Postoperative starvation after gastrointestinal surgery

doi:10.1136/bmj.324.7335.481

BMJ 2002;324:481 ( 23 February )

Letters

Postoperative starvation after gastrointestinal surgery

Type of intravenous nutrition given in control groups is not indicated

Meta-analysis was not appropriate

Authors' reply

Anaesthetic technique during gastrointestinal surgery has postoperative effects

Rest in peace, drip and suck

Type of intravenous nutrition given in control groups is not indicated

The first 150 words of the full text of this article appear below.

EDITOR $---$ We appreciated Lewis et al's wise conclusions in their study: "there seems to be no clear advantage to keeping patientsnil by mouth after elective gastrointestinal resection."¹ Thesubtitle of the accompanying editorial sounded less prudent: "earlyfeeding is beneficial."² This positive statement stimulatesreaders to raise several questions that cannot be answered fromthe study. Which diet is beneficial? By which route? And comparedwith which intravenousfeeding?

From table 1 we note that four types of diet were used in the 11 studies (standard, elemental, oral, and immune enhancing),through four different routes (oral, nasoduodenal, nasojejunal,and jejunostomy), giving rise to seven different combinations.No indication is given of the quality and quantity of the intravenousnutrition in the control groups. This is because the originalstudies were more concerned with feasibility, safety, and toleranceof enteral feeding than with its effect on postoperative outcome.The control diet . . . [Full text of this article]

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Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials: Stephen J Lewis, Matthias Egger, Paul A Sylvester, and Steven Thomas
BMJ 2001 323: 773. [Abstract] [Full Text] [PDF]