Abstract
Objective
This prospective randomized controlled trial was conducted to compare the safety, tolerability and outcome of early oral feeding vs. traditional feeding in patients undergoing elective open bowel surgery.
Methods
A total of 120 consecutive patients who underwent elective open bowel surgeries were randomized into either early feeding (n = 60) or traditional feeding group (n = 60). Patients in the early feeding group were started on oral fluids on post-operative day 1, while those in the traditional feeding group were started orals after the resolution of ileus. Patient characteristics, surgical procedures, co-morbidity, first flatus, first defecation, time of starting solid diet, complications and length of hospitalization were assessed between the two groups.
Results
The two groups were similar in demographic and baseline data. The number of days to first flatus (p < 0.0001), first defecation (p < 0.0001), length of post-operative stay (p = 0.011) and time of starting solid diet (p < 0.0001) were significantly earlier in the early feeding group. Anastomotic leak, wound infection, fever, vomiting, abdominal distention and other complications were similar. Multivariate analysis showed that patients in the early oral feeding group were discharged 3.4 days earlier (p = 0.037).
Conclusion
In patients undergoing elective open bowel surgeries, early post-operative feeding is safe, is well tolerated and reduces the length of hospitalization.
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References
Levine AL. A new gastroduodenal catheter. JAMA 1921; 76:1007.
Bauer JJ, Gelernt IM, Salky BA, Kreel I. Is routine postoperative nasogastric decompression really necessary? Ann Surg 1985; 201: 233-236.
Argov S, Goldstein I, Barzilai A. Is routine use of the nasogastric tube justified in upper abdominal surgery? Am J Surg 1980; 139: 849-850.
Nathan BN, Pain JA. Nasogastric suction after elective abdominal surgery: a randomized study. Ann R Coll Surg Engl 1991;73:291-294.
Meltvedt R, Knecht B, Gibbons G, Stahler C, Stojowski A, Johansen K:Is nasogastric suction necessary after elective colon resection? Am J Surg 1985;149:620-622.
Wolff BG, Pemberton JH, Van Heerden JA, Beart RW,. Nivatvongs S, Devine RM, Dozois RR, Ilstrup DM. Elective colon and rectal surgery without nasogastric decompression. Ann Surg 1989;209(6):670-3.
Petrelli NJ, Stulc JP, Rodriquez-Bigas M, Blumenson L. Nasogastric decompression following elective colorectal surgery. Am Surg 1993; 59: 632-635.
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991;1:144-150.
Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D. Laparoscopic colectomy. Ann Surg 1992; 216:703-707.
Corbitt JD Jr. Preliminary experience with laparoscopic guided colectomy. Surg Laparosc Endosc 1992; 2:79-81.
Wexner SD, Cohen SM, Johansen OB, Nogueras JJ, Jagelman DG. Laparoscopic colorectal surgery: a prospective assessment and current perspective. Br J Surg 1993; 80:1602-1605.
Wexner SD, Johansen OB, Nogueras JJ, Jagelman DG. Laparoscopic total abdominal colectomy: a prospective assessment. Dis Colon Rectum 1992; 35:651-655.
Zucker KA, Pitcher DE, Martin DT, Ford RS. Laparoscopic assisted colon resection. Surg Endosc 1994; 8:12-18.
Hoover HC, Ryan JA, Anderson EJ, Fischer JE . Nutritional benefits of immediate postoperative jejunal feeding of an elemental diet. Am J Surg 1980; 139:153-159.
Ryan JA Jr, Page CP, Babcock L .Early postoperative jejunal feeding of elemental diet in gastrointestinal surgery. Am Surg 1981; 47:393-403.
Meguid MM, Campos AC, Hammond WG. Nutritional support in surgical practice: part II. Am J Surg 1990; 159:427-443.
Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM Jr, Welling RE, Moore EE. Early enteral feeding compared with parenteral reduces postoperative septic complications: the results of a meta-analysis. Ann Surg.1992; 216:172-183.
Rao W, Zhang X, Zhang J, Yan R, Hu Z, Wang Q. The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis 2011; 26(4):423-9.
Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005; 92(6):673-80.
Sindell S, Causey MW, Bradley T, Poss M, Moonka R, Thirlby R. Expediting return of bowel function after colorectal surgery. Am J Surg 2012; 203(5):644-8.
Macarone Palmieri R, Amodio PM, Rizzello M, Goglia A, Piciollo M, Piccioni E, et al. Does the nasogastric tube has a role in elective colorectal surgery? G Chir 2012; 33(3):58-61.
Han-Geurts IJM, Hop WCJ, Kok NFM, Lim A, Brouwer KJ, Jeekel J. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery. Br J Surg. 2007; 94(5):555-61.
Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis. Colon Rectum. 2003;46(7):851-9.
Fukuzawa J, Terashima H, Ohkohchi N. Early postoperative oral feeding accelerates upper gastrointestinal anastomotic healing in the rat model. World J Surg 2007; 31(6):1234-9.
Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001; 323(7316):773-6.
Dag A, Colak T, Turkmenoglu O, Gundogdu R, Aydin S. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clin Sao Paulo Braz. 2011; 66(12):2001-5.
Rohatiner T, Wend J, Rhodes S, Murrell Z, Berel D, Fleshner P. A prospective single-institution evaluation of current practices of early postoperative feeding after elective intestinal surgery. Am Surg 2012; 78(10):1147-50.
Burden S, Todd C, Hill J, Lal S. Preoperative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012.
Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 2013; 56(5):667-78.
Sagar S, Harland P, Shields R. Early postoperative feeding with elemental diet. BMJ 1979 (3);1:293–5.
Hartsell PA, Frazee RC, Harrison JB, Smith RW. Early postoperative feeding after elective colorectal surgery. Arch Surg. 1997;132(5):518-20.
Han-Geurts IJ, Jeekel J, Tilanus HW, Brouwer KJ. Randomized clinical trial of patient-controlled versus fixed regimen feeding after elective abdominal surgery. Br J Surg. 2001;88(12):1578-82.
Lucha PA Jr, Butler R, Plichta J, Francis M. The economic impact of early enteral feeding in gastrointestinal surgery: a prospective survey of 51 consecutive patients. Am. Surg. 2005;71(3):187–90.
Zhou T, Wu XT, Zhou YJ, Huang X, Fan W, Li YC. Early removing gastrointestinal decompression and early oral feeding improve patients rehabilitation after colorectostomy. World J Gastroenterol. 2006;12: 2459–2463.
Behrns KE, Kircher AP, Galanko JA, Brownstein MR, Koruda MJ. Prospective randomized trial of early initiation and hospital discharge on a liquid diet following elective intestinal surgery. J Gastrointest Surg. 2000;4(2):217-21.
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Pragatheeswarane, M., Muthukumarassamy, R., Kadambari, D. et al. Early Oral Feeding vs. Traditional Feeding in Patients Undergoing Elective Open Bowel Surgery—a Randomized Controlled Trial. J Gastrointest Surg 18, 1017–1023 (2014). https://doi.org/10.1007/s11605-014-2489-1
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DOI: https://doi.org/10.1007/s11605-014-2489-1