title: Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition Negative effect of Metoclopramide in postoperative adynamic ileus. A prospective, randomized, double blind study Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy. Effect of intravenous erythromycin on postoperative ileus. Does metoclopramide reduce the length of ileus after colorectal surgery? The effect of erythromycin on gastrointestinal motility in subtotal gastrectomized patients A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery Reduction of Postoperative Ileus by Early Enteral Nutrition in Patients Undergoing Major Rectal Surgery: Prospective, Randomized, Controlled Trial Early oral feeding in patients undergoing elective colonic anastomosis. Reduction of Postoperative Complication Rate with the Use of Early Oral Feeding in Gynecologic Oncologic Patients Undergoing a Major Surgery: A Randomized Controlled Trial Efficacy of metoclopramide in postoperative ileus after exploratory laparotomy. Early oral feeding after colorectal resection: a randomized controlled study Comparing early oral feeding with traditional oral feeding in upper gastrointestinal surgery. Must early postoperative oral intake be limited to laparoscopy? Early Oral Versus “Traditional” Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intestinal Resection: a Randomized Controlled Trial Early Feeding and the Incidence of Gastrointestinal Symptoms After Major Gynecologic Surgery A simplified rehabilitation program for patients undergoing elective colonic surgery—randomized controlled clinical trial A randomised controlled trial of early initiation of oral feeding after caesarean delivery in Mulago Hospital. The Effect of Erythromycin on Bile Excretion and Proximal Small Bowel Motility Following Divided Gastric Bypass Surgery: A Prospective Randomized Placebo-Controlled Trial Early feeding after elective open colorectal resections: a prospective randomized trial. Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection. Early Oral Feeding vs. Traditional Feeding in Patients Undergoing Elective Open Bowel Surgery—a Randomized Controlled Trial Randomized clinical trial of patient‐controlled versus fixed regimen feeding after elective abdominal surgery Effect of early enteral feeding after upper gastrointestinal surgery. Early Oral Feeding Versus Traditional Postoperative Care After Abdominal Emergency Surgery: A Randomized Controlled Trial Early Versus Delayed Postoperative Feeding After Major Gynaecological Surgery and its Effects on Clinical Outcomes, Patient Satisfaction, and Length of Stay: A Randomized Controlled Trial. Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy. A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra‐abdominal Surgery Early nasogastric tube removal combined with metoclopramide after radical cystectomy and urinary diversion. Early postoperative feeding after elective colorectal surgery. Is early postoperative feeding feasible in elective colon and rectal surgery? Prokinetic effect of erythromycin after colorectal surgery Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery A randomised controlled trial of early initiation of oral feeding after cesarean section Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin. Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection The postoperative clinical outcomes and safety of early enteral nutrition in operated gastric cancer patients. Metoclopramide role in preventing ileus after cesarean, a clinical trial Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial.
abstract: Objective To evaluate the potential clinical , metabolic , and economic advantages of enteral nutrition over total parenteral nutrition . Design Prospect i ve , r and omized clinical trial . Setting Department of surgery in a university hospital . Patients Two hundred and fifty-seven patients with cancer of the stomach ( n = 121 ) , pancreas ( n = 110 ) , or esophagus ( n = 26 ) were r and omized to receive postoperative total parenteral nutrition ( TPN group , n = 131 ) or early enteral nutrition ( EEN group , n = 126 ) . The nutritional goal was 25 kcal/kg/day . The two nutritional formulas were isocaloric and isonitrogenous , and they were continued until oral intake was at least 800 kcal/day . Measurements Morbidity , mortality , length of hospital stay , and treatment costs were evaluated in all patients . In 40 consecutive patients , selected nutritional , immunologic and inflammatory variables were studied . Moreover , intestinal oxygen tension was evaluated by micropolarographic implantable probes . Main Results The nutritional goal was reached in 100/126 ( 79.3 % ) patients in the EEN group and