מתוך medicontext.co.il
LONDON (Reuters Health) – Despite being widely practised, delayed feeding after gastrointestinal surgery offers no clear advantages over early enteral feeding, according to a report published in the October 6th issue of the British Medical Journal. In fact, early feeding may actually reduce the risk of certain postoperative complications.
Dr. Stephen J. Lewis, Addenbrooke's Hospital in Cambridge, UK, and colleagues performed a meta-analysis of 11 randomised controlled trials that compared early (< 24 hours after surgery) with delayed feeding after elective gastrointestinal surgery. The trials included a total of 837 patients. Six trials involved feeding directly into the small bowel and five involved oral feeding.
Patients fed early had a relative risk of developing an infection of 0.72 compared with patients who received delayed feeding, the authors report. The mean hospital length of stay was also significantly shorter for patients who were fed early (p = 0.001). Vomiting, however, was more common among patients fed early than among delayed feeding patients.
Early feeding was linked to a reduced risk of anastomotic dehiscence, wound infection, pneumonia, intra-abdominal abscess, and mortality, but the associations were not statistically significant.
While the findings suggest that early feeding offers several benefits, the data are insufficient to establish this conclusively, the investigators note. However, the results do indicate that an adequately powered trial evaluating early feeding is warranted.
In a related editorial, Dr. D. B. A. Silk and Dr. N. Menzies Gow, from Central Middlesex Hospital in London, comment that the current findings show "that there is no clinical benefit to starving patients in the early postoperative period after gastrointestinal resection."
Dr. Silk and Dr. Gow believe that "the finding that postoperative infections can be reduced and hospital stay shortened by starting early postoperative enteral nutrition should challenge clinicians to consider this treatment."
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