Oral Feeding Time Research Articles

Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A Systematic Review and Meta-analysis.

To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes. Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery. Comprehensive literature searches were conducted across 5 databases from January 1980 until June 2015 without language restriction. Risk of bias of included studies was appraised and random-effects model meta-analyses were performed to synthesize outcomes of anastomotic leaks, pneumonia, nasogastric tube reinsertion, reoperation, readmissions, and mortality. Fifteen studies comprising 2112 adult patients met all the inclusion criteria. Mean hospital stay was significantly shorter in the early-fed group than in the late-fed group [weighted mean difference = -1.72 d, 95% confidence interval (CI) -1.25 to -2.20, P < 0.01). Postoperative length of stay was also significantly shorter (weighted mean difference = -1.44 d, 95% CI -0.68 to -2.20, P < 0.01). There was no significant difference in risk of anastomotic leak, pneumonia, nasogastric tube reinsertion, reoperation, readmission, or mortality in the randomized controlled trials (RCTs). The pooled RCT and non-RCT results, however, showed a significantly lower risk of pneumonia in early-fed as compared with late-fed group (odds ratio = 0.6, 95% CI 0.41-0.89, P = 0.01). Early postoperative oral feeding as compared with traditional (or late) timing is associated with shorter hospital length of stay and is not associated with an increase in clinically relevant complications.

Effect of palady and cup feeding on premature neonates' weight gain and reaching full oral feeding time interval.

Background:Premature neonates’ feeding is of great importance due to its effective role in their growth. These neonates should reach an independent oral nutrition stage before being discharged from the Neonatal Intensive care Unit. Therefore, the researcher decided to conduct a study on the effect of palady and cup feeding on premature neonates’ weight gain and their reaching full oral feeding time interval.Materials and Methods:This is a clinical trial with a quantitative design conducted on 69 premature infants (gestational age between 29 and 32 weeks) who were assigned to cup (n = 34) and palady (n = 35) feeding groups through random allocation. The first feeding was administrated either by cup or palady method in each shift within seven sequential days (total of 21 cup and palady feedings). Then, the rest of feeding was administrated by gavage.Results:Mean hospitalization time (cup = 39.01 and palady = 30.4; P < 0.001) and mean time interval to reach full oral feeding (cup = 33.7 and palady = 24.1; P < 0.001) were significantly lower in palady group compared to cup group. Mean weight changes of neonates 7 weeks after the intervention compared to those in the beginning of the intervention were significantly more in palady group compared to the cup group (cup = 146.7 and palady = 198.8; P < 0.001).Conclusions:The neonates in palady group reached full oral feeding earlier than those of cup group. Subjects’ weight gain was also higher in palady group compared to the cup group. Premature neonates with over 30 weeks of gestational age and physiological stability can be fed by palady.

Predictors of the time to attain full oral feeding in late preterm infants.

The aim of this study was to determine the factors that predict the timing and age at which preterm infants (born 32-36 weeks gestation) commenced and attained full oral feeding. We conducted a retrospective review of medical records of 647 preterm infants born 2005-2011. Infants were from six neonatal intensive care units in New Zealand, all World Health Organisation Baby-friendly Hospital Initiative accredited. Median time to the first oral feed offered was one day, and median time to the time of full oral feeding was 12 days. No infants attained full oral feeding before 33(+3) weeks postmenstrual age. Gestational age, birthweight, medical conditions and location of the neonatal unit were significantly associated with the time taken to commence and attain full oral feeding. This study highlights the factors that are associated with the rate at which late preterm infants commence oral feeding and progress to full oral feeding. These findings offer important considerations not only for clinical practice but also discharge planning given the preference for preterm infants reaching full oral feeds before discharge from hospital. Prospective experimental research is required to confirm infant, maternal and environmental factors that influence feeding milestones in late preterm infants.

The Effects of Non-Nutritive Sucking and Pre-Feeding Oral Stimulation on Time to Achieve Independent Oral Feeding for Preterm Infants.

