Publication:

A comparative study on early versus conventional feeding in patients under going small bowel anastomosis

Background Postoperative nutritional management plays a critical role in surgical recovery, particularly following gastrointestinal procedures such as small bowel anastomosis. Traditional practice delays enteral nutrition until bowel sounds or flatus return; however, recent evidence suggests that early enteral feeding (EEN) may improve outcomes without increasing complications. Aim was to compare patient compliance, tolerance, and clinical outcomes between early enteral feeding and conventional feeding methods in patients undergoing elective small bowel anastomosis.

Methods This prospective comparative study was conducted at a tertiary care center over a two-year period. A total of 100 patients undergoing elective small bowel anastomosis were randomly divided into two groups: Group A (Early feeding, n=50): Initiated enteral feeding via nasogastric tube on postoperative day (POD) 2. Group B (Conventional feeding, n=50): Began oral feeding after return of bowel sounds, typically POD 5-7. Parameters assessed included vomiting, abdominal distension, return of bowel function, nasogastric tube removal, infection, anastomotic leak, length of hospital stay, and patient compliance. Data were analyzed using standard statistical tests; a p<0.05 was considered significant.

Results Early return of bowel function: Flatus passed significantly earlier in group A (mean 2.4±0.6 days) vs. group B (3.6±0.7 days), p<0.001. Shorter hospital stay: Group A had a significantly shorter stay (6.1±1.3 days) than group B (9.4±1.6 days), p<0.001. Lower abdominal distension: Group A (10%) vs Group B (26%), p=0.04. Similar complication rates: anastomotic leak was rare and not significantly different (2% vs. 4%, p=0.56). High compliance: 92% in Group A tolerated early feeding; 100% in Group B adhered to conventional feeding.

Conclusions Early enteral feeding following small bowel anastomosis is better tolerated and enhances postoperative recovery of the patients, faster bowel function recovery and reduced hospital stay without increasing the risk of complications. Following Early enteral feeding in routine practice is aligned with Enhanced Recovery After Surgery protocol (ERAS).