Early Postoperative Oral Feeding Research Articles

A clinical study on gastric cancer patients administered EN and PN versus PN alone in enhanced recovery after surgery.

Enhanced recovery after surgery (ERAS) recommends avoiding enteral nutrition (EN) due to undesirable sequelae such as pulmonary aspiration and infections. Not using of EN in nongastric resections under ERAS pathways is often successful. However, parenteral nutrition (PN) alone followed by early postoperative oral feeding in gastric cancer patients, recommended by the ERAS guidelines, has unclear benefit and is only adopted after gastric resection. This study aimed to compute the postoperative outcomes of EN and PN compared to those of the ERAS-recommended nutritional pathway. Our secondary objective was to compare postoperative complications between the two groups. Of 173 gastrectomy patients, 116 patients were in the combined group (EN and PN), whereas 57 patients were in the PN alone group. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) version 26.0.0 software. The data were analyzed by one-way ANOVA, the independent sample t-test, or, in the case of several independent samples, by the Kruskal-Wallis test. Categorical data were analyzed by Pearson's χ2 test or Fisher's exact test. The observed indices included C-reactive protein (CRP), platelet (PLT), white blood cells (WBC), hemoglobin (Hb), albumin, and PRE-albumin. The secondary outcomes included length of hospital stay (LOS), cost, incidence of pulmonary infection, and total incidence of infection. The combined mode of nutrition is feasible and is not associated with postoperative complications in gastric cancer patients under ERAS.

377. EARLY POSTOPERATIVE ORAL FEEDING IS SAFE FOLLOWING MAJOR UPPER GASTROINTESTINAL SURGERY (PROPENSITY SCORE MATCHING STUDY)

Abstract Background The traditional feeding method, which started 5–7 days after upper gastrointestinal (UGI) tumor resections is the widely accepted method worldwide. ERAS protocol is becoming more and more common, but there is still not enough evidence that early postoperative oral feeding is safe following major UGI surgery. Patients and Methods: A propensity score matching study was conducted at the University of Pecs, Department of Surgery, Hungary between January 2020 and July 2022. The study included patients with UGI tumor resections where our early oral feeding (EOF) protocol were applied. Data were collected retrospectively and the EOF- group was compared with a control group, who have been cared for the traditional feeding method during this period. Results the study included 50 patients, 25 in the early oral feeding group, and 25 case-matched patients in the traditional oral feeding group. The start of the oral feeding was on day 2.09 in the EOF, and on day 5.52 in the LOF group. Statistically significant decreases were observed in the EOF group in the postoperative length of stay (8.875 days vs 12.06 days), first bowel movement, and length of postoperative intravenous fluid therapy. There were no significant differences in mortality, anastomosis insufficiency, anastomosis inflammation and stricture. Conclusions Our results confirmed, that in the EOF group the mortality and anastomosis leakages do not increase compared to the traditional feeding protocol. However EOF decreased the length of hospital stay resulted earlier recovery, and the quality of life was improved by starting early oral feeding.

Faster recovery and bowel movement after early oral feeding compared to late oral feeding after upper GI tumor resections: a meta-analysis.

There were more than 1 million new cases of stomach cancer concerning oesophageal cancer, there were more than 600,000 new cases of oesophageal cancer in 2020. After a successful resection in these cases, the role of early oral feeding (EOF) was questionable, due to the possibility of fatal anastomosis leakage. It is still debated whether EOF is more advantageous compared to late oral feeding. Our study aimed to compare the effect of early postoperative oral feeding and late oral feeding after upper gastrointestinal resections due to malignancy. Two authors performed an extensive search and selection of articles independently to identify randomized control trials (RCT) of the question of interest. Statistical analyses were performed including mean difference, odds ratio with 95% confidence intervals, statistical heterogeneity, and statistical publication bias, to identify potential significant differences. The Risk of Bias and the quality of evidence were estimated. We identified 6 relevant RCTs, which included 703 patients. The appearance of the first gas (MD = -1.16; p = 0.009), first defecation (MD = -0.91; p < 0.001), and the length of hospitalization (MD = -1.92; p = 0.008) favored the EOF group. Numerous binary outcomes were defined, but significant difference was not verified in the case of anastomosis insufficiency (p = 0.98), pneumonia (p = 0.88), wound infection (p = 0.48), bleeding (p = 0.52), rehospitalization (p = 0.23), rehospitalization to the intensive care unit (ICU) (p = 0.46), gastrointestinal paresis (p = 0.66), ascites (p = 0.45). Early postoperative oral feeding, compared to late oral feeding has no risk of several possible postoperative morbidities after upper GI surgeries, but has several advantageous effects on a patient's recovery. identifier, CRD 42022302594.

