EARLY ENTERAL FEEDING WITHIN 24 HOURS OF ELECTIVE GASTROINTESTINAL SURGERY VERSUS CONVENTIONAL NOTHING PER ORAL-A PROSPECTIVE CONTROLLED INTERVENTIONAL STUDY CONDUCTED AMONG ADULT POPULATION IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA.
Main Article Content
Keywords
Delayed enteral feeding, early enteral feeding, gastrointestinal resection and anastomosis, nil by mouth, nothing per oral.
Abstract
Background and objective: Traditionally the patients are kept on fasting till recovery of gut motility following gastrointestinal surgery to prevent postoperative vomiting, rupture of anastomosis and other known complications. The study was carried out to assess whether a period of postoperative fasting has a clear advantage over early enteral feeding following gastrointestinal surgery, particularly intestinal resection and anastomosis, in terms of outcomes mentioned above alongside pneumonia, sepsis, intraabdominal abscess, length of hospital stay and mortality.
Materials and method: Following approval of institutional ethics committee and written informed consent from the patients posted for elective gastrointestinal surgery, this prospective controlled interventional study was conducted by randomly allocating participants as per defined inclusion and exclusion criteria to one of the two groups: Early enteral feeding (EEF) and Nothing per oral (NPO), with thirty-three in each arm. Following surgery, each participant was managed prospectively and evaluated against predetermined outcomes. Appropriate statistical principles were applied for calculation of significance level (P= 0.05 and below).
Result: Early feeding significantly reduced the risks of postoperative wound infection, pneumonia, fever and hospital stay, while no clear advantage was observed in terms of postoperative nausea and vomiting, abdominal distension, anastomotic leakage and mortality in the conventional delayed feeding patients.
Conclusion: It does not seem rational to keep patients in fasting after elective gastrointestinal resection-anastomosis as early feeding clearly has an edge in postoperative recovery and reduced hospital stay. However, multicentric trials are recommended to confirm or refute the observations of the current study.
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Dr. Amit Prakash Singh
MS (General Surgery), Ex-Junior Resident, Department of Surgery, R G Kar Medical College and Hospital, 1 Khudiram Bose Sarani, Kolkata-700004 (Place of work being primarily carried out). Currently working as Medical Officer (Specialist), Suri District Hospital, Birbhum, West Bengal.
Dr. Debajit Das
MS (General Surgery), Assistant Professor, Department of Surgery, Malda Medical College and Hospital, Malda, West Bengal.
Dr. Somnath Ghosh
MD (Pathology), Assistant Professor, Department of Pathology, Malda Medical College and Hospital, Malda, West Bengal.