A prospective randomized controlled study: early enteral nutrition following gastrointestinal surgery

Abstract

Background: The word anastomosis originates from the Greek word (ἀναστόμωσις) meaning communicating opening. Gut anastomosis is one of the frequently performed surgeries in both emergency and elective setup. Anastomosis following gut resections in emergency set up is mostly done due to traumatic rupture, benign or malignant perforation or obstruction and in certain other inflammatory conditions. Anastomosis is also done in some elective conditions like mostly due to malignancy of GI system. As conventional practice following gut anastomosis, patients are kept “NIL BY MOUTH” till bowel sounds return.

Methods: It’s a prospective study, carried out over period of 18 months in Department of General Surgery, Sri Guru Ramdas Institute of Medical Sciences and Research, Vallah, Amritar. The objective of this study was to whether early enteral feeding within 48 hours of small gut anastomosis is tolerable to the patient. Whether early enteral feeding within 48 hours of small gut anastomosis is beneficial to the patient.

Results: This prospectively conducted comparative study was carried out on 60 patients, meeting inclusion criteria, undergoing gastrointestinal anastomosis either elective or emergency, in the Department of General Surgery, SGRD Medical College, between Jan 2012 to June 2013. Random selection of patients into group A (30) and group B (30) was done after having fulfilled inclusion and exclusion criteria. The group A was fed via enteral route within 48 hrs of enteric anastomosis. The group B was fed via enteral route after 48-72 hours or appearance of full peristaltic sounds following enteric anastomosis. These patients were followed in post-operative period for their drain output, any nausea, vomiting, or significant abdominal distension, prolonged ileus, clinical leakage, infective complications, hospital stay.

Conclusions: The following inferences can therefore be drawn from this study: Appearance of intestinal peristaltic sounds is earlier in early enterally fed group, Mean duration of post-operative hospital stay is lower in early enterally fed group, mean post-operative day 4 albumin level is higher in early enterally fed group. The rate of infective complications (UTI, RTI, wound complications) is equal in both the groups. The rate of clinical leakage, nausea/vomiting are equal in both the groups. The rate of re-exploration for anastomotic leakage is equal in both the groups.