The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: Protocol for a systematic review and meta-analysis.

Given the ever-shorter length of hospital stay after surgical procedures, nowadays it is more important than ever to study interventions that may have an impact on surgical patients' wellbeing. According to the ERAS (Enhanced Recovery After Surgery protocols) program, early feeding must be considered one of the key components to facilitate early recovery while improving outcomes and patients' overall experiences. To date, the international literature has reported that early postoperative feeding compared with traditional (or late) timing is safe; nevertheless, small clinical outcomes effects has been reported, also for recovery of gastrointestinal function. Therefore, the effectiveness of early postoperative feeding to reduce postoperative ileus duration remains still debated. To analyse the effects of early versus delayed oral feeding (liquids and food) on the recovery of intestinal motility after gastrointestinal surgery. Pubmed, Embase, Cinahl, Cochrane Central Register of Controlled Trials (CENTRAL), and the ClincalTrials.gov register will be searched to identify the RCTs of interest. Randomized clinical trials (RCTs) comparing the effect of early postoperative versus late oral feeding on major postoperative outcomes after gastrointestinal surgery will be included. Two review authors will independently screen titles and abstracts to determine the initially selected studies' inclusion. Any disagreements will be resolved through discussion and consulting a third review author. The research team members will then proceed with the methodological evaluation of the studies and their eligibility for inclusion in the systematic review.

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings.

Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.

Early versus Delayed Initiation of Oral Feeds among Mothers after Caesarean Delivery: A Comparative Study

Introduction: It is a common practice to keep a patient ‘nil’ per oral, till the return of bowel sounds, after any laparotomy. Enhanced Recovery After Surgery (ERAS) society, now recommends evidenced-based guidelines for postoperative early oral feeding after an uncomplicated Caesarean Delivery (CD), as opposed to the delayed (conventional) initiation of oral feeds. Aim: To compare the effects of early feeding versus delayed oral feeding in women undergoing CD. Materials and Methods: This prospective study was conducted in Department of Obstetrics and Gynaecology at MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India, from November 2020 to October 2021. Total of 148 women with uncomplicated singleton pregnancy undergoing CD, under spinal anaesthesia, were allocated into two groups. Early Feeding group (n=70) (EF) where feeding was started within 2-8 hours of surgery and Delayed feeding group (n=78) (DF) where feeding was started between 18-24 hours of CD. The outcome measures were maternal satisfaction, and the effect on gastrointestinal function (return of bowel sounds, passage of flatus and stool), mobilisation of patient and complications in postoperative period. Student’s t-test and Chi-square test were used as appropriate, and p-value &lt;0.05 was determined to be statistically significant. Results: The mean age of women in DF was 24.79±4.37 years and in EF group was 25.09±3.86 years. Overall, the maternal satisfaction was high in both the groups; DF (80%) and in EF (98.57%). There was an early return of bowel sounds in EF group 4.71±1.83 hours versus 13.72±3.08 hours in DF group. Participants in EF group recorded. early passage of flatus (9.89±3.00 hours versus 13.72±3.08 hours), and early ambulation (9.57±1.62 versus 14.95±3.9 hours) when compared to DF group participants. Conclusion: The ERAS strategy is a safe and effective approach for postoperative care for women undergoing caesarean delivery and results in overall high patient satisfaction.

Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study.

Although postoperative early oral feeding in the enhanced recovery after surgery (ERAS) program for pancreaticoduodenectomy (PD) is deemed safe, the assessment of oral intakes has been insufficient. This study aimed to investigate postoperative oral intakes and the effectiveness of an ERAS program incorporating early enteral nutrition (EN). In total, 203 patients with PD were enrolled retrospectively. The first group (group E1; n = 61) comprised 11 ERAS care elements, whereas the second group (group E2; n = 106) comprised 19 elements. The control group (group C; n = 36) was managed using traditional care before ERAS was implemented. Postoperative energy and protein requirements were estimated at 25-30 kcal per kilogram of ideal body weight and 1.2-1.5 g per kilogram of ideal body weight, respectively, and were investigated along with the length of hospital stay (LOS). The oral energy and protein intakes from the diets in the ERAS groups at postoperative day 7 significantly increased compared with those in group C. Intakes in groups E1 and E2 were not significantly different and provided <30% of the requirements. However, the total intakes, which were compensated by EN, were maintained at >80% of the requirements. LOS was significantly shorter in groups E1 (31 days) and E2 (19 days) than in group C (52 days). Postoperative early oral energy and protein intakes of this modified ERAS program failed to meet the dietary requirements. However, early EN compensated for the shortages and contributed to the reduction of LOS.

