a comparative study between early enteral feeding (within 24 hours) versus conventional enteral feeding after enteric anastomosis.
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Date
2012-07
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Abstract
Background: Traditionally, enteric feeds are withheld for a period of 48-72 hrs, sometimes even more following
enteric anastomosis depending upon return of full peristaltic sounds. This results in a period of nonstimulation
of gut –‘Gut Rest’, which was supposed to result in better anastomotic healing. But this same
also deprives the intestinal mucosa of surface nutrients as well as prolongs parenteral fluid therapy, thereby
depriving the patients of adequate nutrition. Along with it, prolonged parenteral therapy also keeps the
patients bound to bed with its resultant complications like, prolonged hospital stay and increased cost of
therapy. Objectives: To compare the benefits of early enteral feeding over conventional enteric feeding following
enteric anastomosis with special regards to patients recovery and complications. Methods and
materials: The selection of patients into group A (60) and group B (60) was done after having fulfilled
inclusion and exclusion criteria. Informed consent was obtained. The patients of group A were fed via
enteral route within 24 hrs of enteric anastomosis. The patients of group B were fed via enteral route after
48-72 hrs or appearance of full peristaltic sounds following enteric anastomosis. These patients were followed
in post operative period for their drain output, any nausea, vomiting or significant abdominal distension,
prolonged ileus, post operative duration of shospital stay, post operative infective complications (e.g.
wound infection, UTI, RTI), and different haematological and biochemical examinations. Results: This
study shows that post operative nausea-vomiting, anastomotic leakage rate, re-exploration , wound infection
and RTI rates are higher in group A than those of group B. In this study, the incidence of UTI in post
operative period is higher in group B. But the differences in above mentioned variables are not statistically
significant. Whereas appearance of intestinal peristaltic sound is earlier in group A (42.8 ± 10.68 hours)
compare to that of group B (52.6 ± 13.46 hours). Here, the difference is statistically significant (p value =
0.000022) The duration of post operative hospital stay is shorter in group A (8.45 ± 5.143 days) than that
of group B (10.533 ± 4.952 days). The difference of duration post operative hospital stay is statistically significant
(p value = 0.0257). Removal of nasogastric tube, resumption of oral feeding, and passage of first
flatus and/or defecation were earlier in the group A than that of the group B; the differences were statistically
significant. The post operative day-5 albumin level is better in group A (3.147 ± 0.4409 gm/dl) than
that of group B (2.935 ± 0.3124 gm/dl). This difference is also statistically significant (p value = 0.0029).
There are three mortalities in group Awhereas one mortality in group B. This difference in mortality in two
groups is not statistically significant.
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Keywords
Early enteral feeding (within 24 hours), Conventional enteral feeding, Enteric anastomosis
Citation
Chatterjee S, Bala S K, Chakraborty P, Dey R, Sinha S, Ray R, Rahed A. a comparative study between early enteral feeding (within 24 hours) versus conventional enteral feeding after enteric anastomosis. Bangladesh Journal of Medical Science. 2012; 11(4): 273-283.