English

Abstract

Thirty five patients who were randomly allocated to early feeding beginning with liquid diet 7 hour post-operatively then controlled liquid, liquid diet then semisolid and solid diet. Ryle's tube was removed immediately after operation. Post-operative ileus, anastomotic leak, wound dehiscence, mesenteric embolus, wound infection are not related to early feeding. Early feeding in G.I anastomosis seems to be safe, well tolerated and was not associated with increased post-operative GI complications. Though the number of patients is less in this study without comparative post- operative conventional feeding yet no untoward post-operative complication encountered and patients were discharged within 5-10 days post-operatively. INTRODUCTION: A period of starvation (Nil by Mouth) is common practice for last 50 years after gastrointestinal surgery during which an intestinal anastomosis has been formed. There is no evidence that bowel rest and a period of starvation are beneficial for healing of wounds and anastomotic integrity 1. Indeed, the evidence is that luminal nutrition may enhance wound healing and increase anastomotic strength, particularly in malnourished patients. The rationale of by is to prevent post-operative nausea and vomiting and to protect the anastomosis, allowing it time to heal before being stressed by food. Post-operative dysmotility predominantly affects the stomach and colon, with the small bowel recovering normal function 4-8 hours after laparotomy. Feeding within 24 hours after laparotomy is tolerated and the feed absorbed. Gastrointestinal surgery is often undertaken in patients who are malnourished, which in severe cases is known to increase morbidity. In animals, starvation reduces the collagen content in anastomotic scar tissue and diminishes the quality of healing. Whereas feeding reverses mucosal atrophy induced by starvation and increases anastomotic collagen deposition and strength. 1, 2 Study reveals enteral nutrition is associated with an improvement in wound healing. Finally early enteral feeding may reduce septic morbidity after abdominal trauma and pancreatitis. The routine use of a nasogastric tube after elective gastrointestinal and colorectal surgery is no longer mandatory. Traditionally, after abdominal surgery, the passage of flatus or bowel sounds is the clinical evidence for starting an oral diet. The resolution of post-operative ileus defined by the passage of flatus usually occurred within 5 days. 3 Studies with a small group of patients were undertaken to evaluate whether different abdominal surgeries could benefit from early feeding. Early feeding improves the outcome of patients with trauma burns, although few studies have examined its use after gastrointestinal anastomosis. Theoretically, early enteral feeding improves tissue healing and reduces septic complications after gastrointestinal surgery. There is no benefit in keeping patients nil by mouth after gastrointestinal surgery. Septic complications and length of hospital stay were reduced in those patients who received early enteral feeding. In patients who received early enteral