A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery

Abstract

OBJECTIVE:This prospective randomized clinical study was conducted to evaluate the safety and tolerability of early oral feeding after colorectal operations.METHODS:A total of 199 patients underwent colorectal surgery and were randomly assigned to early feeding (n = 99) or a regular diet (n = 100). Patients' characteristics, diagnoses, surgical procedures, comorbidity, bowel movements, defecation, nasogastric tube reinsertion, time of tolerance of solid diet, complications, and length of hospitalization were assessed.RESULTS:The two groups were similar in terms of gender, age, diagnosis, surgical procedures, and comorbidity. In the early feeding group, 85.9% of patients tolerated the early feeding schedule. Bowel movements (1.7±0.89 vs. 3.27±1.3), defecation (3.4±0.77 vs. 4.38±1.18) and time of tolerance of solid diet (2.48±0.85 vs. 4.77±1.81) were significantly earlier in the early feeding group. There was no change between the groups in terms of nasogastric tube reinsertion, overall complication or anastomotic leakage. Hospitalization (5.55±2.35 vs. 9.0±6.5) was shorter in the early feeding group.CONCLUSIONS:The present study indicated that early oral feeding after elective colorectal surgery was not only well tolerated by patients but also affected the postoperative outcomes positively. Early postoperative feeding is safe and leads to the early recovery of gastrointestinal functions.

A myth that early feeding causes bowel anastomotic leakage: is it true?

“…[6][7][8] Most of the practicing surgeon even today practicing, keep the patient NPO for 4-5 days after ileostomy closure and uses nasogastric tubes until resolution of the post operative ileus .Recently ,this approach has been questioned and few studies have shown that nasogastric tube insertion has a limited role in postoperative care of abdominal surgery. 2 In present study ,nasogastric tube was inserted before surgery and removed after 6 hr of surgery and this approach was tolerated by all the patients and in no patients we needed reinsertion of nasogastric tube.…”

“…3 Post operative starvation changes the metabolism of the body within 24 hours by increasing insulin resistance and reducing muscle function. 2 The purpose of this study is to evaluate that early feeding is having any additional advantage over the traditional feeding in terms of post operative ileus, bowel anastomosis leakage and hospital stay.…”

ACERTO guidelines of perioperative nutritional interventions in elective general surgery

“…According to the reviewed studies, although the tolerance of the patient to the resumption of the diet is not universal, it is generally high [85][86][87] The use of nutritional strategies, including the prescription of oral supplements in the postoperative period and after discharge from patients undergoing major operations, can prevent complications and reduce the chances of readmission 130,131 . This is especially important in elderly patients 132 .…”

Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review

“…The mean age of the included patients was between 16 and 94 years (5,8), except one of them (16) that had a small group of children of 10 years, whom were not considered in this revision and only adults were included in the review. Men were more predominant within 18 (66.6%) of the studies (10)(11)(12)(13)(14)(17)(18)(19)(20)22,23,(25)(26)(27)(28)(29)(30)(31) and there was no mention about sex proportion in 2 (7.4%) works (6,8). Most of the studies proposed 2 groups, the intervention group (fast-track, G-FT) and the control group (traditional, G-T), only in 2 works 4 groups were designed (22,28) (Table I).…”

“…The postoperative follow-up varied by time and used method ranging from a minimum of 3 postoperative days (POD) and a maximum of 29 POD (8,11,12,(15)(16)(17)19,22,27), only on author didn't mention the total follow-up period (9). The most of the authors monitored their patients even though others didn't mention It (5)(6)(7)13,14,23,25,28,29). Sometimes the follow-up was performed twice a day (9,12) while in another occasions a telephonic follow-up was used (10,18,21,24,27,30), those that reported the duration of follow-up period extended it until the 7 th POD or until patient hospital discharge (31).…”