Immediate diet

After colorectal surgery, metaanalyses comparing early nutrition (within 24 hours) compared to traditional step-wise introduction of oral intake after return of bowel function conclude that early feeding decreases complications without increasing the risk of leak or affecting bowel function; NG tube reinsertion was not significantly increased (10% versus 7%) (1). After laparoscopic bowel surgery, patients are offered fluids after recovery from anesthesia and started on solid food the next morning. There is less data from upper GI surgery but one large RCT that started normal food on POD1 found no advantage to withholding feeding (2). Metaanalyses from Asian centres including total and distal gastrectomy concluded that early feeding, even the day of surgery, was associated with shorter hospital stay and return of bowel function without increasing complications (3). Interestingly, this debate does not seem to apply to roux-en-Y gastric bypass where early fluids and avoidance of NG tubes is standard.

For more information, see Chapter 14: Early Nutrition and Early Mobilization: Why They Are Important and How to Make it Happen in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery

1. Osland E, Yunus RM, Khan S, Memon MA. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. JPEN J Parenter Enteral Nutr. 2011 Jul;35(4):473-87.

2. Lassen K1, Kjaeve J, Fetveit T, Tranø G, Sigurdsson HK, Horn A, Revhaug A. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg. 2008 May;247(5):721-9

3. Liu X, Wang D, Zheng L, Mou T, Liu H, Li G. Is early oral feeding after gastric cancer surgery feasible? A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014 Nov 14;9(11):e112062.

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