Early postoperative enteral feeding increases anastomotic strength in a peritonitis model

Abstract

I read with great interest the study by Khalili et al [1] as published in The American Journal of Surgery. This paper looks at the beneficial effects of early postoperative enteral feeding on anastomotic healing. They hypothesized that early postoperative enteral feeding would change the cytokine response after surgery, mainly by decreasing TNF-α levels, which would increase the collagen synthesis and so anastomotic strength. They used cecal ligation and puncture model to produce acute peritonitis in rats, and then obtained chronic sepsis by treating acute phase surgically and with intravenous fluid resuscitation. They looked at the cytokine profile and anastomotic burst strength in postoperatively enteral fed group and compared it with the controls (no feeding). They found decreased TNF-α levels and increased anastomotic strength in early fed animals, and concluded that early postoperative enteral feeding decreased TNF-α levels, which resulted in increased collagen formation and better anastomotic healing.