in 128/131 ( 97.7 % ) patients in the TPN group ( p < .001 ) . In the EEN group , hyperglycemia ( serum glucose , > 200 mg/dL ) was observed in 4.7 % of the patients vs. 9.1 % in the TPN group ( p = NS ) . Alteration of serum electrolyte levels was 3.9 % in the EEN group vs. 13.7 % in the TPN group ( p < .01 ) . No significant difference was found in nutritional , immunologic , and inflammatory variables between the two groups . The overall complication rate was similar ( 40.4 % for TPN vs. 35.7 % , for EEN;p = .52 ) . No difference was detected for either infectious or noninfectious complications , length of hospital stay , and mortality . From postoperative day 5 , intestinal oxygen tension recovered faster in the EEN group than in the TPN group ( 43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7;p < .001 ) . EEN was four-fold less expensive than TPN ( $ 25 vs. $ 90.60/day , respectively ) . Conclusion EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinical ly require postoperative artificial nutrition In a double blind controlled study including 60 patients it was found that Metoclopramide has a negative effect upon the resolution of postoperative adynamic ileus .  Metoclopramide causes a delay in the time from operation to the first passage of flatus AIM To evaluate the feasibility , safety , and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma . METHODS Three hundred and sixteen patients su bmi tted to operations associated with colorectostomy from January 2004 to September 2005 were r and omized to two groups : In experimental group ( n=161 ) , the nasogastric tube was removed after the operation from 12 to 24 h and was promised immediately oral feeding ; In control group ( n=155 ) , the nasogastric tube was maintained until the passage of flatus per rectum . Variables assessed included the time to first passage of flatus , the time to first passage of stool , the time elapsed postoperative stay , and postoperative complications such as anastomotic leakage , acute dilation of stomach , wound infection and dehiscense , fever , pulmonary infection and pharyngolaryngitis . RESULTS The median and average days to the first passage of flatus ( 3.0+/-0.9 vs 3.6+/-1.2 , P<0.001 ) , the first passage of stool ( 4.1+/-1.1 vs 4.8+/-1.4 , P<0.001 ) and the length of postoperative stay ( 8.4+/-3.4 vs 9.6+/-5.0 , P<0.05 ) were shorter in the experimental group than in the control group . The postoperative complications such as anastomotic leakage ( 1.24 % vs 2.58 % ) , acute dilation of stomach ( 1.86 % vs 0.06 % ) and wound complications ( 2.48 % vs 1.94 % ) were similar in the groups , but fever ( 3.73 % vs 9.68 % , P<0.05 ) , pulmonary infection ( 0.62 % vs 4.52 % , P<0.05 ) and pharyngolaryngitis ( 3.11 % vs 23.23 % , P<0.001 ) were much more in the control group than in the experimental group . CONCLUSION The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications . On the contrary , it may increase the incidence rate of fever , pharyngolaryngitis and pulmonary infection . These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation We attempted to determine whether the administration of erythromycin shortens the period of postoperative ileus by a prospect i ve , double-blind , placebo-controlled study . Seventy-seven patients were r and omized and included in the statistical calculations . The patients were stratified according to the operation performed ( cholecystectomy , celiotomy , or other major abdominal operations ) . Forty-one patients ( group 1 ) received 250 mg erythromycin intravenously every 8 h for nine doses upon admission to the recovery room . Thirty-six patients ( group 2 ) received placebo . The time ( in hours ) to first passage of flatus , first liquid meal , first bowel movement , and total length of hospital stay was recorded . There was no significant difference between group 1 and group 2 in time to first flatus ( 54.9 + /- 29 vs. 53.9 + /- 27 h , respectively ) , first meal ( 70.4 + /- 44 vs. 71.7 + /- 65 ) , first bowel movement ( 81.8 + /- 32 vs. 80.1 + /- 28 ) , or length of hospital stay ( 185.2 + /- 183 vs. 182.1 + /- 163 ) . Erythromycin , in the dosage tested in this study , does not seem to alter clinical parameters of gastrointestinal motility after an abdominal operation . New prokinetic agents may deserve further studies Between August 1988 and September 1989 , 100 consecutive patients who underwent elective abdominal colorectal surgical procedures were prospect ively r and omized to receive or not to receive metoclopramide . Metoclopramide was intravenously administered every 8 hours from the completion of surgery until a solid food diet was