The Role of Chewing Gum on Post-operative Bowel Recovery after Gynecological Laparoscopic Surgery: A Short Report and Updated Review

BACKGROUND: Adverse post-operative complication of gynecological laparoscopic surgery, post-operative ileus, could be reduced by mimicking early post-operative oral feeding; however, the role of chewing gum is still lack evidence. AIM: This study was conducted to assess chewing gum’s role in post-operative bowel recovery after gynecological laparoscopic surgery. METHODS: This prospective clinical trial recruited 60 participants who had undergone gynecological laparoscopic surgery under general anesthesia. The study was conducted at Arifin Achmad Hospital, Riau Province, Indonesia, from January to April 2021. The patients were equally divided into two groups: Intervention (n = 30) and control (n = 30). They were asked to chew sugar-free gum every 2 h after the surgery (i.e. 5 times within 10 h post-surgery). Time of the first flatus and the first bowel sounds were recorded (i.e. 5 times of assessment within 10 h post-surgery). In addition, a literature review was conducted to add evidence of the role of chewing gum on postoperative bowel recovery after gynecological laparoscopic surgery. RESULTS: Patients from both groups had a close age range (23–44-year-old versus 21–42-year-old). Our data suggested a significant difference in the time of the first flatus between the treatment and control group (15.95 h vs. 45.05 h), p &lt; 0.001. The length of stay in the hospital among those from the treatment group was also significantly shorter compared to controls (15.50 h vs. 45.50 h), p &lt; 0.001. The literature review of four updated randomized clinical trials suggests chewing gum in the early onset of first flatus and bowel movement. CONCLUSION: Chewing gum following gynecological laparoscopic surgery could accelerate gastrointestinal recovery.

Effects of preoperative oral carbohydrate administration combined with postoperative early oral intake in elderly patients undergoing hepatectomy with acute-phase inflammation and subjective symptom burden: A prospective randomized controlled study

BackgroundEnhanced recovery after surgery (ERAS) has received increasing attention. Preoperative oral carbohydrate and postoperative early oral feeding (POC-PEOF) as the basic nutrition administration in the ERAS program suffers from low adherence. The role and benefits of administering POC-PEOF in elderly patients with hepatocellular carcinoma (HCC) are unclear. Therefore, the randomized controlled trial evaluated the effects of POC-PEOF in elderly patients with HCC undergoing hepatectomy with inflammation and patient self-reported symptom burden compared with the corresponding outcomes of traditional fasting protocols. MethodsElderly patients with HCC (n = 126) were randomly assigned to two groups using the sealed envelope technique. Sixty-three patients were included in the intervention (POC-PEOF) group and received POC-PEOF administration, whereas the 63 patients in the control (FAST) group underwent conventional fasting. Acute-phase inflammation markers, patient self-reported symptom burdens, and postoperative outcomes were compared between the two groups. ResultsThe average age was 69.60 ± 5.00 years in the POC-PEOF group and 70.44 ± 6.15 years in the FAST group. Compared to prolonged fasting, POC-PEOF achieved significant positive results, including lower overall levels of inflammatory response mediators (CRP, IL-6) on postoperative day (POD) 1, POD 3, and POD 5 (P < 0.05), lower patient self-reported symptom burdens of thirst, hunger, anxiety and nausea (P < 0.05), faster gastrointestinal function return with shortened times to first flatus and first defecation (48.31 ± 13.24 h vs. 96.26 ± 23.12 h and 72.87 ± 21.12 h vs. 144.34 ± 23.31 h, and P = 0.034 and P = 0.013, respectively). Furthermore, the average postoperative hospitalization duration in the POC-PEOF group was shorter than that in the FAST group (6.93 ± 0.98 d vs. 8.12 ± 1.15 d, P = 0.042). There was no significant difference of total complications between the groups (25.39 % vs 36.51 %, RR 0.696, 95 % CI 0.408–0.187, P = 0.177). ConclusionPOC-PEOF helps lessen acute-phase inflammation and relieves the subjective symptom burden, which can ensure better positive postoperative outcomes in elderly HCC patients undergoing hepatectomy.

