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Feeding Gut Surgery Patients is OK

Study questions withholding food for 24 hours

FRIDAY, Oct. 5, 2001 (HealthDayNews) -- While eating may be the last thing on a patient's mind after gastrointestinal surgery, new research shows that feeding a liquid diet through a tube within a day of the operation does no harm and may be beneficial.

In fact, British surgeons report that early tube feeding may reduce the risk of infection and the average time spent in the hospital after the procedure.

Senior investigator Dr. Steven Thomas says common practice for doctors has been not to feed a patient by mouth for 24 hours after gastrointestinal surgery, then slowly reintroducing food. The idea is to give the recovering gut time to start working again.

The research, reported in the Oct. 6 issue of the British Medical Journal, involved analysis of 11 studies of 837 patients who were denied food or who were fed via tube within 24 hours of surgery.

Thomas and his colleagues found that the risk of infection dropped 28 percent in patients fed early after surgery, while the risk of death was more than halved. Early feeding also reduced the risk of pneumonia.

The average length of hospital stay was 16 percent shorter in patients who were fed early. However, their risk of vomiting rose 27 percent compared with patients who received no food in the first 24 hours after surgery.

How early feeding may prevent infection is not clear, Thomas says.

"Experimental data suggests that feeding into the gut may improve wound healing and stimulate the gut by producing local effects in the gut itself, but also generally in the body," says Thomas..

Dr. Eric Weiss, director of surgical endoscopy in the department of colorectal surgery at the Cleveland Clinic Florida, in Fort Lauderdale, says most U.S. surgeons try to reintroduce a liquid diet as soon as possible after gastrointestinal surgery.

In a series of previous studies, Weiss looked at early tube feeding in patients undergoing colorectal surgery. "You could feed the vast majority of patients clear liquids immediately after surgery without using a [nasogastric, or NG] tube," says Weiss. "About 15 percent of the patients would develop a significant [lack of intestinal mobility] which would require either cutting off the liquid diet or placing an NG tube, but the other 80 to 85 percent did well."

Also, he says, "It promoted patients moving their bowels sooner and passing gas sooner. There was no downside from the standpoint of infections," he says.

Giving a patient food may fuel both the gastrointestinal tract's absorptive function and its role in preventing bacteria from passing through the bowel wall and into the bloodstream, Weiss says.

"The theoretical advantage of feeding the [gastrointestinal] tract is that you're maintaining what it does normally so that the cells within the [gastrointestinal] tract will function more normally and decrease the rate of infection."

Thomas says both the location of the surgery within the gastrointestinal tract and the extent of the surgery may be important.

"We think that it should encourage people to question the current [nil by mouth] practice," says Thomas. "It's good that surgeons are questioning what they do."

"But what really needs to be done is a large clinical trial to establish whether the current practice should be changed. We really have to establish what the best method [of feeding] is, and how the feeding is actually helping," Thomas says.

His team is trying to organize such a trial.

What To Do: For information on digestive disorders, check the National Institute of Diabetes and Digestive and Kidney Diseases, the University of Pennsylvania Health System, or the Society of American Gastrointestinal Endoscopic Surgeons.

SOURCES: Interviews with Steven Thomas, M.D., Ph.D., senior lecturer, department of maxillofacial surgery, University of Bristol, Bristol, England, and Eric G. Weiss, M.D., director, surgical endoscopy, department of colorectal surgery, Cleveland Clinic Florida and clinical assistant professor, Department of Surgery, University of South Florida, Tampa, Fla.; Oct. 6, 2001, British Medical Journal
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