Early oral feeding after elective colorectal surgery: is it safe

Abstract

The authors have carried out a prospective trial to assess the safety, tolerability and outcome of early resumption of oral feeding after elective abdominal surgery involving the small or the large bowel. Over the study period, 161 patients undergoing elective laparotomy and bowel resection were randomized to two groups. Patients undergoing laparoscopic surgery were not included. In both groups, the nasogastric tube was removed immediately after surgery. In group I, oral feeding was started on first postoperative day, beginning with clear fluids and gradually progressing to a normal diet over a period of 24 to 48 hours, as tolerated. In group II, oral feeding was started after resolution of postoperative ileus, starting again with clear fluids as in group I. The resolution of postoperative ileus was defined as having bowel movements with no abdominal distention or vomiting. In both groups, nasogastric tube was reinserted if the patient had two episodes of vomiting of more than 100 ml over 24 hours in the absence of bowel movements. Postoperative analgesia was similar in both groups and same criteria for discharge from the hospital were followed. Of the 161 patients, 80 were in the early feeding group and 81 in the other group. The age and sex distribution of the patients in both groups was similar. In both groups, segmental colonic, rectal or small bowel resection was the commonest surgery. In group I, 79% patients tolerated feeds compared to 86% in group II. The incidence of vomiting was thus 21% in group I and 14% in group II, the difference being statistically insignificant. Reinsertion of nasogastric tube was required only in 11% patients in group I and 10% patients in group II. Further, the length of postoperative ileus (3.8 + 0.1 vs 4.1 + 0.1 days), length of hospital stay (6.2 + 0.2 vs 6.8 + 0.2 days) and incidence of complications (7.5% vs 6.1%) were not significantly different between the two groups. However, regular diet was tolerated significantly earlier. (p <0.001) in group I as compared to group II (2.6 + 0.1 vs. 5.0 + 0.1 days). Further, there was no incidence of anastomotic leaks or aspiration pneumonia, complications which could be expected to occur secondary to early feeding. The authors have reviewed the literature which shows a trend towards decreasing use of routine postoperative nasogastric drainage. Based on the results of the current study, they suggest that there is no need to delay oral feeding till resolution of colonic ileus as early feeding is safe and well tolerated. They also suggest that early resumption of oral feeding may have a positive impact on the psychological state of the patient and may help the recovery.