Early Feeding vs 5-Day Fasting after Distal Elective Bowel Anastomoses in Children. A Randomized Controlled Trial

Abstract

<p align="justify"> <b><span>Purpose:</span></b><span> D</span><span>etermine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. <b>Methods:</b><span> </span>Controlled randomized trial including pediatric patients with DEBA, excluding non-elective and high risk patients. <span>Variables: </span>Demographics, operative time, anastomosis placement, <span>beginning peristalsis and bowel movement, time to full diet intake, post-operative stay, </span>persisting <span>vomiting and</span> abdominal distention, wound infection or dehiscence, anastomotic leak, reoperation, death. Randomization into: <span>1</span></span><span>)</span><span> <span>Experimental group (EG)</span>: early feeding group, after a minimum 24 hours fasting period, oral fluids and diet was started</span><span>;</span><span> <span>2</span></span><span>)</span><span> Control group (CG): obligatory </span><span>5-day fasting. <span>Descriptive Statistics</span></span><span>:</span><span> </span><span>Student</span><span>’</span><span>s t test for quantitative and Chi square for qualitative variables, a <span>p-value <</span></span><span> </span><span>0.05 was considered significant.</span><span> <b>Results:</b><span> 60</span> patients were included since June 2003 to May 2004, 30 ineach group. Mean age 2 years, weight16 kg, malnutrition 33%. Stomal Ethiology: Anorectal-malformation 46%, Hirschsprung 13%, inflammatory 35%, tumoral 5%. Mostly in colon 71%. Mean surgical time 142 min. None developed vomiting or required nasogastric-tube. Mild abdominal distension 13%, mild fever 16.5% and wound complications 18%. Anastomosis leakage 6.5%, none required reoperations. Demographic variables showed no statistical differences. Full oral intake was in the 2nd postoperative day in the EG vs CG (p = 0.001). Postoperative hospital stay was 6.0</span><span> </span><span>±</span><span> </span><span>3 in</span><span> the EG vs 9.8</span><span> </span><span>±</span><span> </span><span>4 days in the CG with clinical but not statistical significance. Peristalsis beginning, first flatus passage and bowel movements showed no statistical differences. The complication incidence was low and equally distributed. <b>Conclusions:</b><span> E</span>arly feeding after DEBA is safe and well tolerated in children.</span><span></span> </p> <p> <span></span> </p

Early oral feeding after gastrointestinal anastomosis

“…26 No.1 -April 2022 prevent gastric dilation, treat ileus, and allow the anastomosis to heal [3,11,14,16,17,22,24] . This belief has been used to justify this practice and its benefits [6,13] .…”

“…However, various studies have questioned this traditional concept [4,6,13,24,25] . In our study, most patients tolerate CLD as the first meal successfully in the EOF group compare the LOF group and we find no difference in tolerance between the two groups.…”

“…Advocated general surgeons offer the explanation for that a food bolus would increase intraluminal pressure and cause anastomotic dehiscence [9,11,19,24] . However, restricted ON is not scientific evidencebased [6,4,25] . On the contrary, experimental studies demonstrated that early postoperative oral intake accelerates GI anastomotic healing in the animal (rabbit and rat) models in comparison with parenteral feeding with a fasting period and the increase in hydroxyproline (collagen) content of the anastomotic tissue was the underlying mechanism [4, 12, 16 -18, 22] .…”

“…1 -April 2022 We are looking at this issue from a physiological standpoint; first, even when not being fed, the GI tract produces 500 to 1000 ml/day of gastric secretions and 1L to 2L of biliary and pancreatic secretions per day. Second, the bowel mucosa heals rapidly, and a watertight seal will have formed within 24 hours of the postoperative period [3,4,6,7,16,17,23] . This may also help to explain why the rate of AL was low in the EOF group in our study.…”

“…There are many studies are supporting EOF in adults, but few in children [4] . Three studies were concluded that EOF following intestinal anastomosis in children are safe and well tolerated [4,6,19] .…”