LLL Course modules: 1) Metabolic Responses to Surgical Stress, 2) Managing Surgical Stress: Principles of Enhanced Recovery and Effect on Outcomes, 3) Making the Gut Work, 4) Nutritional Therapy in the Perioperative Period

Course Objectives:

• To know the important stressors in surgical care;
• To understand the important mediators of the metabolic responses to surgery;
• To know the key responses of carbohydrate, protein and lipid metabolism in the surgical patient;
• To know how the metabolic responses to surgery relate to surgical complications;
• To know the mechanisms of the strategies that have been shown to reduce the metabolic responses to surgery;
• To understand the special metabolic problems posed by some co-morbidities in surgical patients.
• Understand the key concepts underpinning modern perioperative care;
• Know the principle domains within an ERAS protocol (pain, GI function and mobilisation);
• To understand the principles of prehabilitation and how it relates to ERAS;
• Be able to discuss practical aspects of patient management to manage surgical stress and attain optimal organ function and recovery in the perioperative period;
• Understand the importance of the multidisciplinary team, unit organisation, patient information, discharge criteria and audit within an ER programme;
• Gain insight into the key outcomes that are possible with an ERAS approach.
• To understand the pathophysiological changes leading to postoperative ileus (POI);
• To estimate the magnitude of the problem;
• To examine the evidence behind strategies to prevent and treat POI;
• To learn about strategies that may be helpful in the prevention and treatment of POI in the future;
• Pseudo-obstruction or delayed gastric emptying will not be discussed.
• Necessity of nutritional risk screening in surgical patients;
• Definition of “high nutritional risk”;
• Indications and concepts for perioperative nutritional therapy according to the ESPEN guidelines;
• Preoperative conditioning;
• Enteral, parenteral, and combined enteral/parenteral nutrition;
• Macro-, and micronutrients;
• Indications for immune-enhancing diets;
• Nutritional monitoring and follow-up after discharge.

After course, there will be presented two case report with interactive discussion with participants, and an Assessment test. A certificate of 4 CME credits is awarded after passing a test (24 correct out of 30 true/false questions).