Abstract
Purpose: Determine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. Methods: Controlled randomized trial including pediatric patients with DEBA, excluding non-elective and high risk patients. Variables: Demographics, operative time, anastomosis placement, beginning peristalsis and bowel movement, time to full diet intake, post-operative stay, persisting vomiting and abdominal distention, wound infection or dehiscence, anastomotic leak, reoperation, death. Randomization into: 1) Experimental group (EG): early feeding group, after a minimum 24 hours fasting period, oral fluids and diet was started; 2) Control group (CG): obligatory 5-day fasting. Descriptive Statistics: Student’s t test for quantitative and Chi square for qualitative variables, a p-value 0.05 was considered significant. Results: 60 patients were included since June 2003 to May 2004, 30 ineach group. Mean age 2 years, weight16 kg, malnutrition 33%. Stomal Ethiology: Anorectal-malformation 46%, Hirschsprung 13%, inflammatory 35%, tumoral 5%. Mostly in colon 71%. Mean surgical time 142 min. None developed vomiting or required nasogastric-tube. Mild abdominal distension 13%, mild fever 16.5% and wound complications 18%. Anastomosis leakage 6.5%, none required reoperations. Demographic variables showed no statistical differences. Full oral intake was in the 2nd postoperative day in the EG vs CG (p = 0.001). Postoperative hospital stay was 6.0 ± 3 in the EG vs 9.8 ± 4 days in the CG with clinical but not statistical significance. Peristalsis beginning, first flatus passage and bowel movements showed no statistical differences. The complication incidence was low and equally distributed. Conclusions: Early feeding after DEBA is safe and well tolerated in children.
Highlights
After the demonstration that nasogastric tube (NGT) decompression was not necessary after a distal elective bowel anastomosis (DEBA) [1], in the last few years the standard management after DEBA at our hospital became a mandatory 5-day fasting without the use of a NGT
Our results showed that both groups were comparable given the homogeneity in the distribution of the demographic and intraoperative variables, and the only difference was the early feeding in the experimental group
There were two limitations of the study: First it was not blinded for the personel that recorded the follow up variables because it was impossible to hide the food in the control group and second, it only included distal elective bowel anastomosis, so there is a need of more studies to test the safety on other types of anastomosis
Summary
After the demonstration that nasogastric tube (NGT) decompression was not necessary after a distal elective bowel anastomosis (DEBA) [1], in the last few years the standard management after DEBA at our hospital became a mandatory 5-day fasting without the use of a NGT. This was justified by the perception that the fasting would protect the anastomosis from any complication such as abdominal distention, vomiting, ileus, anastomotic dehiscence or leaks, wound infections and would allow a hermetic closure of the anastomosis before the beginning of the enteral feeding [2,3,4]. There is only one study in 34 children postoperated (PO) of colostomy closure secondary to anorectal malformation in which the authors concluded that the EF is safe and allows less hospital stay but it is retro-
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