Fast-track Rehabilitation after Oesophagectomy

The multimodal and interprofessional concept of fast-track rehabilitation ("enhanced recovery after surgery", ERAS) is generally applicable to transthoracic oesophagectomy, but is associated with two special features as compared to other oncological procedures. Due to the high comorbidity of oesophageal cancer patients, fast-track pathways have to be considered as one component of perioperative management and cannot be separated from prehabilitation with preoperative conditioning of single organ dysfunctions. Since gastric reconstruction causes a high prevalence of delayed gastric conduit emptying (DGCE), early and sufficient postoperative oral feeding is not easily feasible. There is currently no generally accepted algorithm for the postoperative nutritional management as well as for the prophylaxis/treatment of DGCE. Fast-track prehabilitation does not influence the mortality rate in specialised centres. At present, it is not clear whether a fast-track pathway helps to reduce postoperative morbidity. After modified fast-track rehabilitation, hospital discharge is possible from the 8th postoperative day.

Early enteral nutrition after lower gastrointestinal surgery: impact on hospital stay and complications.

British Journal of Community NursingVol. 25, No. 7 Cochrane CornerEarly enteral nutrition after lower gastrointestinal surgery: impact on hospital stay and complicationsPreethy D'Souza, Rovan D'Souza, Vishnu RenjithPreethy D'SouzaE-mail Address: preethy.d'[email protected]Research Associate, Social Sciences Research Unit, Department of Social Sciences, University College London Institute of Education, LondonSearch for more papers by this author, Rovan D'SouzaConsultant, Vascular and General Surgery, Royal Free Hospital, LondonSearch for more papers by this author, Vishnu RenjithLecturer, School of Nursing and Midwifery, Royal College of Surgeons in Ireland—Medical University of BahrainSearch for more papers by this authorPreethy D'Souza; Rovan D'Souza; Vishnu RenjithPublished Online:2 Jul 2020https://doi.org/10.12968/bjcn.2020.25.7.356AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Herbert G, Perry R, Andersen HK et al.. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev. 2018; 10:CD004080. https://doi.org/10.1002/14651858.CD004080.pub3 Medline, Google ScholarBardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia and early oral nutrition and mobilisation. Lancet. 1995; 345(8952):763–764. https://doi.org/10.1016/s0140-6736(95)90643-6 Crossref, Medline, Google ScholarBurton B, Nicholson G, Hall G. Endocrine and metabolic response to surgery. Continuing Educ Anesthesia Crit Care Pain. 2004; 4(5): 144–147. https://doi.org/10.1093/bjaceaccp/mkh040 Crossref, Google ScholarCatchpole BN. Smooth muscle and the surgeon. Aust N Z J Surg. 1989; 59(3):199–208. https://doi.org/10.1111/j.1445-2197.1989.tb01502.x Crossref, Medline, Google ScholarMcSorley ST, Horgan PG, McMillan DC. The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Crit Rev Oncol Haematol. 2016; 101:139–150. https://doi.org/10.1016/j.critrevonc.2016.03.011 Crossref, Medline, Google ScholarMoore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma—reduced septic morbidity. J Trauma. 1989; 29(7):916–922. https://doi.org/10.1097/00005373-198907000-00003 Crossref, Medline, Google ScholarSchroeder D, Gillanders L, Mahr K, Hill GL. Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. J Parenter Enteral Nutr. 1991; 15(4):376–383. https://doi.org/10.1177/0148607191015004376 Crossref, Medline, Google ScholarSoop M, Nygren J, Thorell A et al.. Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clin Nutr. 2004; 23(4):733–741. https://doi.org/10.1016/j.clnu.2003.12.007 Crossref, Medline, Google ScholarZhuang CL, Ye XZ, Zhang CJ et al.. Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: a meta-analysis of randomized clinical trials. Digestive Surg. 2013; 30:225–232. https://doi.org/10.1159/000353136 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 July 2020Volume 25Issue 7ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 2 July 2020 Published in print 2 July 2020 Information© MA Healthcare LimitedPDF download

Effect of long-lasting nutritional prehabilitation on postoperative outcome in elective surgery for IBD

