Early Postoperative Feeding Research Articles

A randomised controlled trial to compare the occurrence of postoperative nausea and vomiting in early versus conventional feeding in children undergoing daycare surgery under general anaesthesia.

The time paediatric patients should resume oral intake after surgery is still ill-defined. No specific evidence suggests that the usual practice of postoperative fasting of 4-6 h to reduce postoperative nausea and vomiting (PONV) is beneficial. The primary objective of this study was to assess the occurrence of PONV with early oral feeding compared to conventional feeding in children undergoing daycare surgery under general anaesthesia. A randomised controlled trial was conducted in 300 children undergoing daycare surgery under general anaesthesia. Children were randomised into the early feeding group (Group EF, n = 150) or the conventional feeding group (Group CF, n = 150). Group EF received carbohydrate-containing oral fluids when the child demanded feed in the postoperative period. Group CF received oral fluids 4 h post-anaesthesia. All patients were monitored for occurrence of PONV, postoperative pain, duration of hospital stay and parental satisfaction. The incidence of PONV was compared using the Chi-squared test, while other continuous variables were compared using the Student's t-test. Both groups were comparable regarding PONV (12% in Group EF vs. 18.7% in Group CF, P = 0.109). The Face, Legs, Activity, Cry, Consolability scores were significantly lower in Group EF at 0 min (P = 0.011), 30 min (P = 0.001) and 1 h (P < 0.001). Patients in Group EF had a significantly shorter duration of hospital stay, that is, 6.31 [standard deviation (SD): 3.52] [95% confidence interval (CI): 1.45-12.24] h in EF versus 10.13 (SD: 2.99) (95% CI: 5.12-16.33) h in CF (P < 0.001). Parents of the children in Group EF had significantly better parental satisfaction scores (P < 0.001). Early postoperative feeding in children undergoing lower abdominal, non-gastrointestinal surgery under general anaesthesia does not increase the incidence of PONV.

Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study.

Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.

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.

So many measures in ERAS protocol: Which matters most?

ObjectivesEnhanced recovery after surgery (ERAS), which includes multiple measures, has gradually become the standard perioperative management in pediatric surgery. However, it is still unclear which of its many measures affects the outcomes more. MethodsWe retrospectively analyzed the medical records of children with congenital choledochal cysts who underwent surgical treatment in a specialized children's hospital from January 2019 to December 2022. Data including baseline factors, implementation of ERAS interventions, postoperative complications, and postoperative length of stay (PLOS) were collected. Univariate and multivariate analyses were performed to identify the association between PLOS and baseline factors or specific ERAS measures. ResultsThe implementation rate of ERAS measures ranged from 5.02% to 100% in 219 cases who underwent 3 to 14 ERAS measures. Univariate analysis showed that body mass index-for-age z-scores, liver function indicators, and postoperative complications were the significant baseline factors for PLOS. At the same time, the measures with the greatest effect on PLOS were early postoperative feeding and early removal of tubes. Multivariate analysis with different models revealed that postoperative complications, early postoperative feeding, and early catheter removal influenced the PLOS the most. ConclusionsA prolonged PLOS was associated with poor preoperative nutritional status, elevated liver function indexes, and postoperative complications. Early postoperative feeding and removal of tubes appeared more likely with a reduced PLOS than other measures, requiring more attention when implementing the ERAS protocol.

Endoskopische Unterdrucktherapie

Abstract Introduction Early postoperative reflux (PR) can compromise anastomotic healing after Ivor Lewis esophagectomy (ILE) and poses a risk for aspiration. Anastomotic insufficiency is the most threatening surgical complication. We present the protective method of pre-emptive active reflux drainage (PARD) with simultaneous enteral feeding. We report our experience with this new safety concept in esophageal surgery in a cohort of 43 patients. Materials and Methods For PARD we use a double lumen open porous film drainage (dOFD). To create the dOFD, the gastric tube of a Trelumina probe (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore drainage film (Suprasorb®CNP drainage film, Lohmann &amp; Rauscher) over a length of 25 cm. The dOFD is endoscopically inserted into the tubular stomach intraoperatively after completion of the anastomosis. Continuous negative pressure is applied with an electronic pump (−125 mm Hg). The PR is continuously aspirated completely and the stomach and anastomotic region are decompressed. At the same time, nutrition is delivered via an integrated intestinal tube. Depending on the results of the endoscopic control after 5 days, PARD is either continued or terminated. Results During the observation period (2017–2023), PARD was used in all patients (n = 43) with ILE. The healing rate under PARD was 100% and healing was observed in all anastomoses. No additional endoscopic procedures or surgical revisions of the anastomoses were required. The median duration of PARD was 8 days (range 4–21). We observed problems in the healing of the anastomosis in 20 of 43 patients (47%) for whom we defined endoscopic criteria for at-risk anastomosis. Conclusions Our results suggest that PARD has a strong protective effect on anastomotic healing and may reduce the risk of anastomotic insufficiency. The integrated feeding tube of the dOFD allows early postoperative enteral feeding while simultaneously applying negative pressure. PARD appears to prevent the negative consequences of impaired anastomotic healing.