Background:The survival rates of preterm infants has increased over the last years, but oral feeding difficulties are the most common problems encountered by them Objectives:This study aimed at comparing the effects of non-nutritive sucking (NNS) and pre-feeding oral stimulation on feeding skills, length of hospital stay and weight gain of 26-32 weeks gestational age preterm infants in NICU, to determine the more effective intervention.Patients and Methods:Thirty-two preterm infants were assigned randomly into three groups. One intervention group received pre-feeding oral stimulation program and the other received non-nutritive sucking stimulation, while the control group received a sham intervention. Gestational age of infants was calculated during 1, 4 and 8 oral feeding and discharge time from NICU. The infants’ weights were measured weekly from birth and at discharge time.Results:Mean gestational age on 8 time oral feeding per day, in 3 groups was not significant (P = 0.282). Although NNS and pre-feeding oral stimulation groups has fulfilled this criterion 7.55 and 6.07 days sooner than the control group, respectively (a result which is of great clinical and economic importance), but the difference did not reach statistical significance. Weight gaining at discharge time in NNS group was significantly higher than control and pre-feeding oral stimulation groups (P < 0.05).Conclusions:This study revealed that pre-feeding oral stimulation and NNS programs both were effective on oral feeding skills and weight gaining of the immature newborns. Yet, it seems that NNS program was more effective than pre-feeding oral stimulation on weight gaining.

Laparoscopic verses open appendicectomy

Background:Most commonly performed abdominal surgery is appendicectomy open appendectomy (OA) was introduced by Mc-burney in 1884 still it is the operation of choice in acute appendicitis. Laparoscopic appendectomy (LA) though widely practiced, has not gained universal approval. LA was first described in 1983. Recent studies showed overall benefit in favour of LA. This study is done to view the therapeutic benefit of LA by comparing with conventional OA.Methods: It is a prospective study in 103 patients who underwent appendicectomy in KBN medical college hospital from 15th January 2015 to 15th August 2015. Out of them 60 had conventional OA and 43 had LA. We compared the mean operation time, time of adequate oral feeding, analgesic requirement, and duration of post-operative hospital stay.Results:We found that mean operation time was 33±5.8 minute for open appendicectomy and 47± 7.5 minute for laparoscopic appendicectomy. Duration of post-operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy can be diagnosed and managed laparoscopically in the same sitting.Conclusions:Our study found that laparoscopic appendectomy is an effective and safe procedure irrespective sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stay and less requirement of analgesic.

Oral feeding following laryngectomy: Early or delayed?

A best evidence topic in otolaryngology was written according to a structured protocol. The question addressed was: In patients having undergone laryngectomy, does the timing of oral feeding lead to a higher post-operative complication rate? 172 papers were found using the described protocol. Five of these papers were chosen to describe the best evidence to address the question. The authors, date and country of publication, study type, patient group, outcomes and key results of these papers have been represented in a table. All of these studies demonstrate that initiation of early feeding in patients post-laryngectomy provides no increased risk of development of pharyngocutaneous fistulas than delayed initiation of feeding. One study demonstrated a statistically significant reduction in hospitalisation of patients after early post-operative feeding. Therefore despite problems with study design, the literature concludes that early feeding is as safe as delayed feeding and may reduce the hospitalisation period. Further powered studies are required before recommendations on explicit inclusion criteria and feeding regimen details can be made.

Laparoscopic vs Open Appendectomy : A Comparative Study

Backgraound: Open appendectomy (OA) has been the treatment of choice for acute appendicitis since its introduction by Mc-burney in 1884. Laparoscopic appendectomy(LA) though widely practiced, has not gained universal approval. LA was first described in 1983. Some early studies showed equivocal results about benefit of LA. Recent studies showed overall benefit in favour of LA. So far no such a large study was done in any Bangladeshi hospital. So, we decided to do this study with a view to evaluate the therapeutic benefit of LA by comparing with conventional OA.Materials and methods: We collected data of 763 appendectomies done in Jahurul Islam medical college hospital from July 2007 to June 2012 for a period of 5 years. Out of them 448 had conventional OA and 315 had LA. We compared the mean operation time, time of first oral feeding, narcotic analgesic requirement, duration of post operative hospital stay.Results: We found that mean operation time was 33±5.8 minute and 37± 7.5 minute in LA and OA respectively. Duration of post operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. Laparoscpic appendectomy was safely performed in paediatric patient without any adverse effect. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy and endometriosis can be diagnosed and managed laparoscopically in the same sitting.Conclusion: Our study found that laparoscopic appendectomy is an effective and safe procedure irrespective of age and sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stay and less requirement of narcotic analgesic.

