Early Versus Delayed (Traditional) Postoperative Oral Feeding in Patients Undergoing Colorectal Anastomosis

Nematihonar, Behzad; Salimi, Sohrab; Noorian, Vahid; Samsami, Majid

doi:10.4103/abr.abr_290_16

Cited by 28 publications

(22 citation statements)

References 24 publications

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“…These RCTs described their early nutrition intervention as “water” (Wang et al, 2013 ), “5% glucose” (Cao, 2009 ; Li et al, 2006 ), “clear liquid” (Reissman et al, 1995 ; Pragatheeswarane et al, 2014 ), “allowed to drink” (Feo et al, 2004 ), “oral liquids” (Chatterjee et al, 2012 ), an “oral liquid diet” (da Fonseca et al, 2011 ), a “fluid diet” (Dag et al, 2011 ), “fluids” (El et al, 2009 ), a “liquid diet” (Hartsell et al, 1997 ), a “semi-fluid diet” (Lee et al, 2011 ), or “filtrate liquids” (Nematihonar et al, 2018 ).…”

Section: Resultsmentioning

confidence: 99%

Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: a meta-analysis of randomized clinical trials

Heighes

Simpson

et al. 2021

Perioper Med

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Background Although current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centered benefits. We hypothesized this finding was attributable to pooling studies providing effective protein-containing diets with ineffective non-protein liquid diets. Therefore, the aim of this paper was to investigate the safety and efficacy of early oral protein-containing diets versus later (traditional) feeding after elective lower gastrointestinal tract surgery in adults. Methods PubMed, Embase, and the China National Knowledge Infrastructure databases were searched from inception until 1 August 2019. Reference lists of retrieved studies were hand searched to identify randomized clinical trials reporting mortality. No language restrictions were applied. Study selection, risk of bias appraisal and data abstraction were undertaken independently by two authors. Disagreements were settled by obtaining an opinion of a third author. Majority decisions prevailed. After assessment of underlying assumptions, a fixed-effects method was used for analysis. The primary outcome was mortality. Secondary outcomes included surgical site infections, postoperative nausea and vomiting, serious postoperative complications and other key measures of safety and efficacy. Results Eight randomized clinical trials recruiting 657 patients were included. Compared with later (traditional) feeding, commencing an early oral protein-containing diet resulted in a statistically significant reduction in mortality (odds ratio [OR] 0.31, P = 0.02, I2 = 0%). An early oral protein-containing diet also significantly reduced surgical site infections (OR 0.39, P = 0.002, I2 = 32%), postoperative nausea and vomiting (OR 0.62, P = 0.04, I2 = 37%), serious postoperative complications (OR 0.60, P = 0.01, I2 = 25%), and significantly improved other major outcomes. No harms attributable to an early oral protein-containing diet were identified. Conclusions The results of this systematic review can be used to upgrade current guideline statements to a grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults.

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Section: Resultsmentioning

confidence: 99%

Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: a meta-analysis of randomized clinical trials

Heighes

Simpson

et al. 2021

Perioper Med

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“…The ERAS protocol argues that liquid food on the 2nd hour and solid food intake on the 4th hour of the post-operative period should be encouraged for the patients [1]. Studies conducted in different countries indicate that the earlier oral feeding starts for the patients the shorter the time of the first defecation and the duration of hospital stay is [21,22], not the presence of anastomosis leakage and abscess and the patient satisfaction was high [23]. In laparoscopic colorectal resection surgery, in addition to preoperative oral carbohydrate administration in accordance with ERAs recommendations, patients, who switched to post-operative oral nutrition early had faster recovery of their postoperative clinical functions, decrease in recovery time and decrease in-hospital stay [24].…”

Section: Discussionmentioning

confidence: 99%

Evaluate the compliance of perioperative practices of the patients with the enhanced recovery after surgery protocols

Ciğerci

Celebi

2021

Health Sci. Q.

