Early feeding is beneficial

Papers p 773

The widespread practice of starving patients in the immediate period after gastrointestinal surgery has been challenged by a systematic review and meta-analysis in this issue (p 773), which finds that “nil by mouth” after gastrointestinal surgery may not be beneficial.1 Further, the apparently beneficial effects of early postoperative enteral feeding on infection rates and length of stay in hospital are compelling arguments in favour of a change in clinical practice.

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. Nausea and vomiting, however, occur more commonly after upper gastrointestinal surgery than after resection of the small intestine and colon. In our clinical experience nasogastric decompression can usually be discontinued 12-24 hours after resection of the small intestine and colon.

There is no evidence that bowel rest and a period of starvation are beneficial for healing of wounds and anastomotic integrity. Indeed, the evidence is that luminal nutrition may enhance wound healing and increase anastomotic strength, …