Early vs. delayed oral feeding after colorectal surgeries, a clinical trial
Researcher Bulletin of Medical Sciences,
Vol. 25 No. 1 (2020),
Background: The start of oral nutrition after colorectal surgery has always been an issue of debate. There is a long-standing practice of beginning oral feeding 4-5 days after surgery. However, in recent years a number of surgeons have questioned this method and in fact, have begun ordering immediate oral nutrition for their postoperative patients. The current article presents the findings of a clinical trial study, which compared the early and delayed start of oral feeding after colorectal surgery.
Materials and Methods: The present clinical trial recruited 52 patients undergoing colorectal anastomosis and divided these subjects into two groups. In the control group, oral feeding started 4-5 days after the operation. In contrast, the study group commenced oral nutrition soon after surgery. The outcomes for both groups were measured in terms of demographic data, anastomotic leakage rate, nausea and vomiting, the start of bowel movements, and complications.
Results: The two patient groups did not differ in their rates of ileus and diet intolerance (p=1). As for the factors of nausea and vomiting, there were no observed statistically significant differences between the study and control groups (p=0.1). The most critical outcome of the early and late start feeding groups was anastomotic leakage, for which there was no significant difference to report. The length of hospital stay was significantly shorter in the early feeding study group (3.56 days) than in the delayed feeding control group (7.36 days) (p<0.001). Defecation among patients receiving early oral nutrition was 2.8 days on the average, but 4.91 days among the control group patients, a statistically important difference (p<0.004).
Conclusion: While the early start of oral nutrition after colorectal surgery resection and anastomosis does not raise postoperative risks and mortality; it does reduce postoperative complications, the length of hospital stay, and final health care costs. As a result, early feeding after surgery can be considered as a viable alternative to delayed feeding.
- Oral feeding; Early, Delay; Colorectal anastomosis
How to Cite
2. Sagar S, Harland P, Shields R. Early postoperative feeding with elemental diet. Br Med J. 1979;1(6159):293-5. URL: https://pubmed.ncbi.nlm.nih.gov/105777/
3. Serafini F, Anderson W, Ghassemi P, Poklepovic J, Murr MM. The utility of contrast studies and drains in the management of patients after Roux-en-Y gastric bypass. Obesity surgery. 2002;12(1):34-8. URL:https://pubmed.ncbi.nlm.nih.gov/11868295/
4. Sims TL, Mullican MA, Hamilton EC, Provost DA, Jones DB. Routine upper gastrointestinal Gastrografin® swallow after laparoscopic Roux-en-Y gastric bypass. Obesity surgery. 2003;13(1):66-72. URL:https://pubmed.ncbi.nlm.nih.gov/12630616/
5. AHQ DS. Comparison of early versus delayed oral feeding in elective intestinal anastomosis. Pak J Surg. 2014;30(2):120-7.
6. Amanollahi O, Azizi B. The comparative study of the outcomes of early and late oral feeding in intestinal anastomosis surgeries in children. African Journal of Paediatric Surgery. 2013;10(2):74. URL: https://pubmed.ncbi.nlm.nih.gov/23860050/
7. Jochum SB, Ritz EM, Bhama AR, Hayden DM, Saclarides TJ, Favuzza J. Early feeding in colorectal surgery patients: safe and cost effective. International journal of colorectal disease. 2020:1-5. URL: https://pubmed.ncbi.nlm.nih.gov/31901948/
8. Nematihonar B, Salimi S, Noorian V, Samsami M. Early versus delayed (traditional) postoperative oral feeding in patients undergoing colorectal anastomosis. Advanced biomedical research. 2018;7. URL: https://pubmed.ncbi.nlm.nih.gov/29531928/
9. Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database of Systematic Reviews. 2006(4). URL: https://pubmed.ncbi.nlm.nih.gov/17054196/
10. Consoli MLD, Fonseca LM, da Silva RG, Correia MITD. Early postoperative oral feeding impacts positively in patients undergoing colonic resection: results of a pilot study. Nutricion hospitalaria. 2010;25(5):806-9. URL: https://pubmed.ncbi.nlm.nih.gov/21336439/
