patients are particularly under-nourished, or when, after operation, muscle wasting lasts abnormally owing to the temporary incapacity of the digestive tract to fulfil its role, or when catabolism takes on a dangerous appearance owing to the magnitude of the surgical aggression, or the onset of a complication, such as suppuration, it is essential to administer a high calory diet, either by venous catheter in a large vein, or, by continuous administration through a gastric catheter and using the nutripump.