Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials

Objective To determine whether a period of starvation (nil by mouth) after gastrointestinal surgery is beneficial in terms of specific outcomes. Design Systematic review and meta-analysis of randomised controlled trials comparing any type of enteral feeding started within 24 hours after surgery with nil by mouth management in elective gastrointestinal surgery. Three e lectronic databases (PubMed, Embase, and the Cochrane controlled trials reg ister) were searched, reference lists checked, and letters requesting detai ls of unpublished trials and data sent to pharmaceutical companies and auth ors of previous trials. Main outcome measures Anastomotic dehiscence, infection of any type, wound infection, pneumonia, intra-abdominal abscess, length of hospital stay, and mortality. Results Eleven studies with 837 patients met the inclusion criteria. In six studies patients in the intervention group were fed directly into the smal l bowel and in five studies patients were fed orally. Early feeding reduced the risk of any type of infection (relative risk 0.72, 95% confidence inte rval 0.54 to 0.98, P = 0.036) and the mean length of stay in hospital (numb er of days reduced by 0.84, 0.36 to 1.33, P=0.001). Risk reductions were al so seen for anastomotic dehiscence (0.53, 0.26 to 1.08, P=0.080), wound inf ection, pneumonia, intra-abdominal abscess, and mortality, but these failed to reach significance (P > 0.10). The risk of vomiting was increased among patients fed early (1.27, 1.01 to 1.61, P = 0.046). Conclusions There seems to be no clear advantage to keeping patients nil by mouth after elective gastrointestinal resection. Early feeding may be of b enefit An adequately powered trial is required to confirm or refute the ben efits seen in small trials.