Tolerance of early oral feeding following surgery of the lower gastrointestinal tract

Introduction: Oral feeding is usually offered following surgery of the lowe r gastrointestinal tract when clinical signs of normal intestinal motility are present. However, some studies have shown that early oral feeding is we ll tolerated with low morbidity. Methods: A prospective cohort study was pe rformed to evaluate whether early oral feeding according to a standardized schedule is tolerated under normal clinical circumstances. One hundred cons ecutive patients following small- or large-bowel resection with anastomosis were offered fluids on post-operative day 1, soup on post-operative day 2, mashed food on post-operative day 3 and a regular diet on post-operative d ay 4. Parenteral nutrition was only given if necessary. Tolerance of oral f eeding and the amount of food were checked twice a day. End points of the s tudy were nausea (VAS score 1-100), vomiting (> 200 ml), reinsertion of a n asogastric tube, level of food intake, parenteral nutrition (ml), appetite and well-being. Results. Loop ileostomies were done in 21 patients, colonic resections above the sigmoid in 32, and sigmoid and rectal resections in 4 7. The average age was 63 +/- 13 years. The frequency of nausea was less th an 30% and of vomiting less than 10%. Only in two cases was a nasogastric t ube inserted. Forty-three percent of all patients tolerated feeding very we ll according to the schedule. On post-operative day 3 more than 60% tolerat ed oral intake, on post-operative day 4, 74% and on post-operative day 5, 8 8%. Only 22% of the patients needed parenteral fluids on post-operative day 4. The first bowel movement was noted after 2.8 +/- 1.1 days. Surgical com plications were documented in 18 patients and general complications in 6 pa tients. Conclusion: Most patients tolerated early oral feeding very well ac cording to the schedule with low morbidity. Therefore, early feeding is now a substantial component of the postoperative treatment following small- or large-bowel resections.