title: Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial.
abstract: BACKGROUND
  The current trend in postoperative nutrition is to promote a normal oral diet as early as possible. However, postoperative ileus is a frequent and common problem after major abdominal surgery. This study was designed to investigate whether early enteral nutrition (EEN), as a bridge to a normal diet, can reduce postoperative ileus.
  
  
  METHODS
  Patients undergoing major rectal surgery for locally advanced primary or recurrent rectal carcinoma (after neoadjuvant (chemo)-radiation, with or without intraoperative radiotherapy) were randomly assigned to EEN (n = 61) or early parenteral nutrition (EPN, n = 62) in addition to an oral diet. Early nutrition was started 8 hours after surgery. Early parenteral nutrition was given as control nutrition to obtain caloric equivalence and minimize confounding. The primary endpoint was time to first defecation; secondary outcomes were morbidity, other ileus symptoms, and length of hospital stay.
  
  
  RESULTS
  Baseline characteristics were similar for both groups. In intention-to-treat analysis, the time to first defecation was significantly shorter in the enteral nutrition arm than in the control arm (P = 0.04). Moreover, anastomotic leakage occurred significantly less frequently in the enteral group (1 patient) compared with parenteral supplementation (9 patients, P = 0.009). Mean length of stay in the enteral group was 13.4 ± 2.2 days versus 16.7 ± 2.3 days in the parenteral group (P = 0.007).
  
  
  CONCLUSIONS
  Early enteral nutrition is safe and associated with significantly less ileus. Early enteral nutrition is associated with less anastomotic leakage in patients undergoing extensive rectal surgery.
authors.affiliation: *Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands †Department of Surgery, Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands ‡Department of Surgery, Research Institute Growth and Development of the Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Petra G
authors.initials: PG
authors.lastname: Boelens
authors.forename: Fanny F B M
authors.initials: FF
authors.lastname: Heesakkers
authors.forename: Misha D P
authors.initials: MD
authors.lastname: Luyer
authors.forename: Kevin W Y
authors.initials: KW
authors.lastname: van Barneveld
authors.forename: Ignace H J T
authors.initials: IH
authors.lastname: de Hingh
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: Arnout N
authors.initials: AN
authors.lastname: Roos
authors.forename: Harm J T
authors.initials: HJ
authors.lastname: Rutten
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000517:prevention & control; D003672:Defecation; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control*; D057194:Intention to Treat Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome