Comparison of the outcome of early versus delayed oral feeding after gastrointestinal anastomosis in adults

Background: Patients are routinely placed on nil per oral after gastrointestinal anastomosis and only allowed oral intake after the onset of bowel sounds or the passage of flatus. Studies suggest that oral feeding within 24hours of anastomosis is safe. Aims: To compare the time for return of bowel motility, complication rates and length of postoperative hospital stay between early and delayed oral feeding group. Methods: This study was a prospective randomized control study. Sixty patients were randomized equally into early (study) and delayed (control) oral feeding groups. The study group was commenced on oral feeding 24hours postoperatively and the control group after passing flatus. Outcome measures were evaluated and compared using chi-square test and t-test with SPSS version 20 software. Results: The study and control groups passed flatus 42.6±22.0hrs and 70.3±23.3hrs postoperatively (p=0.000), passed stool at 69.8±37.0hrs and 89.5±29.2hrs postoperatively (p=0.026) and bowel sounds returned 31.4±13.3hrs and 53.8±21.7hrs postoperatively (p=0.000) respectively. Eight (27.6%) and 17(56.7%) patients had surgical site infection in the study and control group respectively (p=0.024). No patient in the study group had anastomotic leak while one (3.3%) leaked in the control group (p=1.000). The length of postoperative hospital stay was 9.6±4.8 and 13.9±7.9 days in the study and control group respectively (p= 0.021). Conclusions: Early oral feeding after anastomosis led to an earlier return of bowel sound, passage of flatus and stool. There was also an observed reduction in the rate of surgical site infection and a reduction in the length of postoperative hospital stay among the early feeding group but no effect on anastomotic leak or chest infection.