Preoperative patient care optimisation appears to be crucial for obtaining good surgical outcomes. Enhanced Recovery After Surgery (ERAS) underlines the necessity to recognize and treat malnutrition perioperatively and to prehabilitate with interventions that can modulate the lean body mass before and after surgery. This procedure has been extensively reported in colorectal cancer patients but in Inflammatory Bowel Disease (IBD) it has not yet been clearly evaluated. The aim of this study was to implement the perioperative nutritional items in surgical Crohn's disease (CD) and ulcerative colitis (UC) patients electively operated in an ERAS setting, thus to clarify the impact of a long-lasting prehabilitation program in IBD. Consecutive adult patients (age ≥18) were included as soon as scheduled for elective surgery for CD or UC. The nutritional intervention included personalized dietary counseling and oral nutritional supplements when necessary. Data prospectively recorded in each phase were: FFM, FM, FFMI and phase angle detected with BIVA, weight, BMI, unintended weight loss, DASI, energy and nutritional intake, gastrointestinal symptoms and bowel functions. Nutritional risk was detected according to the NRS 2002 screening tool. The impact of early oral nutrition on postoperative recovery was analysed. A total of 61 IBD patients (45 CD and 16 UC) were included. Muscle wasting was present at baseline assessment in 28% of cases, significantly associated with the presence of ileostomy (p<0.011) and of a previous IBD surgery (p<0.011). During the preoperative phase, there was a significant improvement in weight, BMI, FFM (CD p=0.035; UC p=0.017), FFMI (CD ns; UC p=0.011) and phase angle (CD p=0.014; UC p=0.027). During the intra-hospital phase, weight and FFM decreased due to the catabolic effect of surgery, but in the whole perioperative period, both CD and UC patients did not change significantly in terms of body composition. Patients with earlier resumption of oral feeding had a significantly shorter hospital stay and a faster recovery of bowel function with no significant relationship with early postoperative complications. Nutritional prehabilitation positively modulated the body composition of IBD patients scheduled for elective surgery and therefore could represent a beneficial strategy to attenuate the impact of the surgical stress response on lean tissue in an ERAS setting. This effect is even more evident in high nutritional risk patients. Early postoperative oral feeding seems feasible and well tolerated in IBD. This approach positively influences the restoration of bowel function and the duration of hospital stay.

Early enteral feeding on esophageal cancer patients after esophageal resection and reconstruction.

In patients under esophagectomy, early postoperative oral feeding has traditionally been contraindicated to minimize the risk of anastomotic leaks. Because early oral feeding preserves the integrity and function of gut mucosa, the aim of this study was to investigate the impact of postoperative early oral feeding on esophagectomy. Between Oct 2013 and Jan 2016, 41 consecutive patients with esophageal carcinoma (stages I- III), who had undergone minimally invasive Ivor-Lewis surgery, were enrolled in this study. The patients were randomly arranged into the early oral feeding (EOF) group (21 cases) and the simple tube feeding (STF) group (20 cases). The nutritional goal for both groups was 25 kcal/(kg·day). The patients in the EOF group were tube-fed with enteral nutrition and orally fed with 5% glucose in normal saline during the first 4 postoperative days, after that the patients were placed on a liquid diet. The patients in the STF group were postoperatively tube-fed with enteral nutrition for 7 days before being switched to liquid diet. The length of the postoperative hospital stay, rate of perioperative complications, and overall mortality were recorded. Preoperative and postoperative levels of serum albumin (ALB), prealbumin (PA), transferrin (TP), and C reactive protein (CRP) were also monitored. There were no significant differences of the incidence of postoperative complications and overall mortality between the EOF group and the STF group, but the duration of hospital stay, interval until the first liquid food, and time of ambulation in the EOF group were lower than those of the STF group (P<0.05). EOF patients also showed significantly lower CRP levels compared with the STF group (P<0.05). EOF might reduce the duration of hospital stays and CRP levels in esophageal cancer patients who underwent esophagectomy while the mortality and complications were not affected.

