Early postoperative feeding after elective colorectal surgery
P. A. Hartsell, R. C. Frazee, J. B. Harrison and R. W. Smith
Department of Surgery, Scott & White Clinic and Memorial Hospital, Temple, USA.
BACKGROUND: Several investigators have demonstrated that routine
nasogastric decompression after abdominal surgery is unnecessary and can be
safely eliminated, and 1 recent study demonstrated the safety of early oral
feedings. OBJECTIVE: To test the hypothesis that successful early feeding
would lead to a shorter duration of hospitalization and, therefore, would
be more cost-effective. PATIENTS: Fifty-eight patients with elective
colorectal surgery. METHODS: Patients were prospectively randomized to 1 of
2 postoperative treatment arms: early feeding (EF group, n = 29) and
traditional feeding (TF group, n = 29). All patients in the EF group began
a liquid diet on the first postoperative day and were advanced to a regular
diet when they consumed 1000 mL in 24 hours. All patients in the TF group
began a liquid diet after resolution of the postoperative ileus and were
advanced to a regular diet after consuming 1000 mL in 24 hours. Patients
were dismissed after tolerating two thirds of the regular diet. Both groups
had intraoperative orogastric tubes that were removed at the end of
surgery. Nasogastric tubes were inserted for persistent postoperative
vomiting. RESULTS: No significant differences were noted in age, types of
procedures, or in prior abdominal surgery in either group. No significant
differences were seen in rates of nausea (55% in EF vs 50% in TF group) or
vomiting (48% in EF vs 33% in TF group). One patient in the EF group had
aspiration pneumonia, and anastomotic leak resulted in sepsis and eventual
death of 1 patient in the TF group. No significant difference was observed
in length of hospital stay between the 2 groups (mean +/- SD, 7.2 +/- 3.3
days in EF vs 8.1 +/- 2.3 days in TF group). CONCLUSIONS: Early oral
feeding after elective colorectal surgery is safe. Most of the patients
tolerated EF; however, there was no significant difference in duration of
hospitalization in these patients.