Endoscopic negative pressure treatment : From management of complications to pre-emptive active reflux drainage in abdominothoracic esophageal resection-A new safety concept for esophageal surgery

Early postoperative reflux (PR) can compromise anastomotic healing after Ivor Lewis esophagectomy (ILE) and poses a risk for aspiration. Anastomotic insufficiency is the most threatening surgical complication. We present the protective method of pre-emptive active reflux drainage (PARD) with simultaneous enteral feeding. We report our experience with this new safety concept in esophageal surgery in a cohort of 43 patients. For PARD we use a double lumen open porous film drainage (dOFD). To create the dOFD, the gastric tube of a Trelumina probe (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore drainage film (Suprasorb®CNP drainage film, Lohmann & Rauscher) over a length of 25 cm. The dOFD is endoscopically inserted into the tubular stomach intraoperatively after completion of the anastomosis. Continuous negative pressure is applied with an electronic pump (-125 mm Hg). The PR is continuously aspirated completely and the stomach and anastomotic region are decompressed. At the same time, nutrition is delivered via an integrated intestinal tube. Depending on the results of the endoscopic control after 5 days, PARD is either continued or terminated. During the observation period (2017-2023), PARD was used in all patients (n = 43) with ILE. The healing rate under PARD was 100% and healing was observed in all anastomoses. No additional endoscopic procedures or surgical revisions of the anastomoses were required. The median duration of PARD was 8 days (range 4-21). We observed problems in the healing of the anastomosis in 20 of 43 patients (47%) for whom we defined endoscopic criteria for at-risk anastomosis. Our results suggest that PARD has a strong protective effect on anastomotic healing and may reduce the risk of anastomotic insufficiency. The integrated feeding tube of the dOFD allows early postoperative enteral feeding while simultaneously applying negative pressure. PARD appears to prevent the negative consequences of impaired anastomotic healing.

Early vs Traditional Postoperative Feeding in Patients Undergoing Small Bowel Surgery

Purpose: The postoperative management of patients undergoing gastrointestinal (GI) surgery was followed by keeping them ‘nil by mouth' and provide gastric decompression via a nasogastric tube (NGT) until the postoperative ileus resolves and bowel function resumes. Early feeding and recovery are being portrayed as the new solution for these problems. To compare the outcomes in early vs traditional postoperative feeding in patients undergoing small bowel surgery.&#x0D; Methodology: Study design: Randomized controlled trial. Setting: Department of General Surgery, Services Hospital Lahore. Data collection: The sample size is calculated as 60 (30 in each group), by using WHO sample size calculator by keeping the confidence interval equal to 95%, power equal to 80%, and hospital stay as 4 ± 0.64 days vs. 6.1 ± 0.84 days in early vs late feeding group respectively.&#x0D; Findings: In group A, the mean age of was 33.59±9.34 years and in group B, the mean age of was 34.76±9.87 years. In group A, there were 14 (46.7%) males and 16 (53.3%) females. In group B, there were 14 (46.7%) males and 16 (53.3%) females. In group A, the mean duration of surgery was 59.17±17.28 min. In group B, the mean duration of surgery was 57.17±16.54 min. In group A, there were 4 (13.3%) patients who had postoperative vomiting. In group B, there were 13 (43.3%) patients who had postoperative vomiting (p&lt;0.05). In group A, there were 3 (10%) patients who had postoperative anatomic leak. In group B, there were 5 (16.7%) patients who had postoperative anatomic leak (p&gt;0.05).In group A, the mean time to pass first stool was 4.14±0.90 days. In group B, the mean time to pass first stool was 6.42±1.09 days (p&lt;0.05). In group A, the mean hospital stay was 4.76±0.73 days. In group B, the mean hospital stay was 6.83±1.34 days (p&lt;0.05).&#x0D; Recommendations: The conclusion of the study that early feeding cases are beneficial as compare to conventional (delayed) feeding. It reduces infection complications and length of hospital stay.

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.

