title: Early oral feeding after emergency abdominal operations: another paradigm to be broken?
abstract: OBJECTIVE
  The scope of this article is to provide an updated review examining the role of early feeding in the postoperative period.
  
  
  RESULTS
  Guidelines for postoperative care after abdominal surgery have historically outlined the dogma of 'nil by mouth' until bowel movement returns, but they are currently questioned. This change in mindset, especially after colorectal surgery, was initiated with fast-track or enhanced recovery after surgery programs, which particularly led to an opioid-sparing strategy. Many randomized trials and meta-analyses suggested an absence of benefit in keeping patients 'nil by mouth'. Conversely, in elective abdominal surgery, improvement in comfort without increased morbidity is now demonstrated with a liberal strategy, and a recent meta-analysis even demonstrated a decrease in mortality. Early caloric hydration and chewing gum are the most acceptable actions with a high level of proof. After emergency surgery, few data are available but a similar strategy should probably be chosen with no obvious benefit from maintenance of fasting.
  
  
  CONCLUSIONS
  Early oral intake is possible after elective abdominal surgery and should be moderate and progressive to be well tolerated. Any sign of nausea may mean intestinal or gastric disturbance and is a caution not to pursue this policy. The strategy in emergency abdominal surgery still requires adequately powered, randomized controlled trials.
authors.affiliation: Department of Anesthesiology, Hôpital Foch, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Le Guen
authors.forename: Julien
authors.initials: J
authors.lastname: Fessler
authors.forename: Marc
authors.initials: M
authors.lastname: Fischler
mesh_terms: D002638:Chewing Gum; D013505:Digestive System Surgical Procedures; D017558:Elective Surgical Procedures; D004630:Emergencies; D005215:Fasting; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*
chemical_list: D002638:Chewing Gum