SS  Vol.4 No.1 , January 2013
Early Feeding vs 5-Day Fasting after Distal Elective Bowel Anastomoses in Children. A Randomized Controlled Trial
Abstract

Purpose: Determine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. Methods: Controlled randomized trial including pediatric patients with DEBA, excluding non-elective and high risk patients. Variables: Demographics, operative time, anastomosis placement, beginning peristalsis and bowel movement, time to full diet intake, post-operative stay, persisting vomiting and abdominal distention, wound infection or dehiscence, anastomotic leak, reoperation, death. Randomization into: 1) Experimental group (EG): early feeding group, after a minimum 24 hours fasting period, oral fluids and diet was started; 2) Control group (CG): obligatory 5-day fasting. Descriptive Statistics: Students t test for quantitative and Chi square for qualitative variables, a p-value < 0.05 was considered significant. Results: 60 patients were included since June 2003 to May 2004, 30 ineach group. Mean age 2 years, weight16 kg, malnutrition 33%. Stomal Ethiology: Anorectal-malformation 46%, Hirschsprung 13%, inflammatory 35%, tumoral 5%. Mostly in colon 71%. Mean surgical time 142 min. None developed vomiting or required nasogastric-tube. Mild abdominal distension 13%, mild fever 16.5% and wound complications 18%. Anastomosis leakage 6.5%, none required reoperations. Demographic variables showed no statistical differences. Full oral intake was in the 2nd postoperative day in the EG vs CG (p = 0.001). Postoperative hospital stay was 6.0 ± 3 in the EG vs 9.8 ± 4 days in the CG with clinical but not statistical significance. Peristalsis beginning, first flatus passage and bowel movements showed no statistical differences. The complication incidence was low and equally distributed. Conclusions: Early feeding after DEBA is safe and well tolerated in children.


Cite this paper
Davila-Perez, R. , Bracho-Blanchet, E. , Galindo-Rocha, F. , Tovilla-Mercado, J. , Varela-Fascinetto, G. , Fernandez-Portilla, E. , Lezama-del-Valle, P. and Nieto-Zermeño, J. (2013) Early Feeding vs 5-Day Fasting after Distal Elective Bowel Anastomoses in Children. A Randomized Controlled Trial. Surgical Science, 4, 45-48. doi: 10.4236/ss.2013.41008.
References

[1]   R. Davila-Perez, E. Bracho-Blanchet, J. M. Tovilla-Mercado, J. A. Hernandez-Plata; A. Reyes and J. Nieto-Zermeno, “Unnecessary Gastric Decompression in Distal Elective Bowel Anastomoses in Children. A Randomized Study,” World Journal of Surgery, Vol. 34, No. 5, 2010, pp. 947-953. doi:10.1007/s00268-010-0442-3

[2]   M. L. Pearl, F. A. Valea, M. Fisher, L. Mahler and E. Chalas, “A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-Abdominal Surgery,” Obstetrics & Gynecology, Vol. 92, No. 1, 1998, pp. 94-97. doi:10.1016/S0029-7844(98)00114-8

[3]   B. T. Stewart, R. J. Woods, B. T. Collopy, R. J. Fink, J. R. Mackay and J. O. Keck, “Early Feeding after Elective Open Colorectal Resections: A Prospective Randomized Trial,” Australian and New Zealand Journal of Surgery, Vol. 68, No. 2, 1998, pp. 125-128. doi:10.1111/j.1445-2197.1998.tb04721.x

[4]   I. J. Han-Geurts, W. C. J. Hop, N. F. M. Kok, et al., “Randomized Clinical Trial of the Impact of Early Enteral Feeding on Postoperative Ileus and Recovery,” British Journal of Surgery, Vol. 94, No. 5, 2007, pp. 555-561. doi:10.1002/bjs.5753

[5]   I. Gokpinar, E. Gurleyik, M. Pehlivan, O. Ozcan, I. Ozaydin, A. Aslaner, Y. Demiraran and M. Gultepe, “Early Enteral and Glutamine Enriched Enteral Feeding Ameliorates Healing of Colonic Anastomosis: Experimental Study,” Ulusal Travma ve Acil Cerrahi Dergisi, Vol. 12, No. 1, 2006, pp. 17-21.

[6]   P. Reissman, T. A. Teoh, S. M. Cohen, E. G. Weiss, J. J. Nogueras and S. D. Wexner, “Is Early Oral Feeding Safe after Colorectal Surgery? A Prospective Randomized Trial,” Annals of Surgery, Vol. 222, No. 1, 1995, pp. 73-77. doi:10.1097/00000658-199507000-00012

[7]   V. Seenu and A. K. Goel, “Early Oral Feeding after Elective Colorectal Surgery: Is It Safe,” Tropical Gastroenterology, Vol. 16, No. 4, 1995, pp. 72-73.

[8]   M. Senkal, A. Mumme, U. Eickhoff, B. Geier, G. Spath, D. Wulfert, U. Joosten, A. Frei and M. Kemen, “Early Postoperative Enteral Immunonutrition: Clinical Outcome and Cost Comparison Analysis in Surgical Patients,” Critical Care Medicine, Vol. 25, No. 9, 1997, pp. 1489-1496. doi:10.1097/00003246-199709000-00015

[9]   T. Bisgaard and H. Kehlet, “Early Oral Feeding after Elective Abdominal Surgery—What Are the Issues?” Nutrition, Vol. 18, No. 11, 2002, pp. 944-948. doi:10.1016/S0899-9007(02)00990-5

[10]   C. V. Feo, B. Romanini, D. Sortini, R. Ragazzi, P. Zamboni, G. C. Pansini and A. Liboni, “Early Oral Feeding after Colorectal Resection: A Randomized Controlled Study,” ANZ Journal of Surgery, Vol. 74, No. 5, 2004, pp. 298-301. doi:10.1111/j.1445-1433.2004.02985.x

[11]   P. A. Lucha Jr., R. Butler, J. Plichta and M. Francis, “The Economic Impact or Early Enteral Feeding in Gastrointestinal Surgery: A Prospective Survey of 51 Consecutive Patients,” American Surgeon, Vol. 71, No. 3, 2005, pp. 187-190.

[12]   H. K. Andersen, S. J. Lewis and S. Thomas, “Early Enteral Nutrition within 24 h of Colorectal Surgery versus Later Commencement of Feeding for Postoperative Complications (Review),” Cochrane Collaboration, Vol. 2, 2009, pp. 1-30.

[13]   S. Sangkhathat, S. Patrapinyokul and K. Tadyathikom, “Early Enteral Feeding after Closure of Colostomy in Pediatric Patients,” Journal of Pediatric Surgery, Vol. 38, No. 10, 2003, pp. 1516-1519. doi:10.1016/S0022-3468(03)00506-2

 
 
Top