Comparative study between early versus late enteral nutrition after gastrointestinal anastomosis operations

Introduction An anastomosis of the digestive tract is a common operation, whether it be an unexpected medical crisis or a planned procedure. Feeding soon after gastrointestinal anastomosis is not only physiological, but also protects against morphologic and functional trauma-related modifications in the gut. Aim of work This research aimed to evaluate the advantages and disadvantages of initiating Enteral Nutrition immediately following gastrointestinal anastomosis surgery versus delaying it for a later time. Additionally, the frequency of Adverse Events. Patients and methods Thirty patients underwent abdominal surgery, with treatments ranging from small- to large-intestine anastomosis, for both urgent and elective reasons. Early postoperative enteral feeding in the early feeding group commenced within 24 h of surgery or immediately following nasogastric tube removal. The delayed feeding group began enteral feeding using the standard technique once bowel sounds were restored, distention was gone, and the patient passed flatus or stool. 14 patients were in the early enteral feeding group (A) while 16 patients were in the late enteral feeding group (B). Data regarding blood loss and transfusion, NGT removal time, time of intestinal sounds return, time of passage flatus and stool, hospital stay and postoperative complications were recorded. Results Among those who ate too early (46.6%), those who ate late (53.3%), abdominal distension was noted in 28.6%,in the early group and 43.8% in late feeding group and vomiting was reported in 50.0%, and 62.5%, respectively. In the first group, 57.1% of those who fed early experienced fever, while in the second group, 75.0% of those who fed late did so. Late feeding is associated with a statistically significant rise in both the Day of NGT removal and the Length of stay. When patients were admitted for early feeding, they stayed in the hospital for an average of 5.71 days. There was no statistically significant difference according serum albumin between the early feeding (3.79) and late feeding (3.50). There was a significantly higher concentration of potassium in the blood in the early feeding group (3.93) compared to the late feeding group (3.219). Anastomotic leaking, surgical site infection, and intensive care unit admission were not significantly different between early and late feeding. Conclusion Early enteral feeding has the upper hand on late enteral feeding as it goes with GIT physiology, we found that early postoperative feeding following gastrointestinal anastomosis surgery significantly reduced the day of NGT removal and the length of hospitalization, which may be attributable to fewer problems and better gut motility and healing.

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.

Long-term nutrition in patients candidate to neoadjuvant and adjuvant treatments

To improve outcomes, to decrease the rate of local recurrence and development of distant metastases neoadjuvant and adjuvant therapies are employed in cancer patients in forms of radiation, chemo-, endocrine-, targeted-, and immunotherapy or their combination. Nutrition therapy plays important role in all phases of the cancer journey. From neoadjuvant therapy to prehabilitation, early postoperative nutrition, and long-term nutrition care during the adjuvant phase and survivorship determines the survival and quality of life of cancer patients.During the neoadjuvant phase patients may be in poor nutritional condition which can be aggravated by the applied oncological treatment. Beside this apparent threat this period also gives an excellent opportunity to maintain or even improve the nutritional status of the patients by nutrition therapy. After surgery the burdening effects of the operation may jeopardize the execution of adjuvant therapy. After early postoperative feeding a long-term nutrition strategy should be developed for cancer patients in order to avoid nutritional deterioration during the usually lengthy postoperative therapy.In this narrative review we discuss how preoperative nutritional status and medical nutrition therapy influence the results of surgery and after the operation what is the available evidence about nutritional status and outcome and the potentials to influence them by nutrition therapy.

AUDIT FOR ASSESSMENT OF THE FULFILLMENT OF CARDIAC ERAS GUIDELINES IN LOW EURO-SCORE II CARDIAC SURGICAL PATIENTS IN THE FREEMAN HOSPITAL.