able to be tolerated . Seven patients were not included in the final tabulations because of one death , one small bowel obstruction requiring laparotomy , one anastomotic leak requiring laparotomy , and four protocol violations . Ninety-three patients , 37 men and 56 women ( mean age , 59.5 ; range , 14–89 years ) underwent 40 segmental colectomies , 13 total abdominal colectomies , 8 abdominoperineal resections , 8 ileoanal pouch procedures , 7 small bowel resections , and 17 other colorectal procedures . The 40 patients who received postoperative metoclopramide were in Group 1 , and the 53 who did not were in Group 2 . The mean length of time between laparotomy and commencement of oral fluid and oral solid intake in Groups 1 and 2 were 3.5 and 4.8 days , and 3.5 and 5.0 days , respectively . These differences were not statistically significant ( P>0.05 ) . Prolonged ileus was seen in seven patients in Group 1 and in eight patients in Group 2 . These differences were also not statistically significant ( P>0.05 ) . Prolonged ileus was defined as the need for nasogastric tube reinsertion or discontinuation of oral intake . We conclude that metoclopramide does not significantly alter the course of postoperative ileus Purpose Our objective was to determine the effect of erythromycin ( EM ) in improving gastrointestinal motility in subtotal gastrectomized patients . We used radio-opaque Kolomarks as an objective method . We conducted a prospect i ve , controlled clinical trial study of 24 patients . Methods All patients underwent subtotal gastrectomy with 3 capsules containing Kolomarks ( 20 markers per 1 capsule ) in the remnant stomach before anastomosis . From the day of the operation to the 2nd postoperative day , patients in the EM group began receiving 200 mg of EM intravenously for 30 minutes continuously . We counted the number of Kolomarks in the stomach , passed by stomach , in rectum , and in stool with serial simple abdominal X-ray films on the first postoperative day up to the 7th postoperative day . Results The study population included 14 patients in the control group and 10 patients in the EM group . The two study groups were compared in terms of their characteristics including age , gender , past medical history , cancer stage , and operation type . No significant differences were found for the demographics between the two groups . We only found a significant difference for the number of Kolomarks passed by the stomach on the 3rd postoperative day ( P = 0.026 ) . Conclusion Our results demonstrated that 200 mg of EM intravenous infusion during the postoperative period induced rapid gastric emptying , although it did not improve gastrointestinal motility for the entire gastrointestinal tract in subtotal gastrectomized patients OBJECTIVE : This prospect i ve r and omized clinical study was conducted to evaluate the safety and tolerability of early oral feeding after colorectal operations . METHODS : A total of 199 patients underwent colorectal surgery and were r and omly assigned to  early feeding ( n = 99 ) or a regular diet ( n = 100 ) . Patients ' characteristics , diagnoses , surgical procedures , comorbidity , bowel movements , defecation , nasogastric tube reinsertion , time of tolerance of solid diet , complications , and length of hospitalization were assessed . RESULTS : The two groups were similar in terms of gender , age , diagnosis , surgical procedures , and comorbidity . In the early feeding group , 85.9 % of patients tolerated the early feeding schedule . Bowel movements ( 1.7±0.89 vs. 3.27±1.3 ) , defecation ( 3.4±0.77 vs. 4.38±1.18 ) and time of tolerance of solid diet ( 2.48±0.85 vs. 4.77±1.81 ) were significantly earlier in the early feeding group . There was no change between the groups in terms of nasogastric tube reinsertion , overall complication or anastomotic leakage . Hospitalization ( 5.55±2.35 vs. 9.0±6.5 ) was shorter in the early feeding group . CONCLUSIONS : The present study indicated that early oral feeding after elective colorectal surgery was not only well tolerated by patients but also affected the postoperative outcomes positively . Early postoperative feeding is safe and leads to the early recovery of gastrointestinal functions Background : The current trend in postoperative nutrition is to promote a normal oral diet as early as possible . However , postoperative ileus is a frequent and common problem after major abdominal surgery . This study was design ed to investigate whether early enteral nutrition ( EEN ) , as a bridge to a normal diet , can reduce postoperative ileus . Methods : Patients undergoing major rectal surgery for locally advanced primary