Early feeding after gastrointestinal surgery reduces the risk of infections and shortens length of stay in hospital. Systematic reviews in health care: meta-analysis in context. receive their prescribed drug treatment? EurekAlert! An adequately powered trial is required to confirm or refute the benefits seen in small trials. 3. For example, definition of the patients' pre-existing nutritional state and severity of underlying disease was generally poor. of over-dose effects. compliance. Controlled intraoperative water testing of left-sided colorectal anastomoses: are ileostomies avoidable. ewilkinson@bmj.com A further type of hazard may occur when the 'nil by mouth' period 13 20–31 We excluded two of these trials because no information on relevant outcomes was given, and attempts to obtain unpublished data from the authors were unsuccessful. Clinical experience, with objective demonstration of intestinal absorption and motility. Thomas makes not a single mention of the clinical pharmacological aspects Secondly, in these patients early feeding may be beneficial. What is already known on this topic Enteral feeding within 24 hours after gastrointestinal surgery is tolerated, Theoretically, early enteral feeding improves tissue healing and reduces septic complications after gastrointestinal surgery, What this study adds There is no benefit in keeping patients “nil by mouth” after gastrointestinal surgery, Septic complications and length of hospital stay were reduced in those patients who received early enteral feeding, In patients who received early enteral feeding there were no significant reductions in incidence of anastomotic dehiscence, wound infection, pneumonia, intra-abdominal abscess, and mortality. Design: Systematic review and meta-analysis of randomised controlled trials comparing any type of enteral feeding started within 24 hours after surgery with nil by mouth management in elective gastrointestinal surgery. Six studies included only lower gastrointestinal surgery. We do not capture any email address. Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. Our patients themselves have also become so used to this principle that they are often too frightened to follow the (up to date) fasting instructions we give … SJL wrote to all the trialists and feed companies requesting additional data and coordinated the writing of the paper. The rationale of nil by mouth and gastric decompression is to prevent postoperative nausea and vomiting and protect the anastomosis, allowing it time to heal before being stressed by food. of 'rebound' effects upon sudden discontinuation of some drugs. They suggest that such a trial should also assess surgical fatigue, muscle function, quality of life after discharge from hospital, and cost effectiveness. 5. Several clinical trials directly comparing strategies of early feeding with nil by mouth after elective gastrointestinal surgery have been performed. The association found for mortality was probably a chance finding. Main outcome measures: Anastomotic dehiscence, infection of any type, wound infection, pneumonia, intra-abdominal abscess, length of hospital stay, and mortality. 1. Early enteral feeding versus "nil by mouth" after gastrointestinal Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Long-term use of beta blockers: the need for sustained In most of the trials assessed infections were not clearly defined. rebound effects have, besides their well-documented propensity to trigger been clear for over a decade that the sudden discontinuation of the most We also approached pharmaceutical companies that produce enteral feeds and asked whether they held data from unpublished trials. 975 HAMILTON AVENUE, Brit Med J 1988; 296:744. Is early oral feeding safe after elective colorectal surgery? of the order (5). Cell proliferation, plasma enteroglucagon and plasma gastrin levels in starved and refed rats. This article looks at car… The combined relative risk was 0.72 (0.54 to 0.98), indicating a significant (P=0.036) reduction in the risk of infection, with little evidence of heterogeneity between trials (χ2=10.7, P=0.22). Rangno RE, Langlois S. Comparison of withdrawal phenomena after In four studies feeding was started within six hours after surgery. Patients are restricted from eating and drinking, commonly known as being nil by mouth (NBM), as a result of a variety of conditions and at different times in their treatment pathway, particularly during surgery. Emma Wilkinson Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. Furthermore, the definition of dehiscence varied between trials. Thirdly, we believe these results indicate the necessity for an adequately powered clinical trial to assess early enteral feeding in patients undergoing elective gastrointestinal surgery. There is no benefit in keeping patients "nil by mouth" (a period of starvation) after gastrointestinal surgery, suggests a study in this week's BMJ. This is frequently necessary for several hours prior to surgery requiring general anesthesia, for certain medical conditions, and after some types of surgery.To prevent dehydration, hospital staff will frequently administer fluids through an IV. Early postoperative feeding after non-gastrointestinal surgery has also been shown to reduce length of stay in hospital. There were insufficient data to comment on the causes of death. All analyses were performed with Stata version 6.0 (StataCorp, College Station, Texas). EurekAlert! These findings should challenge doctors to consider starting early feeding in these patients. Anastomotic dehiscence is a major complication of gastrointestinal surgery with considerable morbidity and mortality.32 The combined estimate failed to reach conventional levels of significance but indicates that early feeding may reduce the risk of dehiscence.
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