Allowing Normal Food at Will After Major Upper Gastrointestinal Surgery Does Not Increase Morbidity
Lassen K, Kjaeve J, Fetveit T, et al.
Ann Surg. 2008;247:721-729
Summary
To determine the safety of immediate postoperative feeding, the authors conducted a multicenter trial involving 453 patients recruited in 5 Norwegian hospitals. Postoperative patients were allowed nothing by mouth (NPO) and fed by a catheter jejunostomy introduced at the time of surgery or were allowed to consume normal food. Gastric and pancreatic operations were the most commonly performed procedures. There were no differences in mortality rates (4.4% in NPO group, 5% in patients fed by mouth) or in complication rates. Recovery of bowel function was slightly more rapid in patients who resumed a normal diet: 2.6 days vs 3.0 days in the NPO group (P = .01). Wound infection rates before and after discharge were higher in the NPO group (8% vs 2.4%, P = .01).
Viewpoint
Traditionally, surgeons have been reluctant to feed patients after major gastrointestinal surgery because of the widespread belief that food intake should be withheld until the return of gastrointestinal function. This large randomized trial provides level 1 evidence to refute this viewpoint. This trial suggests that early feeding is safe for most patients and may even speed recovery after gastrointestinal surgery. Only 10% of the patients who were allowed a normal diet required nasogastric intubation during the postoperative period.
Reviewed by Ramaz Mitaishvili, MD