Early drip feeding on growth, development and gastrointestinal function of premature infants

Objective To study the influence of early drip feeding on growth,development and gastrointestinal function of premature infants.Methods A total of 48 cases of premature infants were randomly divided into two groups.Twenty-four cases with early drip feeding were included in study group and 24 cases with early nasogastric tube feeding in control group.Body weight,meconium excretion time,the time of beginning oral feeding,total enteral feeding,hospital stay time and gastrointestinal function were recorded and compared between the two groups.Results Compared with the control group,body weight increased faster in study group (P＜0.01).However,completely meconium excretion time,the time of beginning oral feeding,the time of total enteral feeding,and hospital stay time were obviously shorter in study group than in control group (P＜0.05 or 0.01).With incidence of gastrointestinal disorders in study group and control group were 33％ and 60％,respectively.Conclusion Early drip feeding can promote weight gain,and shorten the time (including completely meconium excretion time,the time of beginning oral feeding,the time of total enteral feeding,and hospital stay time).It is conducive to the development of gastrointestinal function of premature infants Key words: Infant; Drip feeding; Growth, Development

The comparative study of the outcomes of early and late oral feeding in intestinal anastomosis surgeries in children

A leakage of intestinal anastomosis is typically regarded as a devastating post-operative complication. Traditionally its believed that long fasting after intestinal surgery protect anastomosis site and most surgeons applied this method. Post-operative long fasting has many physical and mental adverse effects, especially in children, but its benefit has not proven yet. This study aimed to compare the outcomes of early and late oral feeding in intestinal resection and anastomosis surgery in children. This randomized, double-blind controlled trial evaluated the outcome of early-feeding following in children aged 1 month to 12 years who underwent intestinal resection and anastomosis and compared the results with those who had late-feeding. The results were anlysed for fever, nausea and vomiting, abdominal distension, first passage of gas and stool were also evaluated hospital stay time, major post-operative complications such as anastomosis leakage, wound infection or dehiscence, intra-abdominal abscess between the two groups. The mean time of first oral feeding in the early feeding group (study group) was 2.5 ± 0.7 days but it was 5.3 ± 0.6 days in the late feeding group (control group). There was no mortality in both groups. There was no difference in major complications in both groups (anastomosis leakage). In the study group, first defecation time was shorter than the control group (3.7 days v. 4.4 days) and they had less hospital stay also (5.2 days vs. 8.3 days) and lower cost of hospitalization. Early oral feeding after intestinal resection and anastomosis in children is a safe method, it has many benefits and does not increase the major or minor post-operative complications (anastomosis leakage) long time fasting is not necessary and has not any beneficial effect and early feeding increases satisfaction of the parents and children, and reduce hospital stay and costs.

The effect of early oral feeding compared to standard oral feeding following total laryngectomy: a systematic review

The effect of early oral feeding compared to standard oral feeding following total laryngectomy: a systematic review

Swallowing and laryngeal function preserving in surgical treatment of the head and neck tumors involving the tongue root

To investigate the surgical technique which could preserve the swallowing and laryngeal function effectively in the malignant head and neck tumors involving the tongue root. From January 2003 to December 2008, 31 cases of malignant head and neck tumors involving the tongue base had been treated in this hospital were retrospectively analyzed. There were 27 males and 4 females in which 9 cases of primary malignant tumor were from the base of tongue; 3 cases were from the tonsil, 11 cases were from supraglottic laryngeal carcinoma and 8 cases were from hypopharyngeal carcinoma. Preserved the lingual artery of the reserved side and the normal tissue of the root of tongue according to the clinical anatomy of lingual artery during the operation. If preoperative CT had indicated that bilateral lingual arteries were involved, total glossectomy should have been done. The epiglottis, vocal cords and the ventricular band of larynx was preserved as much as possible for the mechanisms of laryngeal function. In this group, residual tongue necrosis did not occurred. One case with total glossectomy didn't remove the trachea cannula. Five had total laryngectomy. The other 25 cases decannulated from 14th days to 90th days postoperatively. The time of oral feeding was started from 10th days to 31st days postoperatively. Two cases with hypopharyngeal carcinoma developed fistula, which were cured by dressing change. Two with root of tongue cancer and 1 with tonsil cancer had postoperative infection and healed in 2 weeks. The median follow-up time was 36 months, and the Kaplan-Meier 3-years and 5-years survival rates were 79.5% and 69.6% respectively. In the surgical treatments of the malignant head and neck tumors involving the base of tongue, the excisions and reconstructions of the primary tumor and the involved tongue base according to the clinical anatomy of lingual artery and the protection mechanisms of laryngeal function during the operation was one of the most effective technique to preserve the swallowing and laryngeal function.

