Early Oral Feeding Compared With Traditional Postoperative Care in Patients Undergoing Emergency Abdominal Surgery for Perforated Duodenal Ulcer

Abstract

Introduction Enhanced recovery after surgery (ERAS) protocols have been widely studied in elective abdominal surgeries with promising outcomes. However, the use of these protocols in emergency abdominal surgeries has not been widely investigated. This study aimed to evaluate ERAS application outcomes via early oral feeding compared to regular postoperative care in patients undergoing perforated duodenal ulcer repairs in emergency abdominal surgeries. Materials and methods We conducted a randomized controlled trial at the Surgical Unit 1 Benazir Bhutto Hospital from August 2018 to December 2019. A total of 42 patients presenting to the emergency department with peritonitis secondary to suspected perforated duodenal ulcer were included in the study. Patients were randomly assigned into two groups. Group A patients followed an ERAS protocol for early oral feeding, and Group B received regular postoperative care (i.e., delayed oral feeding). Our primary outcomes were the length of hospital stay, duodenal repair site leak, the severity of pain (via the visual analog scale), and postoperative ileus duration. Results were analyzed via IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). and chi-square and independent t-tests were applied. Results Patients who received early oral feeding (Group A) showed a shorter length of hospital stay, lower pain scores, and shorter postoperative ileus duration than patients in the traditional postoperative care group. Also, we noted no duodenal repair site leak in the early oral feeding group. The differences between the two groups were statistically significant (P<0.05). Conclusions Based on our results, ERAS protocols that promote early oral feeding can be applied in patients undergoing emergency abdominal surgery for perforated duodenal repair. Early oral feeding in emergency surgery patients can reduce the patient burden on hospitals. In addition, early oral feeding can promote better outcomes and reduced economic burden for patients. Keywords: Perforated duodenal ulcer, ERAS protocol, randomized controlled trial, duodenal repair site leak, length of hospital stay, VAS score, postoperative ileus.

Early versus delay oral feeding for patients after upper gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials

“…The potential clinical implications of this meta-analysis are as follows: (1) this is an updated meta-analysis to evaluate the efficacy and safety of EOF in patients after upper gastrointestinal surgery. Compared to previous studies, we included 12 RCTs that contained a large sample size of 1771 participants; (2) Sensitivity analyses and subgroup analyses were conducted to decompose heterogeneity and explore the influence of sample size on the overall effect; (3) All the included studies were RCTs and the literature was of high quality; (4) Compared with previous studies, literature from different regions was included in this study, such as China, Japan, India, Norway, Iran, Netherlands, Sweden and USA, which was widely representative; (5) The heterogeneity of this meta-analysis is low and the conclusions are more reliable; (6) Only 2 of the studies [18,28] had sample sizes less than 50; and (7) EOF not only did not increase the risk of pneumonia, but can significantly reduce the risk of pneumonia, which is different from the conclusion of previous studies. And it might be another potential benefit of EOF in upper gastrointestinal surgery, which needs to be further confirmed by higher quality RCTs.…”

Early Enteral Feeding Versus Delayed Enteral Nutrition: Effects On Morbidity After Intestinal Surgery; A Prospective Study

“…Many participating centres simply do not perform preoperative serum lactate dehydrogenase and serum albumin level in this patient population, or it may not be available at the time of surgery. However, next literature must be taken into account that clearly shows hypoalbuminemia is a risk factor in development of postoperative complications as Alwan MH et al (20) mentioned. However, surgeons appear to still favor the delay oral feeding in patients with bowel anastomosis, opines that early feeding will stress the anastomotic site.…”

Pentingnya Pemberian Nutrisi Secara Dini Terhadap Pasien Post-Operasi Laparotomy Perforasi Ileus

“…Penelitian yang dilakukan oleh Abadi (2017) didukung oleh penelitian lain yang dilakukan oleh Masood et al (2021) yaitu diketahui bahwa pasien yang menerima makanan oral secara dini menunjukkan lama tinggal di rumah sakit yang lebih pendek, skor nyeri yang lebih rendah, dan durasi ileus pasca operasi yang lebih pendek daripada pasien dalam kelompok perawatan pasca operasi tradisional. Selain itu juga tidak ada kebocoran duodenum pada kelompok pemberian makanan oral secara dini.…”

“…Selain itu juga tidak ada kebocoran duodenum pada kelompok pemberian makanan oral secara dini. Hal tersebut dikarenakan dengan pemberian nutrisi secara dini akan menyebabkan pemulihan dan penyembuhan luka lebih cepat sehingga lama rawat pasien pun akan semakin pendek dan secara tidak langsung juga akan menekan biaya yang dikeluarkan untuk pengobatan pasien, oleh karena itu hal tersebut menjadi dasar pentingnya pemberian nutrisi secara dini pada pasien pasca bedah perforasi ileus (Masood et al, 2021).…”

“…Hal tersebut dikarenakan nutrisi merupakan dasar untuk meningkatkan penyembuhan luka dan mencegah terjadinya malnutrisi pada pasien, oleh karena itu penting untuk diberikan nutrisi secara dini pada pasien pasca bedah. Hal tersebut sejalan dengan penelitian yang dilakukan oleh Masood, et al (2021), penelitian ini menunjukkan bahwa pasien yang menerima makanan secara dini memiliki lama rawat di rumah sakit yang lebih pendek, nyeri yang lebih rendah, skor, dan durasi ileus pasca operasi lebih pendek daripada pasien dengan perawatan pasca operasi tradisional (Masood et al, 2021). Selain itu pada penelitian yang dilakukan oleh Abadi (2017) menunjukkan bahwa semakin dini pemberian nutrisi maka semakin besar manfaat sistemik bagi pasien.…”