Background: The safety and effectiveness of early oral feeding after colorectal surgery has not been determined. We performed a meta-analysis to evaluate surgical outcomes following early oral feeding compared with traditional oral feeding in patients undergoing elective colorectal surgery. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify randomized clinical trials comparing the outcomes following early oral feeding versus traditional oral feeding in patients undergoing elective colorectal surgery. The trials must have reported at least one of the following end points: anastomotic dehiscence, pneumonia, wound infection, nasogastric tube reinsertion, vomiting, mortality, length of hospital stay, hospital costs, and quality of life. Results: Seven trials, which included a total of 587 patients, met our inclusion criteria. Compared with traditional oral feeding, early oral feeding reduced the length of hospital stay (weighted mean difference -1.58 days; 95% CI -2.77 to -0.39; p = 0.009) and the total postoperative complications (relative risk 0.70; 95% CI 0.50-0.98; p = 0.04). There were no significant differences in the risk of anastomotic dehiscence, pneumonia, wound infection, rate of nasogastric tube reinsertion, vomiting, or mortality. Conclusions: Early oral feeding is safe and effective in patients undergoing elective colorectal surgery.

1.
Bisgaard T, Kehlet H: Early oral feeding after elective abdominal surgery - what are the issues? Nutrition 2002;18:944-948.
2.
Nelson R, Edwards S, Tse B: Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007: CD004929.
3.
Lewis SJ, Egger M, Sylvester PA, Thomas S: Early enteral feeding versus ‘nil by mouth' after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001;323:773-776.
4.
Andersen HK, Lewis SJ, Thomas S: Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev 2006, pp CD004080.
5.
Lewis SJ, Andersen HK, Thomas S: Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 2009;13:569-575.
6.
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;35:473-487.
7.
Gomes GF, Pisani JC, Macedo ED, Campos AC: The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia. Curr Opin Clin Nutr Metab Care 2003;6:327-333.
8.
Ghahremani GG, Gould RJ: Nasoenteric feeding tubes: radiographic detection of complications. Dig Dis Sci 1986;31:574-585.
9.
Levenson R, Turner WW Jr, Dyson A, Zike L, Reisch J: Do weighted nasoenteric feeding tubes facilitate duodenal intubations? JPEN J Parenter Enteral Nutr 1988;12:135-137.
10.
Bourgault AM, Heyland DK, Drover JW, Keefe L, Newman P, Day AG: Prophylactic pancreatic enzymes to reduce feeding tube occlusions. Nutr Clin Pract 2003;18:398-401.
11.
Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535.
12.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.
13.
Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J: Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 2006;11:193-206.
14.
Higgins JP, Thompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-1558.
15.
Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-634.
16.
Hartsell PA, Frazee RC, Harrison JB, Smith RW: Early postoperative feeding after elective colorectal surgery. Arch Surg 1997;132:518-520, discussion 520-521.
17.
Stewart BT, Woods RJ, Collopy BT, Fink RJ, Mackay JR, Keck JO: Early feeding after elective open colorectal resections: a prospective randomized trial. Aust N Z J Surg 1998;68:125-128.
18.
Lucha PA Jr, Butler R, Plichta J, Francis M: The economic impact of early enteral feeding in gastrointestinal surgery: a prospective survey of 51 consecutive patients. Am Surg 2005;71:187-190.
19.
El Nakeeb A, Fikry A, El Metwally T, Fouda E, Youssef M, Ghazy H, Badr S, Khafagy W, Farid M: Early oral feeding in patients undergoing elective colonic anastomosis. Int J Surg 2009;7:206-209.
20.
Lobato Dias Consoli M, Maciel Fonseca L, Gomes da Silva R, Toulson Davisson Correia MI: Early postoperative oral feeding impacts positively in patients undergoing colonic resection: results of a pilot study. Nutr Hosp 2010;25:806-809.
21.
da Fonseca LM, Profeta da Luz MM, Lacerda-Filho A, Correia MI, Gomes da Silva R: A simplified rehabilitation program for patients undergoing elective colonic surgery - randomized controlled clinical trial. Int J Colorectal Dis 2011;26:609-616.
22.
Dag A, Colak T, Turkmenoglu O, Gundogdu R, Aydin S: A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clinics (Sao Paulo) 2011;66:2001-2005.
23.
Kehlet H: Fast-track colorectal surgery. Lancet 2008;371:791-793.
24.
Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH: Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 2009;144:961-969.
25.
Heslin MJ, Latkany L, Leung D, Brooks AD, Hochwald SN, Pisters PW, Shike M, Brennan MF: A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg 1997;226:567-577, discussion 577-580.
26.
Binderow SR, Cohen SM, Wexner SD, Nogueras JJ: Must early postoperative oral intake be limited to laparoscopy? Dis Colon Rectum 1994;37:584-589.
27.
Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD: Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 1995;222:73-77.
28.
Schloerb PR, Wood JG, Casillan AJ, Tawfik O, Udobi K: Bowel necrosis caused by water in jejunal feeding. JPEN J Parenter Enteral Nutr 2004;28:27-29.
29.
Ortiz H, Armendariz P, Yarnoz C: Is early postoperative feeding feasible in elective colon and rectal surgery? Int J Colorectal Dis 1996;11:119-121.
30.
Kehlet H, Buchler MW, Beart RW Jr, Billingham RP, Williamson R: Care after colonic operation - is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 2006;202:45-54.
31.
Villalba Ferrer F, Bruna Esteban M, Garcia Coret MJ, Garcia Romero J, Roig Vila JV: Evidence of early oral feeding in colorectal surgery. Rev Esp Enferm Dig 2007;99:709-713.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.