Early Versus Conventional Postoperative Oral Feeding after Elective Colonic Anastomosis

Objective : The aim of this study was to assess the safety of early oral feeding after elective colonic anastomosis. Method: The study was conducted upon 40 cases at Kasr Al- Ainy teaching hospital. The cases were divided into two groups: Group 1 (Early feeding): 20 patients began fluids on the first postoperative day and advanced to a regular diet within the next 24–48 h, as tolerated. Group 2 (Regular feeding): 20 patients were managed in the traditional way (nothing by mouth for five days). Results: Anastomotic leakage was 0% in early feeding group versus 5% in conventional feeding group. Early oral feeding was tolerated in 90% of patients in early feeding group. The time to first passage of flatus was sooner in the early feeding group (1.05 ± 0.22) than the traditional group (1.95 ± 1.05), p= 0.001. The risk of wound infection was significantly reduced with the early feeding group (10.0%) when compared with the conventional feeding group (40.0%), p = 0.028. Length of hospital stay was significantly less in the early feeding group. Conclusion: Early oral feeding after elective colonic anastomosis is safe and can be tolerated by the majority of patients. Early oral feeding is associated with early return of bowel habits and reduced length of hospital stay. It is also associated with reduced risk of wound infection.

Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

Early Versus Late Oral Refeeding After Pancreaticoduodenectomy for Malignancy: a Comparative Belgian-French Study in Two Tertiary Centers

BackgroundIn the era of fast-track surgery, because pancreaticoduodenectomy (PD) carries a significant morbidity, surgeons hesitate to begin early oral feeding and achieve early discharge. We compared the outcome of two different approaches to the postoperative management of PD in two tertiary centers. MethodsOf patients having undergone PD for malignancy from 2008 to 2017, 100 patients who received early postoperative oral feeding (group A) were compared to 100 patients from another center who received early enteral feeding and a delayed oral diet (group B). Surgical indication and approach and type of pancreatic anastomosis were similar between both groups. Postoperative outcomes were retrospectively reviewed. ResultsPatient characteristics were similar between both groups, except significantly more neoadjuvant treatment in group A (A = 20% vs. B = 9%, p < 0.01). Mortality rates were 3% and 4% in groups A and B, respectively (p = 0.71). The rate of severe postoperative morbidity was significantly lower in group A (13% vs. 26%, p = 0.02), resulting in a lower reoperation rate (p < 0.01). Delayed gastric emptying and clinically relevant pancreatic fistula were similar between both groups but chyle leaks were more frequent in group A (10% vs. 3%, p = 0.04). The median hospital stay was shorter in group A (16 vs. 20 days, p < 0.01). ConclusionIn the present study, early postoperative oral feeding after PD was associated with a shorter hospital stay and did not increase severe postoperative morbidity or the rate of pancreatic fistula. However, it resulted in more chyle leaks and did not prevent delayed gastric emptying.

Application value of enhanced recovery after surgery in minimally invasive radical resection of esophageal cancer

Objective To investigate the application value of enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding in minimally invasive radical resection of esophageal cancer. Methods The retrospective cohort study was conducted. The clinicopathological data of 126 patients who underwent minimally invasive McKeown surgery in the General Hospital of Southern Theatre Command of PLA between March 2016 and October 2017 were collected. There were 80 males and 46 females, aged from 52 to 82 years, with an average age of 64 years. Of 126 patients, 82 undergoing li′s with no gastrointestinal decompression tube and receiving early postoperative oral feeding were allocated into non-tube no fasting group, and 44 undergoing end-to-side gastroesophageal anastomosis with tubular stapler, conventionally indwelling gastrointestinal decompression tube, and beginning oral feeding at 1 week after surgery were allocated into traditional treatment group. Observation indicators: (1) surgical and postoperative recovery situations; (2) results of pathological examination; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence and metastasis up to October 2018. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using independent sample t test. Measurement data with skewed distribution were expressed as M (range), and comparison between groups was analyzed by rank sum test. Count data were described as absolute number or percentage, and comparison between groups was analyzed using chi-square test. Ordinal data were analyzed by rank sum test. Results (1) Surgical and postoperative recovery situations: patients in the two groups underwent minimally invasive McKeown surgery successfully. Operation time, volume of intraoperative blood loss, incidence of anastomotic fistula, incidence of pulmonary complications, and duration of postoperative hospital stay were respectively (326±41)minutes, (225±96)ml, 7.3%(6/82), 24.4%(20/82), and 10 days(range, 6-90 days)in the non-tube no fasting group and (317±37)minutes, (214±66)mL, 9.1%(4/44), 20.5%(9/44), and 14 days (range, 10-42 days) in the traditional treatment group; there was a statistically significant difference in duration of postoperative hospital stay between the two groups (Z=-7.129, P 0.05). (2) Results of pathological examination: the number of lymph node dissected, cases in postoperative TNM stage Ⅰ, Ⅱ and Ⅲ were respectively 27±5, 12, 55, 15 in the non-tube no fasting group and 26±5, 9, 28, 7 in the traditional treatment group, with no statistically significant difference between the two groups (t=0.549, Z=-0.747, P>0.05). (3) Follow-up: of 126 patients, 116 were followed up for 12-31 months, with a median time of 20 months, including 76 in the non-tube no fasting group and 40 in the traditional treatment group. During the follow-up, no tumor recurrence or metastasis was found in the 116 patients. Conclusion The enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding is safe and feasible in the McKeown surgery, which can significantly shorten the postoperative hospitalization time compared with the traditional treatment. Key words: Esophageal neoplasms; Esophageal cancer; No gastrointestinal decompression tube; Early oral feeding; Enhanced recovery after surgery; Minimally invasive; Duration of postoperative hospital stay

