Randomised control study on early enteral feeding after small gut anastomosis

Abstract

Studies show that early enteral feeding after small gut intestinal anastomosis has a better outcome than delayed feeding.The outcome measures are short duration of hospital stay, lower incidence of infection and anastomotic leak. Traditionally enteral feeding has been delayed until the return of bowel sounds or passage of flatus.This practice is not grounded on scientific facts as delayed feeding decreases the deposition of collagen at the anastomotic site, causes mucosal atrophy and negative nitrogen balance .The practice of early enteral feeding (EEF) if adopted will reduce the duration of hospital stay and reduce the overall healthcare costs. Experience in Kenyatta National Hospital (KNH) shows that delayed feeding is preferred after intestinal anastomosis. Objective: This randomized control study sought to compare the outcome of early enteral feeding versus delayed feeding after small gut anastomosis. Main outcome measures: The length of hospital stay, infection rate and rate of anastomotic leak. Study design: Randomized control study. Setting: Kenyatta National Hospital a tertiary hospital in Kenya. Study duration: 1st of March to 30th September 2012. Methods and materials: 66 patients were randomly selected and classified into two groups, group A were fed with liquid diet 6hrs post-operative whereas patients in group B were fed after return of bowel sounds or passage of flatus. The following outcome measures were compared between the study and the control groups: anastomotic leak, wound infection and duration of hospital stay. Results: The mean length of hospital stay was shorter in the early feeding group (7·3 days, 95% CI 6·9-7·6 days) compared to the delayed feeding group (9·7 days CI 7·6-11·7 days). This is statistically significant (p=0·02). The anastomotic leak rate was 3% in the delayed feeding group and none in the study group (p=0·314).The wound infection rate was higher in the delayed feeding arm (15%) than in the early feeding arm (6%) p=0·23.