Enteral Feeding After Gastric Intestinal Resection

Enteral Feeding After Gastric Intestinal Resection Optimum nutrition has always been a major target of post: operative care. Ileus is a common phenomenon after abdominal surgery, therefore early oral feeding is avoided and nasogastric decompression is being used. Conventionally, post abdominal surgery, the passage of flatus, or bowel movement was the clinical evidence of starting an oral diet. The end of post operative ileus based to be taken by the passage of flatus usually occurred within 5 days. The many studies have proved that the routine use of a nasogastric tube after abdominal Surgery and colorectal surgery may not be necessary. studies were undertaken to evaluate /whether different abdominal surgeries could benefit from early feeding. Early feeding improves the outcome of the patients with trauma and Burns although few studies have examined its use after gastro intestinal anastomosis. In case of laparoscopic colectomy patients have been fed routinely on day 2 after operation and that is being safely tolerated by the majority of patients. There are many evidences which indicate that immediate feeding after operation is actually feasible and safe whether post laparoscopic or post laparotomy , including gastro intestinal surgery. It has been proved by many studies that early enteral feeding in surgical patients improves nutrition and immunity and ultimately reducing septic complications and over all morbidity when compared with parenteral nutrition. A study conducted that compared an early regular diet to conventional post operative dietary management to determine G1 complications and mortality after major G1 anastomosis. The aim of this study was to assess the safety and tolerability outcomes of early oral feeding after elective gastro intestinal anastomosis. Patients and Methods Between July 2006 and December 2009, after the study was approved by ethical review committee, patients were offered participation and informed consent taken. Patients with chronic liver disease or those with metastasis and patients with histories of acute obstruction, perforation and intra abdominal infection were excluded. Patients were subject to a thorough history, physical examination and investigations. The patients were then randomized into two groups. Randomization done using sealed envelopes. Group 1 (Early feeding); 30 patients were offered simply a liquid diet within 6 hours of arrival on the ward. If 1 liter was being tolerated they were free for free liquid on the second day and then regular diet on the third day. (Tolerance is being indicated by an absence of vomiting or abdominal distension). Group 2 (Regular feeding) 30 patients were managed conventionally (that is nothing by mouth until the resolution of ileus, then a fluid diet, followed by regular diet. All patients underwent general anesthesia no nasogastric tube was inserted in any patients during surgery in patients in group 1 and a nasogastric tube was inserted in all patients during surgery and continued till the resolution of ileus in group 2. The patients were monitored for vomiting, abdominal distension length of ileus, tolerance of regular diet, length of hospitalization and complications. If there were two episodes of vomiting in the absence of bowel sounds or passage of flatus in the absence of any bowel movement, insertion of nasogastric tube was implemented.Also those who suffered from abdominal distension, emesis and succussion splash of stomach were diagnosed with acute dilatation of stomach, subjected to G I decompression. If there was anastomosis failure, treatment ensued such as antibiotics, nutritional support, ileostomy or colostomy. Patients with normal post operative course were discharged when they could tolerate a regular diet. Demographics were age and sex, medical and surgical histories of the patients and indications for anastomosis were noted. Different patients had different types of anastomosis were randomly allocated to group 1 irrespective of anastomotic type to eliminate bias. Table 1. Indications group 1 group 2 Tuberculous 5 5 Stricture at Ileum Closure of 20 20 Ileostomy Colorectal surgery 5 5 The main outcome was to evaluate post operative complications that included wound infection, leakage of anastomosis, obstruction, mesenteric emboli, upper G1 bleeding, wound dehiscence, prolonged ileus, and mortality. Ileus was defined as hypoactive bowel sounds, abdominal distension and no passage of flatus or bowel movement with or without nausea or vomiting after the first post operative day 3. Statistical analysis of data done by SPSS version 10. For continuous variables, descriptive statistics were calculated and were reported as mean +SD. Categorical variables were described using frequency distribution. The student T-test for paired samples was used to detect difference in the mean of continuous variables and the chi-square test was used in cases with low expected frequencies (a P value