or recurrent rectal carcinoma ( after neoadjuvant (chemo)-radiation , with or without intraoperative radiotherapy ) were r and omly assigned to EEN ( n = 61 ) or early parenteral nutrition ( EPN , n = 62 ) in addition to an oral diet . Early nutrition was started 8 hours after surgery . Early parenteral nutrition was given as control nutrition to obtain caloric equivalence and minimize confounding . The primary endpoint was time to first defecation ; secondary outcomes were morbidity , other ileus symptoms , and length of hospital stay . Results : Baseline characteristics were similar for both groups . In intention-to-treat analysis , the time to first defecation was significantly shorter in the enteral nutrition arm than in the control arm ( P = 0.04 ) . Moreover , anastomotic leakage occurred significantly less frequently in the enteral group ( 1 patient ) compared with parenteral supplementation ( 9 patients , P = 0.009 ) . Mean length of stay in the enteral group was 13.4 ± 2.2 days versus 16.7 ± 2.3 days in the parenteral group ( P = 0.007 ) . Conclusions : Early enteral nutrition is safe and associated with significantly less ileus . Early enteral nutrition is associated with less anastomotic leakage in patients undergoing extensive rectal surgery BACKGROUND This study assesses the safety outcome of early oral feeding and reports on the factors affecting early postoperative feeding after colorectal procedures . PATIENTS AND METHODS Between June 2005 and April 2008 , 120 consecutive patients underwent elective colonic anastomosis and were then r and omized into two groups . The early feeding group began fluids on the first postoperative day while the regular feeding group was managed in the traditional way - nothing by mouth until the resolution of ileus . RESULTS The majority of patients ( 75 % ) tolerated the early feeding . The times to first passage of flatus ( 3.3+/-0.9 days vs 4.2+/-1.2 days ) and stool ( 4.1+/-1.2 days vs 4.9+/-1.2 days ) were significantly quicker in group 1 . Hospital stay was also significantly shorter in the early feeding group ( 6.2+/-0.2 days vs 6.9+/-0.5 days ) . Operative time and amount of blood loss had an impact on the tolerability of early feeding while age , gender , type of operation and previous abdominal operation had no such impact . CONCLUSION Early oral feeding after colorectal surgery is safe and tolerated by the majority of patients . Operative time and amount of blood loss do , however , have an impact on the tolerability of early feeding Background A r and omized controlled trial was performed to assess the outcome of early oral postoperative feeding ( EOF ) compared with traditional oral feeding ( TOF ) in gynecologic oncology patients undergoing a complex laparotomy , including upper abdominal surgery . Methods Patients aged 18–75 years , undergoing an elective laparotomy and with a preoperative suspicion of gynecologic malignancy , were eligible . Exclusion criteria included infectious conditions , intestinal obstruction , severe malnutrition , American Society of Anesthesiologists score ≥4 , intestinal resection , and postoperative stay in the intensive care unit lasting > 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet . Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet . The primary end-point of the trial was length of hospital stay . Results Between January 1 , 2007 , and November 17 , 2007 , a total of 143 patients were r and omized to receive either EOF or TOF . Hospital stay for patients who received EOF ( n = 71 ) was 4.7 vs. 5.8 days for the TOF group ( n = 72 ) ( P = 0.006 ) . The mean level of postoperative satisfaction was significantly higher in the EOF group ( 82.8 vs. 71.7 mm , P ≤ 0.001 ) . Patients who received the TOF scheme had significantly higher overall postoperative complications ( 39 vs. 17 % in EOF group , P = 0.003 ) and infective complications ( 14 % in TOF group vs. 3 % in EOF group , P = 0.017 ) . Variables such as nausea and vomiting , analgesic and antiemetic requirement as well as level of pain and quality of life were not different between groups . Conclusions On the basis of these findings , the policy of EOF should be used after a complex gynecologic oncologic laparotomy STUDY OBJECTIVE To assess the efficacy of metoclopramide for treatment of postoperative ileus in patients who underwent exploratory laparatomy .  