SAFETY OF EARLY VERSUS DELAYED ENTERAL FEEDING FOLLOWING ILEOSTOMY CLOSURE: RANDOMIZED CONTROLLED TRIAL
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Abstract
Objective: to compare the safety of early versus late enteral feeding in terms of tolerability and leak following Ileostomy closure.
Methodology: This prospective randomized trial was conducted at Lady Reading Hospital Peshawar from January 2010 to December 2011 on 60 patients, hospitalized for temporary ileostomy after fulfilling the inclusion and exclusion criteria. The patients were allocated into two groups of 30 each by simple random technique. Group A were allowed oral feeds in the early postoperative period (within 24 hours after surgery). Group B who were postoperatively kept “nil by mouth“ up to 72 hours. All patients were followed up on day 7th and 14th after surgery. Post-Operative complications like intra-abdominal collection, leak/ fistula and any mortality were diagnosed on the basis of clinical examination, ultrasound and C.T Scan abdomen. Data were compiled and analyzed with SPSS 16.
Result: The age of the patients ranged from 21-79 years with the mean age for early oral feeding was 42±13 years and for delayed oral feeding was 44±15 years. The male to female ratio for early feeding was 4:1 and for delayed feeding 2.3:1. Early oral feeding was well tolerated in 83.3% cases while in late oral feeding 90% which was statistically insignificant with P-value=0.7065. In this study no leak, fistula or death was documented in either group.
Conclusion: Early postoperative oral feeding after ileostomy closure is safe, well tolerated and the fear related with its failure do not have solid grounds and it should be encouraged in elective cases.
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References
Krando O, Yalti T , Berber I , Tellioglu G . Early vs. delayed closure of temporary
covering ileostomy. J Hepato-gastroenterol 2008;55(81):142-5.
Renzulli P, Candinas D. Intestinal stomas-indications, stoma types, surgical technique. Ther Umsch 2007;64:517-27.
Rajput A, Samad A, Khanzada TW. Temporary loop ileostomy: prospective study of indications and complications. Rawal Med J 2007;32:159-62.
Sutton CD, Williams N, Marshall LJ, Lloyd G, Thomas WM. A technique for wound closure that minimizes sepsis after stoma closure. ANZ J Surg 2002;72:766–7.
Catchpole BN. Smooth muscle and the surgeon. Aust NZ J Surg 1989; 59:199-208.
Bufo AJ, Feldman S, Daniels GA, Lieberman RC. Early postoperative feeding. Dis Colon Rectum 1994;37:1260-5.
Baver JJ, Gelernt 1M, Salky BA, Kreel I. is routine postoperative nasogastric decompression really necessary. Am Surg 1985; 201:233-6.
Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: A systemic review. Crit Care Med 2002; 29:2264-70.
Livingstone EH, Passaro EP Jr. Postoperative ileus. Dig Dis Sci 1990;35:121-32.
Dervenis C, Avgerinos C, Lytras D, Delis S. Benefits and limitations of enteral nutrition in the early postoperative period. Langenbecks Arch Surg 2003:387(11-12):441-9.
Moore FA, Moore EE, Jones JN, Mc Croskey BI, Peterson VM. TEN versus TPN following major abdominal trauma reduced septic morbidity. J Trauma 1989; 29:916-22.
Windsor AC, Kanwar S, Liag, Barnes E, Guthric JA, Spark JI, Compared with parenteral nutrition, enteral feeding attenuate the acute phase response and improves disease severity in acute pancreatitis. Gut 1998;42: 431-5.
Moore FA, Feliciano DV, Andrassy RJ. Early enteral feeding compared with parenteral reduces postoperative septic complications: the results of a meta analysis. Ann Surg 1992; 216:172-83.
Hoover HC, Ryan JA, Anderson EJ, Fischer JE, Nutritional benefits of immediate postoperative jejuna feeding of an elemental diet. Am J Surg 1980;139: 153-9.
Moore EE, Moore FA. Immediate enteral nutrition following multisystem trauma. J Am Coll Nutr 1991; 10: 633-48.
Delany HM, Demetriore AA, The E, Che BS, Levenson SM. Effect of early postoperative nutritional support on skin wound and colon anastomosis healing. J Parenter Enter Nutr 1990; 14: 357-61.
Peters WR, Bartels TL, Minimally invasive colectomy; are the potential benefits realized? Dis Colon Rectum 1993; 36; 571-56.
Dean PA, Beart RW, Nelson H, Elftmann TD, Sehlinkert RT, Laparoscopic-assisted segmental colectomy: early Mayo Clinic experience. Mayo Clin Proc, 1994;69:834-40.
Hawalsi A, Schroder DM, Lloyd LR, Featherstone R. Elective conventional colectomy in the era of laparoscopic surgery. Am Surgeon 1996; 62:589-93.
Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Wlson P. A prospective randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer: a preliminary report. J Am Coll Surg 1998: 187:46-57.
Lewis SJ, Egger M, Sylvester PA, Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systemic review and meta-analysis of controlled trials. BMJ 2001; 323:773-76.
Mc Carter MD, Gomez, Daly JM. Early postoperative enteral feeding following major upper gastrointestinal surgery. J Gastrointestinal Surg 1996; 1:278-85.
Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD. Is early oral feeding safe after elective colorectal surgery: a prospective randomized trial. Ann Surg 1995;22:73-7.
Goncalves CG, Groth AK, Ferreira M, Matias JE, Coelho JC, Campos AC. Influence of preoperative feeding on the healing of colonic anastomoses in malnourished rats. J Parenter Enteral Nutr. 2009;33:83-9.
Seenu V, Goel AK. Early feeding after elective colorectal surgery: Is it safe? Trop Gastroenterol 1995; 16:72-3.
Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev 2006; CD0040080.
Fukuzawa J, Terashima H, Ohkohchi N. Early post-operative oral feeding accelerates upper gastrointestinal anastomotic healing in the rat model. World J Surg 2007;31: 1234-9.
Ekingen G, Ceran C, Govenc BH, Tuzlaci A, Kahraman H. Early enteral feeding in newborn surgical patients. Nutrition 2005;21:142-6.
Fanaie SA, Ziaee SA. Safety of early feeding after gastrointestinal anastomosis: A randomized clinical trial. Indian J Surg 2005; 67: 185-8.