<h3>Introduction</h3> Enhanced Recovery After Surgery (ERAS) is a multimodal, transdisciplinary care improvement initiative to promote recovery of patients undergoing surgery throughout their entire perioperative journey. These programs aim to reduce complications and promote an earlier return to normal activities. <h3>Aim</h3> Investigate the fulfilment of cardiac ERAS guidelines in low euro-score II cardiac surgical patients in the Freeman hospital in 2020. <h3>Patients & Methods</h3> A retrospective investigation of fulfillment of ERACS recommendations in patients with low euro-score II. - Data collected from the surgical data-base in 2020 and patients e-records. - The recommendations from the ERACS 2019 guidelines were used as a reference. Audit Results: The ERACS guidelines investigated included: - Preoperative data: - ALL patients had Pre-operative Albumin level done. - None of the patients had initiation of Preoperative multimodal analgesic. - None of the patients stopped smoking & hazardous alcohol 4 week before elective surgery. - None had preoperative CHO Loading. - Preoperative HbA1c in 69% of patients. - Clear liquids continued up to 2 to 4 hours before GA in 51% of patients. - Intraoperative data: - In ALL patients Hyperthermia was avoided while rewarming on CPB. - In ALL patients Tranexamic acid was given during on-pump. - Postoperative data: - All patients had Perioperative glycemic control. - ALL patients had an insulin infusion for hyperglycemia postoperatively. - In ALL patients a postoperative delirium screening tool used at least once per nursing shift . - In All patients persistent hypothermia after CPB was avoided. - The peri-operative, multimodal, opioid-sparing, pain management plan: Paracetamol: ALL Tramadol: None Dexmedetomidine: None Gabapentin: None Regional anaesthesia: None - ALL had thromboprophylaxis after surgery . - None had early detection of AKI. - All patients had early postoperative enteral feeding and mobilization. - 76% were extubated within 6 hrs. Audit Recommendations: - Initiate our own ERAS cardiac program. - Add engagement tools in pre-operative education. - Pre-habilitation and optimization for patients with multiple comorbidities. - Smoking and alcohol cessation. - Pre-operative HbA1C in all cases. - Preoperatrive correction of nutritional deficiency . - Clear liquids continued up to 2 to 4 hours before GA. - Oral CHO 2-4 h before surgery. - Pre-operative multimodal analgesic (Gabapentin 300 mg and Paracetamol 1000 mg given orally in preoperative holding area). - Minimal anxiolytics before surgery - Surgical site infection reduction care bundle. - Rigid sternal fixation. - Intraoperative multimodal analgesia. - Strategies to ensure early extubation within 6 h of surgery. - Avoid stripping or breaking the sterile field of chest tubes to remove clots. - Early detection of kidney stress - Goal-directed fluid therapy: - Early removal of Lines and drains - Management of pre-operative anaemia. - Goal directed perfusion strategies. - A protective lung ventilation strategy. ASSESSMENT OF THE FULFILLMENT OF CARDIAC ERAS GUIDELINES IN LOW EURO-SCORE II (<3) CARDIAC SURGICAL PATIENTS IN THE FREEMAN HOSPITAL, IN CALENDAR YEAR 2020.

Effect of early postoperative feeding on gastrointestinal tract motility after cesarean section

Effect of early postoperative feeding on gastrointestinal tract motility after cesarean section

Outcome of Early Oral Feeding after Primary Repair of Traumatic Intestinal Injury: Prospective Observation in a Tertiary Hospital in Bangladesh

Introduction: A period of starvation is common practice after intestinal anastomosis. Starved patient became malnourished and underwent catabolic state, impairing the host immune response and thus increasing the risk of postoperative infections thereby long hospital stay. Objective: To observe the outcome of early oral feeding in patients having primary repair of traumatic intestinal injury and to assess its beneficial effect. Methods: This prospective observational study was conducted on 80 patients who underwent urgent intestinal resection with or without covering stoma in the Department of Casualty Surgery at Dhaka Medical College Hospital. Results: Early oral feeding is safe in the recently performed anastomosis even in emergency situations as there were no cases of clinical anastomotic dehiscence and no increase in morbidity. Among 80 patients 58(72.5%) patients had no complaints; rest 22(27.5%) patients had complication. Wound infection seen in 14(17.5%) patients among them 8(10%) patients had burst abdomen and 1(1.25%) patient had intraabdominal abscess. 14(17.5%) patients had chest infection. 10(12.5%) patients complained nausea and among them 8(10%) patients suffered from few episodes of vomiting. 1(1.25%) patient had diarrhoea. Abdominal distension was seen in 9(11.25%) patients. Hospital stay was significantly shorter in with a mean length of stay (9 ± 1) days. No hospital readmission rate was recorded. Conclusion: Early postoperative feeding is timely, safe and tolerable after emergency intestinal resection anastomosis without raised morbidity and mortality and has a considerable reduction in hospital stay with its physical, psychological and fiscal benefits. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 75-79

The Fast Track Surgery in Perioperative Nursing of HoLEP Operation

Objective: The Fast-track surgery for transurethral holmium laser prostatectomy a perioperative nursing research study.&#x0D; Methods: We performed a retrospective analysis of transurethral holmium laser enucleation of the prostate in 89 patients with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) who were admitted to and treated at our hospital between 2018 and 2019. Measures such as early postoperative feeding and early catheter removal, adequate preoperative preparation, psychological counseling, intraoperative warming, unobstructed lavage, ensuring postoperative sleep, indwelling analgesic pump, and prevention and treatment of postoperative complications, as well as a successful job in postoperative health guidance and discharge guidance, were all implemented, and the extubation was performed, during the perioperative period in which advanced fast track surgery was used.&#x0D; Results: All 89 patients who underwent holmium laser enucleation of the prostate made a full recovery, with only one experiencing post-operative recurrent hyphema, five experiencing post-operative urinary tract infection, and ten experiencing transient and urge urinary incontinence; all were discharged after conservative treatment.&#x0D; Conclusion: Using fast track surgery as a guide for perioperative care of HoLEP surgeries might lessen the number of issues that arise after surgery and help patients get back to normal quicker.