11. El Nakeeb A, Fikry A, El Metwally T, Fouda E, Youssef M, Ghazy H, et al. Early oral feeding in patients undergoing elective colonic anastomosis. International Journal of Surgery. 2009;7(3):206-9. URL: https://pubmed.ncbi.nlm.nih.gov/19332156/
12. Yang F, Wei L, Huo X, Ding Y, Zhou X, Liu D. Effects of early postoperative enteral nutrition versus usual care on serum albumin, prealbumin, transferrin, time to first flatus and postoperative hospital stay for patients with colorectal cancer: A systematic review and meta-analysis. Contemporary Nurse. 2018;54(6):561-77. URL:https://pubmed.ncbi.nlm.nih.gov/30176764/
13. Reissman P, Teoh T-A, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Annals of surgery. 1995;222(1):73. URL: https://pubmed.ncbi.nlm.nih.gov/7618972/
14. Aihara H, Kawamura YJ, Konishi F. Reduced medical costs achieved after elective oncological colorectal surgery by early feeding and fewer scheduled examinations. Journal of gastroenterology. 2003;38(8):747-50. URL: https://pubmed.ncbi.nlm.nih.gov/14505128/
15. Ortiz H, Armendariz P, Yarnoz C. Is early postoperative feeding feasible in elective colon and rectal surgery? International journal of colorectal disease. 1996;11(3):119-21. URL: https://pubmed.ncbi.nlm.nih.gov/8811376/
16. S Marwah RG, R Goyal, N Marwah, R Karwasra. Early enteral nutrition following gastrointestinal anastomosis. The Internet Journal of Gastroenterology. 2007;7(1). URL: http://ispub.com/IJGE/7/1/3576
17. Metwally T EA, Fekry A, Elawady S, Farid M. . Early oral feeding versus delayed oral feeding in patients undergoing intestinal resection. EJS. 2006;25:200-5.
18. Grass F, Hübner M, Lovely JK, Crippa J, Mathis KL, Larson DW. Ordering a Normal Diet at the End of Surgery—Justified or Overhasty? Nutrients. 2018;10(11):1758. URL:https://pubmed.ncbi.nlm.nih.gov/30441792/
19. Nematihonar B, Yazdani A, Falahinejadghajari R, Mirkheshti A. Early postoperative oral feeding shortens first time of bowel evacuation and prevents long term hospital stay in patients undergoing elective small intestine anastomosis. Gastroenterol Hepatol Bed Bench. 2019;12(1):25-30. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441485/
20. da Fonseca LM, Profeta da Luz MM, Lacerda-Filho A, Correia MITD, Gomes da Silva R. A simplified rehabilitation program for patients undergoing elective colonic surgery—randomized controlled clinical trial. International journal of colorectal disease. 2011;26(5):609-16. URL: https://link.springer.com/article/10.1007/s00384-010-1089-0
21. Bufo AJ, Feldman S, Daniels GA, Lieberman RC. Early postoperative feeding. Diseases of the colon & rectum. 1994;37(12):1260-5. URL:https://link.springer.com/article/10.1007/BF02257793
22. Jeffery KM, Harkins B, Cresci GA, Martindale RG. The clear liquid diet is no longer a necessity in the routine postoperative management of surgical patients. The American surgeon. 1996;62(3):167-70.URL: https://europepmc.org/article/med/8607572
23. Lee HS, Shim HJ, Lee HS, Lee JG, Kim KS. The safety of early enteral feeding after emergency gastrointestinal surgery. The Korean Journal of Gastroenterology. 2011;58(6):318-22. URL: https://synapse.koreamed.org/DOIx.php?id=10.4166/kjg.2011.58.6.318
24. Meguid MM, Campos AC, Hammond WG. Nutritional support in surgical practice: Part II. The American journal of surgery. 1990;159(4):427-43. URL:https://www.sciencedirect.com/science/article/pii/S0002961005812905
25. Beier-Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut. 1996;39(6):833-5. URL:https://gut.bmj.com/content/39/6/833.short
26. Di Fronzo LA, Cymerman J, O'Connell TX. Factors affecting early postoperative feeding following elective open colon resection. Archives of Surgery. 1999;134(9):941-6. URL: https://jamanetwork.com/journals/jamasurgery/article-abstract/390371
27. Heslin MJ, Latkany L, Leung D, Brooks AD, Hochwald SN, Pisters PW, et al. A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Annals of surgery. 1997;226(4):567. URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1191079/
- Abstract Viewed: 0 times
- e24 Downloaded: 0 times