Title: Early Versus Late Enteral Nutrition Following Upper Gastrointestinal Surgery – A Prospective Study
Authors: Prof Dr Braja Mohan Mishra, Assoc Prof Dr A. N. Behera, Dr Soumyaranjan Das
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.181
Abstract
Gut anastomosis is one of the frequently performed surgeries in both emergency and elective setup. Anastomosis following gut resections in emergency set up is mostly done due to traumatic rupture, benign or malignant perforation or obstruction and in certain other inflammatory conditions. Mostly the patients are kept nil per orally till the intestinal peristaltic sound returns.
Rationality behind this practice is Postoperative gut dysmotility mainly affects stomach & colon along with small gut in a lesser magnitude. To protect the anastomotic site by providing rest to the gut and avoiding passage of food through it.
Great emphasis has been paid on early enteral feeding within 6 to 24 hrs after operation. Ideas behind early enteral feeding are Gut secretes and reabsorbs about 7 liters of fluid per day irrespective of oral intake, so giving ‘rest to gut and protecting anastomotic site’ is based on a false notion.
Gut recovers from dysmotility within 24 to 48 hours in case of stomach & colon while 4 to 6 hours in case of small bowel. It prevents translocation of bacteria or virus by maintaining integrity of gut mucosa which may become atrophied if gut remains in rest. Many patients remain malnourished before operation; they are predisposed to more postoperative complications. Starvation reduces the collagen content in the scar tissue and diminishes the quality of healing, whereas feeding reverses mucosal atrophy induced by starvation and increases anastomotic collagen deposition and strength.
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