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.

Early postoperative feeding in single-stage repair of anorectal malformation with vestibular or perineal fistula is not associated with increased wound complications

IntroductionThe objective of this study is to assess the postoperative outcomes of single-stage repair of anorectal malformations with vestibular (VF) or perineal fistula (PF) and early initiation of postoperative feeding. MethodsA retrospective review of patients undergoing single-stage repair of isolated low anorectal malformations (VF and PF) from 2017 to 2020 was conducted. All patients underwent an anterior anoplasty with complete mobilization of the rectal fistula, or posterior sagittal anorectoplasty (PSARP), without protective colostomy. The variables examined include age, timing of postoperative feeding initiation, length of stay (LOS), and complications. ResultsNineteen patients with VF or PF underwent a single-stage repair. 12/19 (63%) patients were female. All 7 males and 9/12 females had a PF. The range of age at surgery was 2 days to 3 years with median age of 92 days [IQR 1,3: 9,193]. The median postoperative day for initiation of feeds was day 0 [IQR 1,3: 0,1] and median LOS was 1 day [IQR 1,3: 1,4.5]. 18/19 (95%) patients were evaluated in follow-up and there were no wound infections, wound dehiscences, or recurrent fistulas. Within 90 days postoperatively, no patients were seen in the emergency department for postoperative issues. Within 6 months, 2/19 (11%) patients required an unplanned return to the operating room for anal dilation. ConclusionIn single-stage repair of isolated low anorectal malformations, VF and PF, early initiation of postoperative feeding is safe, results in a short length of stay, and does not lead to increased wound complications. Early enteral feeding eliminates the need for parenteral nutrition and central venous access, and their associated complications. Level of evidenceLevel IV

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.

Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care.

Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes for many years and have not altered much in the last decades. Recent publications have employed more liberal fasting regimes with no evidence of increased aspiration or regurgitation rates. In this first solely paediatric European Society of Anaesthesiology and Intensive Care (ESAIC) pre-operative fasting guideline, we aim to present aggregated and evidence-based summary recommendations to assist clinicians, healthcare providers, patients and parents. We identified six main topics for the literature search: studies comparing liberal with conservative regimens; impact of food composition; impact of comorbidity; the use of gastric ultrasound as a clinical tool; validation of gastric ultrasound for gastric content and gastric emptying studies; and early postoperative feeding. The literature search was performed by a professional librarian in collaboration with the ESAIC task force. Recommendations for reducing clear fluid fasting to 1 h, reducing breast milk fasting to 3 h, and allowing early postoperative feeding were the main results, with GRADE 1C or 1B evidence. The available evidence suggests that gastric ultrasound may be useful for clinical decision-making, and that allowing a 'light breakfast' may be well tolerated if the intake is well controlled. More research is needed in these areas as well as evaluation of how specific patient or treatment-related factors influence gastric emptying.

EARLY ENTERAL FEEDING VERSUS FEEDING AFTER PASSAGE OF FLATUS AFTER ABDOMINAL OPERATION”

BACKGROUND:Aperiod of nil per oral is a common practice after most abdominal surgeries because of postoperative ileus. But the ileus predominantly affects the stomach and colon. However, the small bowel recovers from the ileus within 4-6 hours after laparotomy. Postoperative period of ileus correlates well with patient's age, BMI and small bowel surgery and magnitude of surgery. Many patients come with diseases with vomiting and poor appetite leading to a state of malnutrition which is a common nding in preoperative patients requiring abdominal surgeries. It is well documented that length of hospital stay is prolonged in poorly nourished surgical patients. Keeping the patient nil per oral aggravates the malnutrition further in a state where the need of calorie is more with postoperative stress. The early postoperative feeding is established to be safe and well tolerated. Most of the early enteral feeding study concentrates on a single surgery. Hence, it is decided to include all the abdominal procedures including elective and emergency, open and minimal invasive, benign and malignant to have an overall view of efcacy of early enteral feeding in these patients.