Comparing early oral feeding with traditional oral feeding in upper gastrointestinal surgery

Due to the lack of interest in using early oral feeding and the need for a trial study in this regard, this study aimed to compare the outcome of early oral feeding and traditional oral feeding in patients with upper gastrointestinal surgery. Fifty-two patients who underwent upper gastrointestinal surgery were randomly assigned into two groups in a consecutive manner as either the early oral feeding group or traditional oral feeding group. Tolerance of oral feeding, ileus, nausea and vomiting, post-operative stay, and complications were recorded. Tolerance of oral feeding for the two groups was 24 (92.3%) in the early oral feeding group and 21 (91.3%) in the traditional oral feeding group (p=0.89). The post-operative hospital stays were 5.62 and 8.04 days in the early oral feeding and traditional oral feeding groups, respectively (p<0.0001). There were significant differences between the two groups in terms of the time of the first gas passing/defecation, the post-operative hospital stays, starting time of oral feeding, and satisfaction regarding early nasogastric tube removal. The results of this study show that early oral feeding is a safer and more cost-effective procedure in upper gastrointestinal surgery.

Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker

Introduction Zenker's diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years. Material and method A retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO 2 laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed. Results The endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90 min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36 hours after open surgery and 24 h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach. Conclusions The combined endoscopic approach offers good results in patients with symptomatic Zenker's diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible.

Outcomes From an Oral Feeding Protocol Implemented in the NICU

The purpose of this study was to compare the clinical outcomes of 2 different oral feeding protocols. The old protocol advanced oral feedings based on established feeding times, whereas the new evidenced-based protocol advanced oral feedings using infant cues. This retrospective study, conducted by reviewing the charts of premature infants born less than or at 34 weeks' gestation, documented the differences between the 2 oral feeding protocols. The medical records were reviewed for 200 premature infants admitted to the neonatal intensive care unit at Children's Hospital of Illinois, Peoria, Illinois. The main outcome variables this study compared were when infants started oral feedings, time to achieve 50% and 100% feedings orally, weight at time of oral feeding, day of life, and postmenstrual age. The percentage of feedings when oral stimulation was ordered, frequency of feeding therapy consultations, length of stay, weight at the time of discharge, and postmenstrual age at the time of discharge were also compared. Infants participating in the new feeding protocol began oral feedings at an earlier postmenstrual age as compared to infants using the old feeding protocol. Participants enrolled in this new protocol did not experience adverse events. They were also able to progress to full oral feedings while maintaining adequate weight, had less need for feeding therapy consultations, and length of stay was not prolonged.

Combined endoscopic treatment for Zenker's diverticulum versus open approach; review of our experience

IntroductionZenker's diverticulum is a superior esophagus sphincter disease appropriate for surgical management in symptomatic cases. This treatment has undergone important changes in recent years. Material and methodsA retrospective review was carried out on 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used, as well as a combined endoscopic approach with stapler and CO2 laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay, and occurrence of relapses were analyzed. ResultsThe endoscopic approach was used in 8 patients, converting to conventional open surgery being necessary in 2 cases. Operating time was 90min for the open approach and 45 for the endoscopic. Oral feeding could be reintroduced 36h after open surgery and 24h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery; one case was treated with the endoscopic approach and the other with the open approach. ConclusionsThe combined endoscopic approach offers good results in patients with symptomatic Zenker's diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when good endoscopic exposure is not possible.

Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial

Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has been reported recently, but late feeding is common. Gastrografin not only enhances bowel peristalsis, but also decreases bowel-wall edema. Whether contrast medium allows early oral feeding and reduces the duration of hospitalization requires clarification. Fifty patients underwent elective colorectal surgery in a regional medical center. Patients were prospectively randomized into a Gastrografin group or control group (n = 25 each). Patients in the Gastrografin group began their feeding schedule with 100 mL of 5% dextrose water with 100 mL of Gastrografin on postoperative d 3 and were advanced to a full liquid diet when the contrast reached the colon in 4 h. Patients in the control group began their feeding schedule with 200 mL of 5% dextrose water on postoperative d 3 and were advanced to a full liquid diet after the passage of flatus and stool. Nasogastric tubes were inserted for persistent postoperative vomiting. Fullness, nausea, vomiting, complications, time of anesthesia, time of operation, time of mobilization, time of oral feeding, and duration of hospital stay were recorded and analyzed with Student's t-test. In the Gastrografin group, one patient had aspiration pneumonia and one patient had anastomotic leakage resulting in sepsis and eventual death. This mortality was excluded from the subsequent statistical analysis. In the control group, two patients had wound infections. There was no significant difference between the two groups at the time of anesthesia, time of operation, or time of mobilization. There were significant differences between the two groups in the time of oral feeding (3.3+/-0.3 d in the Gastrografin group vs 4.8+/-0.4 d in the control group; P = odds ratio--, 95%CI [-0.5 to +0.7 d]) and in the length of hospital stay (7.6+/-1.1 d in the Gastrografin group vs 10.2+/-1.3 d in the control group; P = odds ratio--, 95% CI [-1.2 to +1.4 d]). Gastrografin not only allowed early oral feeding but also reduced the duration of hospitalization after elective colorectal surgery.