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The Enhanced Recovery after Surgery (ERAS) protocol is a multimodal and evidence-based medical practice developed to define the concept of perioperative interventions to improve postoperative outcomes. The protocol consists of a number of elements implemented in the pre-, intra - and post-operative periods. This study aimed to evaluate the compliance of perioperative practices with the ERAS protocols in patients undergoing surgical intervention. In this descriptive and prospective study, 405 patients who underwent surgery in the General Surgery Clinic of a University Hospital created a sample of the study. In the study, where no intervention was made to the patients included in the study, the compliance of routine perioperative practices in the clinic offered to patients undergoing surgery to the protocol was evaluated using the questionnaire prepared in this direction. Procedures such as, in the preoperative period, providing verbal information to all the patients and giving antibiotic prophylaxis to 98.5% of the patients, in the intraoperative period, preferring the smallest possible surgical incision, and, in the postoperative period, using the paracetamol (99.5%) as the first choice for analgesia were compatible with the ERAS protocols. Procedures such as, in the preoperative period, not providing oral carbohydrate to any of the patients and keeping the fasting period longer period (10.91 ± 4.79 hours), in the intraoperative period, preferring anesthetic agents that are effective for a long time, and not perform the necessary practices to ensure normothermia in any of the patients, and, in the postoperative period, not starting the oral nutrition early and using urinary catheterization for 87.7% of the patients were not compatible with the ERAS protocols. As a result of the research, it was determined that the routine perioperative applications in the clinic did not sufficiently comply with the ERAS protocol.

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“…A diet is given to patients after surgery according to the comprehensive clinical judgment of doctors based on abdomenal X-ray findings, flatus, and bowel sounds, even if there is no BM. Early feeding of patients who had undergone abdominal surgery led to a reduction in the length of the hospital stay, improvement of the metabolic status, a reduced rate of septic complications, and a reduced morbidity rate [15]. However, the incidence rate of prolonged POI following major abdominal surgery was 10–25% [16].…”

Section: Discussionmentioning

confidence: 99%

Daikenchuto accelerates the recovery from prolonged postoperative ileus after open abdominal surgery: a subgroup analysis of three randomized controlled trials

et al. 2019

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Purpose Prolonged postoperative ileus (POI) is a common complication after open abdominal surgery (OAS). Daikenchuto (DKT), a traditional Japanese medicine that peripherally stimulates the neurogenic pathway, is used to treat prolonged POI in Japan. To analyze whether DKT accelerates the recovery from prolonged POI after OAS, we conducted a secondary analysis of three multicenter randomized controlled trials (RCTs). Methods A secondary analysis of the three RCTs supported by the Japanese Foundation for Multidisciplinary Treatment of Cancer (project numbers 39-0902, 40-1001, 42-1002) assessing the effect of DKT on prolonged POI in patients who had undergone OAS for colon, liver, or gastric cancer was performed. The subgroup included 410 patients with no bowel movement (BM) before the first diet, a DKT group ( n = 214), and a placebo group ( n = 196). Patients received either 5 g DKT or a placebo orally, three times a day. The primary endpoint was defined as the time from the end of surgery to the first bowel movement (FBM). A sensitivity analysis was also performed on the age, body mass index and dosage as subgroup analyses. Results The primary endpoint was significantly accelerated in the DKT group compared with the placebo group ( p = 0.004; hazard ratio 1.337). The median time to the FBM was 113.8 h in the placebo group and 99.1 h in the DKT treatment group. Conclusions The subgroup analysis showed that DKT significantly accelerated the recovery from prolonged POI following OAS. Trial registration number UMIN000026292.

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Early Versus Delayed (Traditional) Postoperative Oral Feeding in Patients Undergoing Colorectal Anastomosis

Cited by 28 publications

References 24 publications

Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: a meta-analysis of randomized clinical trials

Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: a meta-analysis of randomized clinical trials

Evaluate the compliance of perioperative practices of the patients with the enhanced recovery after surgery protocols

Daikenchuto accelerates the recovery from prolonged postoperative ileus after open abdominal surgery: a subgroup analysis of three randomized controlled trials

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