The effect of early oral postoperative carbohydrates feeding on postoperative outcome

Introduction: Ileus commonly occurs after abdominal surgery, and is associated with complications and increased length of hospital stay. Post-operative ileus (POI) is an important reason for remaining patients not permit oral (NPO) in post-operative period. The tradition was that when patients passed flatus, they were ready to consume a liquid diet, and then a solid food diet was gradually introduced. This approach was taken to avoid aspiration, gastric and intestinal distension, and anastomotic dehiscence. Although studies demonstrated that the conventional strict feeding regimens were not necessary, many surgeons still hesitated to allow early oral feeding. There has been concern that early oral intake would result in vomiting and severe paralytic ileus with subsequent aspiration pneumonia, wound dehiscence and anastomotic leakage. This belief has become surgical dogma, unsupported by scientific evidence. Aim: to investigates the effect of early oral postoperative carbohydrates feeding on postoperative outcome. Material and methods: forty abdominal surgery patients were randomly assigned to early oral postoperative feeding group (20) or traditional feeding group (20). In the early feeding group (study group), patients were initially started on clear fluid only 16 h after surgery and progressed to liquids (after 24 h) and then soft and regular diet in next day (after 48 h). In the post-operative period, the patients were visited each 12 h and clinical signs and symptoms such as, time of passed flatus and moved their bowels, nausea and vomiting, and the length hospital stay were assessed. Conclusions: This study showed that early oral postoperative carbohydrates feeding group passed flatus and moved their bowels much sooner than the control group thus reducing the duration of POI and hospital stay, but there is no increase in occurrence of of nausea and vomiting between tow groups.

The effects of oral preoperative carbohydrates administration on postoperative outcome

Introduction: Ileus commonly occurs after abdominal surgery, and is associated with complications and increased length of hospital stay (LOHS). Traditionally, preoperative practice has been to fast the patient for up to 12 h prior to surgery. The rationale for this is to reduce gastric acidity and volume with a consequent decrease in the risk of gastric content aspiration during surgery. However, A Cochrane review found no increased risk of aspiration in patients who were allowed fluids 2–3 h prior to surgery compared to patients having undergone a traditional fasting period .. A carbohydrate-rich beverage given before anaesthesia and surgery alters metabolism from the overnight fasted to the fed state. This reduces the catabolic response (insulin resistance) after operation, which may have implications for postoperative recovery. Aim : to investigates the effect of preoperative carbohydrate treatment on postoperative ileus in adult patients undergoing abdominal surgery. Material and methods: fifty abdominal surgery patients were randomly assigned to preparation with a 12.5% carbohydrate drink (CHO) (25), or overnight fasting group (25). The CHO group were given 600 mL to drink on the evening before and 400 mL on the morning of surgery. The patients' complains of nausea and vomiting was noted, the length hospital stay and the duration of postoperative ileus (POI), was measured in tow groups. Conclusions: This study showed that pre-operative carbohydrate drink may be used safely and also improves patient's comfort as decrease rate of nausea and vomiting and reduce the length of hospital stay in patients undergoing abdominal surgery.