Early Versus Delayed (Traditional) Postoperative Oral Feeding in Patients Undergoing Colorectal Anastomosis

Document Type : Original Article


1 Department of General Surgery, Imam-Hossein General Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Anesthesiology, Imam-Hossein General Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: A period of starvation after colorectal anastomosis to permit for resolution of the clinical evidence of ileus has been an unchallenged surgical dogma until recent years. We intended to determine the safety and feasibility of an unconventional postoperative oral intake protocol in patients experiencing colorectal anastomosis. Materials and Methods: Between 2013 and 2015, sixty consecutive patients underwent colorectal anastomosis and they were randomized into two groups. The early feeding group began fluids on the first postoperative day while the regular feeding group was managed in the traditional way - nothing by mouth until the complete resolution of ileus. Results: The majority of patients (93%) tolerated the early feeding. The times to first passage of flatus (2.66 ± 0.71 days vs. 3.9 ± 0.071 days) and stool (3.9 ± 0.92 days vs. 5.4 ± 0.77 days) were significantly quicker in early feeding group. Hospital stay was also significantly shorter in the early feeding group (4 ± 0.64 days vs. 6.1 ± 0.84 days). Anastomosis leakage and abscess formation were not seen in early feeding group. The patient's satisfaction (visual analog scale) in the early feeding group was higher than delayed feeding group (8.56 ± 1.16 vs. 7.06 ± 1.59, P < 0.001). Conclusions: Early oral feeding after colorectal surgeries is safe and tolerated by the majority of patients.


Levine M. A new gastroduodenal catheter. JAMA 1981;76:1007.  Back to cited text no. 1
Bauer JJ, Gelernt IM, Salky BA, Kreel I. Is routine postoperative nasogastric decompression really necessary? Ann Surg 1985;201:233-6.  Back to cited text no. 2
Argov S, Goldstein I, Barzilai A. Is routine use of the nasogastric tube justified in upper abdominal surgery? Am J Surg 1980;139:849-50.  Back to cited text no. 3
Nathan BN, Pain JA. Nasogastric suction after elective abdominal surgery: A randomised study. Ann R Coll Surg Engl 1991;73:291-4.  Back to cited text no. 4
Meltvedt R Jr., Knecht B, Gibbons G, Stahler C, Stojowski A, Johansen K. Is nasogastric suction necessary after elective colon resection? Am J Surg 1985;149:620-2.  Back to cited text no. 5
Wolff BG, Pemberton JH, Van Heerden JA. Elective colon and rectal surgery without nasogastric decompression. Ann Surg 1987;154:640-2.  Back to cited text no. 6
Petrelli NJ, Stulc JP, Rodriquez-Bigas M. Nasogastric decompression following elective colorectal surgery. Am Surg 1993;59:632-5.  Back to cited text no. 7
de Aguilar-Nascimento JE, Göelzer J. Early feeding after intestinal anastomoses: Risks or benefits? Rev Assoc Med Bras 2002;48:348-52.  Back to cited text no. 8
Petrini JL. Diet and drugs in colorectal surgery. In: Corman ML, editor. Colon and Rectal Surgery. 5th ed. New York: Lippincott Williams & Wilkins; 2005. p. 50.  Back to cited text no. 9
Sagar S, Harland P, Shields R. Early postoperative feeding with elemental diet. Br Med J 1979;1:293-5.  Back to cited text no. 10
Binderow SR, Cohen SM, Wexner SD, Nogueras JJ. Must early postoperative oral intake be limited to laparoscopy? Dis Colon Rectum 1994;37:584-9.  Back to cited text no. 11
Bufo AJ, Feldman S, Daniels GA, Lieberman RC. Early postoperative feeding. Dis Colon Rectum 1994;37:1260-5.  Back to cited text no. 12
Choi J, O'Connell TX. Safe and effective early postoperative feeding and hospital discharge after open colon resection. Am Surg 1996;62:853-6.  Back to cited text no. 13
Hartsell PA, Frazee RC, Harrison JB, Smith RW. Early postoperative feeding after elective colorectal surgery. Arch Surg 1997;132:518-20.  Back to cited text no. 14
Jeffery KM, Harkins B, Cresci GA, Martindale RG. The clear liquid diet is no longer a necessity in the routine postoperative management of surgical patients. Am Surg 1996;62:167-70.  Back to cited text no. 15
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;222:73-7.  Back to cited text no. 16
Hoover HC Jr., Ryan JA, Anderson EJ, Fischer JE. Nutritional benefits of immediate postoperative jejunal feeding of an elemental diet. Am J Surg 1980;139:153-9.  Back to cited text no. 17
Ryan JA Jr., Page CP, Babcock L. Early postoperative jejunal feeding of elemental diet in gastrointestinal surgery. Am Surg 1981;47:393-403.  Back to cited text no. 18
Meguid MM, Campos AC, Hammond WG. Nutritional support in surgical practice: Part II. Am J Surg 1990;159:427-43.  Back to cited text no. 19
Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992;216:172-83.  Back to cited text no. 20
Ortiz H, Armendariz P, Yarnoz C. Is early postoperative feeding feasible in elective colon and rectal surgery? Int J Colorectal Dis 1996;11:119-21.  Back to cited text no. 21
Lee HS, Shim HJ, Lee HS, Lee JG, Kim KS. The safety of early enteral feeding after emergency gastrointestinal surgery. Korean J Gastroenterol 2011;58:318-22.  Back to cited text no. 22
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;(4):CD004080.  Back to cited text no. 23
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;13:569-75.  Back to cited text no. 24
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;25:806-9.  Back to cited text no. 25
Ng WQ, Neill J. Evidence for early oral feeding of patients after elective open colorectal surgery: A literature review. J Clin Nurs 2006;15:696-709.  Back to cited text no. 26
Aihara H, Kawamura YJ, Konishi F. Reduced medical costs achieved after elective oncological colorectal surgery by early feeding and fewer scheduled examinations. J Gastroenterol 2003;38:747-50.  Back to cited text no. 27
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;68:125-8.  Back to cited text no. 28
Seenu V, Goel AK. Early oral feeding after elective colorectal surgery: Is it safe. Trop Gastroenterol 1995;16:72-3.  Back to cited text no. 29
El Nakeeb A, Fikry A, El Metwally T, Fouda E, Youssef M, Ghazy H, et al. Early oral feeding in patients undergoing elective colonic anastomosis. Int J Surg 2009;7:206-9.  Back to cited text no. 30
Charoenkwan K, Phillipson G, Vutyavanich T. Early versus delayed (traditional) oral fluids and food for reducing complications after major abdominal gynaecologic surgery. Cochrane Database Syst Rev 2007;(4):CD004508.  Back to cited text no. 31
Tavasolli A, Abdollahi A, Darkhord A. Early versus delayed post operative oral feeding in patients undergoing colonic anastomosis. Med J Mashhad Univ Med Sci 2010;53:104-9.  Back to cited text no. 32
Sekhavat L, Karimi Zarchi M, Tabatabaii A. Early oral feeding effect on gastrointestinal symptoms and patients satisfaction after cesarean delivery under general anaesthesia. J Babol Univ Med Sci 2009;10:67-72.  Back to cited text no. 33
Kawamura YJ, Uchida H, Watanabe T, Nagawa H. Early feeding after oncological colorectal surgery in Japanese patients. J Gastroenterol 2000;35:524-7.  Back to cited text no. 34