Propofol for pediatric radiotherapy.

Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room. This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20-22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted. The drug was graded on a scale of 0-10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (+/-SD) of all the measured parameters were calculated and compared between the two groups. Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was between 94-95%, was easily treatable with supplementation of oxygen by face mask.

Transition and improvement in surgical treatment for rectal cancer during the last 21 years in our department.

The subject of this study was to examine the net effect of numerous changes in basic strategies, personnel and devices, upon the clinical courses and outcomes of rectal cancer patients. A total of 151 rectal cancer patients who underwent low anterior resection were divided into 4 groups (period 1 to 4) based upon the time period of the operation. They were compared among groups based upon the following parameters: blood loss, operation time, incidence of leakage and urinary dysfunction, incidence of ileus, duration of naso-gastric tube insertion, timing of initial oral feeding and survival. The blood loss during the operations, urinary dysfunction and duration of naso-gastric tube insertion tended to decrease in every period. Timing of initial oral feeding became faster. The operation times, incidence of leakage and ileus were nearly the same in each period. The 5-year survival rates on Dukes' C cases were 100% in period 4, 82.4% in period 3 and 50% in period 2. Survival rates became better. Our net outcome for rectal cancer treatment was satisfactory, because the survival rates became better under function preserving strategies.

Plasma oxytocin and cortisol concentrations in dairy cows in relation to feeding duration and rumen fill

The aim of this study was to investigate if the release of oxytocin and cortisol were different depending on levels of oral manipulation with feed or rumen fill in dairy cows. Blood samples and behavior of 12 rumen-fistulated cows were analyzed in 2 consecutive years during morning and afternoon periods when the cows were subjected to either (A) long duration of oral manipulation of feed with low rumen fill or (B) short duration of oral manipulation of feed but with filled rumen. The response areas under the curve for oxytocin in both years were larger in A than in B in the afternoons. There were peaks in oxytocin release at milking in the afternoon in both treatments. In B, the oxytocin concentration was higher after than before feeding, higher in B than in A after the non-oral rumen filling, and higher in B after than before the non-oral rumen filling in Year 1. The level of cortisol was higher in B than in A in the morning, lower in both treatments before than after milking in the afternoon, and there was a tendency for the cortisol level to be higher in A than in B after oral feeding. The B cows spent a shorter time eating and the A cows spent a shorter time ruminating. This study indicates that a long duration of oral manipulation of feed in cows, may, per se be linked to higher oxytocin but lower cortisol levels, compared with shorter oral feeding time and filled rumen.

Oral feeding after total laryngectomy

Pharyngocutaneous fistulae occur in 15%-25% of patients after total laryngectomy. Factors that may predispose to fistulae formation include prior radiation, surgical technique, tumor size and location, and patient nutritional status. In addition, many surgeons believe that the timing of oral feeding after surgery contributes to fistula development. Thus, they advocate delaying feeding postoperatively, especially in high-risk patients. The traditional guideline has been to wait until the seventh postoperative day. The purpose of this study was to examine the relationship between the timing of postoperative oral feeding and the development of pharyngocytaneous fistulae after total laryngectomy with primary closure in patients with squamous cell carcinoma. A questionnaire was sent to 210 members of the American Society for Head and neck Surgery to determine practice patterns toward feeding after laryngectomy. We also reviewed the records of 137 patients who underwent total laryngectomy at the University of Colorado Health Sciences Center and the Denver VA Medical Center from January 1975 through December 1987. Of the surgeons polled, 84.5% waited at least 7 days after surgery to begin oral feeding. However, in reviewing 94 patients eligible for study, we found no difference in the rate of fistula formation between patients fed on or before the fifth postoperative day and those fed on or after the sixth postoperative day. In fact, most fistulae were evident before the patient started oral feeding. Pyriform sinus tumors were predisposed to fistulae but prior radiotherapy and neck dissection seemed to have no effect. Earlier oral feeding after total laryngectomy may improve patient comfort and shorten hospital stay without increasing the incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)