[Tolerance of early oral feeding after operations of the lower gastrointestinal tract].
BACKGROUND
Oral feeding is usually offered following surgery of the lower gastrointestinal tract when clinical signs of normal intestinal motility are present. However, some studies have shown that early oral feeding is well tolerated with low morbidity.


METHODS
A prospective cohort study was performed to evaluate whether early oral feeding according to a standardized schedule is tolerated under normal clinical circumstances. One hundred consecutive patients following small- or large-bowel resection with anastomosis were offered fluids on post-operative day 1, soup on post-operative day 2, mashed food on post-operative day 3 and a regular diet on post-operative day 4. Parenteral nutrition was only given if necessary. Tolerance of oral feeding and the amount of food were checked twice a day. End points of the study were nausea (VAS score 1-100), vomiting (> 200 ml), reinsertion of a nasogastric tube, level of food intake, parenteral nutrition (ml), appetite and well-being.


RESULTS
Loop ileostomies were done in 21 patients, colonic resections above the sigmoid in 32, and sigmoid and rectal resections in 47. The average age was 63 +/- 13 years. The frequency of nausea was less than 30% and of vomiting less than 10%. Only in two cases was a nasogastric tube inserted. Forty-three percent of all patients tolerated feeding very well according to the schedule. On post-operative day 3 more than 60% tolerated oral intake, on post-operative day 4, 74% and on post-operative day 5, 88%. Only 22% of the patients needed parenteral fluids on post-operative day 4. The first bowel movement was noted after 2.8 +/- 1.1 days. Surgical complications were documented in 18 patients and general complications in 6 patients.


CONCLUSIONS
Most patients tolerated early oral feeding very well according to the schedule with low morbidity. Therefore, early feeding is now a substantial component of the postoperative treatment following small- or large-bowel resections.
Böhm
B
B
Klinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Charité, Campus Mitte, Humboldt Universität Berlin.
Haase
O
O
Hofmann
H
H
Heine
G
G
Junghans
T
T
Müller
J M
JM
D000368:Aged; D015331:Cohort Studies; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D007420:Intestine, Large / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D016896:Treatment Outcome