Early postoperative oral feeding shortens first time of bowel evacuation and prevents long term hospital stay in patients undergoing elective small intestine anastomosis.

This study was conducted to compare outcome of early oral feeding (EOF) versus traditional oral feeding (TOF) in patients undergoing elective small intestine anastomosis. Appropriate nutritional support after major surgeries is a real medical concern. As traditional surgical techniques have been replaced by novel methods, postoperative care should be revised as well. Early postoperative oral feeding was studied in trauma and burn. However, there are few trials among patients after major surgeries. This randomized single-blinded controlled trial was performed on 108 patients who had small intestine anastomosis at Imam Hossein Medical Centre in 2012. The patients were randomly assigned to schedule EOF (with starting oral feeding on the first day after surgery and complete return of the Gag reflex) or TOF (with delaying oral feeding till first passage of flatus and bowel movement). We compared overall prevalence of postoperative complication, length of hospital stay and outcome of surgery in two groups. The time of the first passage of stool was shorter in EOF group than in TOF group (3.2 ± 0.59 days versus 3.6 ± 0.66 days (p= 0.006). The mean length of hospital stay in EOF group was also shorter than in TOF group (3.8 ± 1.06 days versus 6.3 ± 1.0 days, p= 0.001). The length of hospital stay shorter than 4 days was found in 75.9% of patients in EOF group and 11.1% of those patients in TOF group (p < 0.001). The use of EOF in patients undergoing small intestine anastomosis can shorten time of the first passage of stool as well as reduce length of hospital stay.

Prospective comparative study of the effectiveness and patient satisfaction with early postoperative oral feeding as part of the enhanced recovery after surgery (ERAS) protocol managed by the clinical pathway for elective colorectal surgery

Prospective comparative study of the effectiveness and patient satisfaction with early postoperative oral feeding as part of the enhanced recovery after surgery (ERAS) protocol managed by the clinical pathway for elective colorectal surgery

Early Postoperative Oral Feeding After Total Gastrectomy in Gastric Carcinoma Patients: A Retrospective Before-After Study Using Propensity Score Matching.

Despite its clinical benefits, early oral nutrition after total gastrectomy is not widely implemented because of concerns about tolerability and safety. We investigated the feasibility and safety of early oral nutrition after total gastrectomy in gastric carcinoma patients. This is a retrospective before-after study. From 2008-2016, 301 patients received conventional oral feeding (COF) before May 2012, and 454 patients, early oral feeding (EOF) after May 2012. The EOF group received oral diet on postoperative day 1, and the COF group was maintained nil-by-mouth until patients demonstrated gas passage. After balancing potential confounders using propensity score matching, 203 patients were selected in each group. Both matched groups demonstrated well-balanced baseline characteristics. The EOF group demonstrated significantly earlier first flatus time (2.9 vs 3.1 days, P = .013) and hospital discharge (8.9 vs 12.6 days, P < .001) than the COF group. No significant differences were observed for overall morbidity and mortality, but the EOF group demonstrated lower incidence of abdominal infection (3.0% vs 7.4%, P = .044) and anastomosis leakage (1.5% vs 4.9%, P = .048). Subgroup analyses by age, sex, operative approach, lymph node dissection, and tumor stage demonstrated no increased risk of morbidity, anastomosis leakage, and short hospital stay in the EOF group. Early oral nutrition may be feasible and safe after total gastrectomy, with no increase in postoperative complications. Large, randomized, controlled trials are warranted to further investigate the clinical benefits of early oral nutrition after total gastrectomy.