Comparison of Early vs Late Resumption of Enteral Feeding after Small Bowel Anastomosis

Saeed Sarwar; Muhammad Zarin; Abubaker Khattak; Rehan Saeed; Nida Ahmad; Waleed Ahmad

doi:10.70749/ijbr.v3i4.1977

Authors

Saeed Sarwar Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
Muhammad Zarin Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
Abubaker Khattak Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
Rehan Saeed Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
Nida Ahmad Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
Waleed Ahmad Department of Surgery, Naseer Teaching Hospital, Peshawar, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i4.1977

Abstract

Introduction: Small bowel anastomosis is commonly performed in general surgical practice. Traditionally, Patients are kept nil by mouth for 48 to 72 hours in the belief that it will help in the healing of the anastomosis. However, recently, there is increasing evidence that early initiation of enteral feeding is both safe and beneficial. Our study aimed to compare early and traditional practices of enteral feeding after small bowel anastomosis. Materials and Methods: This study was a single-blinded, randomised controlled trial. The sample size was calculated to be 204, 102 in each group. Participants were randomly allocated to the early enteral feeding group (Group A) or the late group (Group B). In the Early group, enteral feeding was commenced after full recovery from anaesthesia, usually within 24 hours of surgery. In the late group, feeding was started after 24 - 48 hours, usually after the return of bowel function. Results: Our study demonstrated a statistically significant difference in terms of time to passage of stool or flatus and mean hospital stay between early and delayed initiation of enteral feeding. The incidence of postoperative vomiting and anastomotic leak had no statistically significant difference. Conclusion: Early initiation of enteral feeding after small bowel anastomosis is safe and is associated with quicker return of bowel function and shorter hospital stay as compared to delayed initiation of enteral feeding.

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References

1. Zhang C, Zhang M, Gong L, Wu W. The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: an updated review. Postgrad Med. 2020;132(5):419-25.

https://doi.org/10.1080/00325481.2020.1734342

2. Schattenkerk LD, Backes M, de Jonge WJ, van Heurn EL, Derikx JP. Treatment of Jejunoileal Atresia by primary anastomosis or Enterostomy: Double the operations, double the risk of complications. J PediatrSurg. 2022;57(9):49-54.

https://doi.org/10.1016/j.jpedsurg.2021.07.021

3. Nematihonar B, Yazdani A, Falahinejadghajari R, Mirkheshti A. Early postoperative oral feeding shortens first time of bowel evacuation and prevents long term hospital stay in patients undergoing elective small intestine anastomosis. Gastroenterol Hepatol. 2019;12(1):25-9.

4. Kunstman JW, Klemen ND, Fonseca AL, Araya DL, Salem RR. Nasogastric drainage may be unnecessary after pancreaticoduodenectomy: a comparison of routine vs selective decompression. J Am Coll Surg 2013;217(3):481-8.

https://doi.org/10.1016/j.jamcollsurg.2013.04.031

5. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Enteral Nutrition: surgery including organ transplantation. Clin Nutr. 2006;25(2):224-44.

https://doi.org/10.1016/j.clnu.2006.01.015

6. Nematihonar B, Salimi S, Noorian V, Samsami M. Early versus delayed (traditional) postoperative oral feeding in patients undergoing colorectal anastomosis. Adv Biomed Res. 2018;7:30.

https://doi.org/10.4103/abr.abr_290_16

7. Ali I, Bhuvan D. Comparative study of early vs late enteral feeding following intestinal anastomosis. Int J Sci Res Public. 2020;10(1):67-70.

https://doi.org/10.29322/ijsrp.10.01.2020.p9711

8. Osland E, Yunus RM, Khan S, Memon MA. Early Versus Traditional Postoperative Feeding in Patients Undergoing Resectional Gastrointestinal Surgery. J Parenter Enter Nutr [Internet]. 2011 May 31 [cited 2025 Jul 19];35(4):473-87.

https://doi.org/10.1177/0148607110385698.

9. Sierzega M, Choruz R, Pietruszka S, Kulig P, Kolodziejczyk P, Kulig J. Feasibility and Outcomes of Early Oral Feeding After Total Gastrectomy for Cancer. J Gastrointest Surg [Internet]. 2014 Dec 18 [cited 2025 Jul 19];19(3):473-9.

https://doi.org/10.1007/s11605-014-2720-0

10. Tian Y, Zhu H, Gulack BC, Alganabi M, Ramjist J, Sparks E, Wong K, Shen C, Pierro A. Early enteral feeding after intestinal anastomosis in children: a systematic review and meta-analysis of randomized controlled trials. Pediatr Surg Int [Internet]. 2021 Feb 17 [cited 2025 Jul 19];37(3):403-10.

https://doi.org/10.1007/s00383-020-04830-w

11. Issac A, Dhiraaj S, Halemani K, Thimmappa L, Mishra P, Kumar B, Mavinatop A. Efficacy of early enteral nutrition on gastrointestinal surgery outcomes: a systematic review and meta-analysis. European Journal of Pediatric Surgery. 2023 Dec;33(06):454-62.

https://doi.org/10.1055/s-0043-1760837