DESIGN Prospect i ve observational study SETTING Surgical intensive care unit ( SICU ) . PATIENTS Thirty-two patients who underwent exploratory laparatomy INTERVENTION Sixteen patients received metoclopramide  , and 16 did not . The primary outcome was time to first postoperative bowel movement . Secondary end points were length of stay ( LOS ) in the SICU and total hospital LOS . MEASUREMENTS AND MAIN RESULTS The mean number of days to first bowel movement was nearly identical for both the treatment group and control group ( 4.8 vs 4.7 days , respectively , p=0.93 ) . Length of stay in the SICU was 8.3 days for the treatment group and 8.6 days for the control group ( p=0.89 ) , and total LOS was 18.0 and 20.1 days , respectively ( p=0.63 ) . CONCLUSION The time to first bowel movement was not significantly different between the treatment and control groups . Also , metoclopramide did not decrease LOS .  Metoclopramide does not have a role in the treatment of postoperative ileus Background : Nasogastric ( NG ) intubation is widely used following elective abdominal operations although it is associated with morbidity and discomfort . The present study is a r and omised controlled trial on the effect of early oral feeding without NG decompression  following elective colorectal resection for cancer BACKGROUND / AIMS Due to the lack of interest in using early oral feeding and the need for a trial study in this regard , this study aim ed to compare the outcome of early oral feeding and traditional oral feeding in patients with upper gastrointestinal surgery . METHODS Fifty-two patients who underwent upper gastrointestinal surgery were r and omly assigned into two groups in a consecutive manner as either the early oral feeding group or traditional oral feeding group .  Tolerance of oral feeding , ileus , nausea and vomiting , post-operative stay , and complications were recorded . RESULTS Tolerance of oral feeding for the two groups was 24 ( 92.3 % ) in the early oral feeding group and 21 ( 91.3 % ) in the traditional oral feeding group ( p=0.89 ) . The post-operative hospital stays were 5.62 and 8.04 days in the early oral feeding and traditional oral feeding groups , respectively ( p<0.0001 ) . There were significant differences between the two groups in terms of the time of the first gas passing/defecation , the post-operative hospital stays , starting time of oral feeding , and satisfaction regarding early nasogastric tube removal . CONCLUSIONS The results of this study show that early oral feeding is a safer and more cost-effective procedure in upper gastrointestinal surgery PURPOSE : This prospect i ve , r and omized study was design ed to evaluate whether or not early postoperative feeding ( cl aim ed as a unique benefit of laparoscopic surgery ) is possible after laparotomy and colorectal resection . METHODS : The trial was performed between July 1 , 1992 and October 31 , 1992 and included all 64 consecutive patients who underwent laparotomy with either a colonic or an ileal resection .  In all cases the nasogastric tube was removed immediately after the operation . Group 1 consisted of 32 patients ( age range , 15–81 years ; mean , 52 years ) who received a regular diet on the first postoperative morning . Group 2 consisted of 32 patients ( age range , 15–87 years ; mean , 52 years ) who were fed in a traditional manner .  Regular food was permitted after resolution of ileus as defined by resumption of bowel movements in the absence of abdominal distention , nausea , or vomiting . RESULTS : The rate of nasogastric tube reinsertion for distention with persistent vomiting was 18.7 percent ( six patients ) in Group 1 and 12.5 percent ( four patients ) in Group 2 . Although vomiting was experienced more frequently by patients in Group 1 ( 44 percentvs.25 percent , respectively ) , there was no difference between the two groups with regard to the duration of postoperative ileus ( 3.6vs.3.4 days , respectively ) . In the 26 patients from Group 1 who did not require nasogastric tube reinsertion , there was a trend toward shorter hospitalization ( 6.7vs.8.0 days , respectively ) . CONCLUSION : Early oral intake is possible after laparotomy and colorectal resection . Thus , the laparoscopic surgeon 's cl aim of early tolerated oral intake may not be unique to laparoscopy Background A r and omized controlled trial was performed to assess the outcome of early oral postoperative feeding ( EOF ) compared with traditional oral feeding ( TOF ) in gynecologic oncology patients undergoing laparotomy with associated intestinal resection . Methods Patients aged 18–75 years , undergoing elective laparotomy , and with preoperative diagnosis of gynecologic malignancy , were eligible . Exclusion criteria included infectious conditions , intestinal obstruction , severe malnutrition , American Society of Anesthesiologists ( ASA ) score ≥4 , and postoperative stay in the intensive care unit lasting > 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet . Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet . The primary end-point of the trial was length of hospital stay . Results Between January 1st , 2007 and March 15th , 2008 , 40 patients were r and omized to receive either EOF or TOF  . Hospital stay in patients who received EOF ( n = 18 ) was 6.9 days versus 9.1 days in the TOF group ( n = 22 ) ( P = 0.022 ) . Requirements for analgesic and antiemetic drugs , intensity of pain , intestinal function recovery , mean levels of postoperative satisfaction , postoperative complications , and quality -of-life scores did not differ between the two groups . Conclusion Early resumption of oral intake is feasible and safe in gynecologic oncology patients undergoing intestinal resection as part of a planned surgical procedure . Moreover , significant reduction in length of hospital stay was demonstrated Objective To compare early feeding with traditional postoperative dietary management for development of postoperative gastrointestinal symptoms , including ileus after major gynecologic surgery for benign conditions . Methods Women who had major gynecologic surgery for benign conditions were r and omly allocated to early feeding of low residue diets 6 hours postoperatively or traditional dietary management of clear liquids with normal bowel sounds , and regular diet with passage of flatus . Demographic and perioperative data were collected , and patients answered question naires on their perception of bowel function and pain using the McGill Pain Scale . Power analysis found that 130 women were needed to find a twofold greater incidence of ileus in the early feeding group with 80 % power and & agr ; = .05 . Results Complete data were available for 139 women , 67 allocated to the early feeding group and 72 to the late feeding group . The incidence of postoperative ileus for the study population was 4.4 % and did not differ between groups ( early 3 % versus late 5.8 % , P = .68 ) . There were no differences in patient demographics , surgical procedures , anesthesia used , and intraoperative complications between groups . With the exception of more complaints of nausea in the late feeding group ( 23 % versus 13 % , P = .04 ) , there were no differences in other postoperative variables , including other perioperative complications , pain medicine requirements , fluid and caloric intake , median pain scores , and gastrointestinal function . The low incidence of perioperative complications made the power to detect differences between groups low . Conclusion Low residue diet 6 hours after major gynecologic surgery for benign indications was not associated with increased postoperative gastrointestinal complaints , including ileus Background We have proposed a simplified perioperative rehabilitation program for elective colonic surgery that is focused on early oral nutrition and that could reduce hospital stay and postoperative ileus time without raising complications and readmission rates . Patients and methods Fifty-four patients admitted for elective colonic surgery were prospect ively r and omized into two groups : ( 1 ) an early feeding group (EFG)—on the first postoperative day , patients initially received a oral liquid diet and were advanced to a regular diet within the next 24 h as tolerated and at their discretion ; ( 2 ) a traditional care group— patients were managed by nothing per orus until the elimination of the first flatus and then su bmi tted to an oral liquid diet , followed by a regular diet within the next 24 h as described for the EFG . All patients followed a well-defined , simplified rehabilitation program . Results Patients ' baseline characteristics were similar in the two groups . Hospital stay was significantly lower in the EFG ( 4.0 [ ±3.7 ] versus 7.6 [ ±8.1 ] days ; p = 0.000 ) . Diet tolerance and progression were similar between groups . Time to first flatus after surgery was significantly lower in the EFG ( 1.5 [ ±0.5 ] versus 2.0 [ ±0.7 ] days ; p = 0.019 ) . Complication and readmission rates were similar in both groups . Conclusions Early oral nutrition associated with a simplified perioperative rehabilitation program reduces postoperative length of hospital stay and ileus time after elective colonic resection without increasing rates of complications or readmissions BACKGROUND The concept of early initiation of oral feeding after caesarean delivery is well tolerated by patients , yet not routinely practice d in Mulago Hospital . An effective postoperative dietary management schedule could have major implication s on the management of maternal post-caesarean section mothers . OBJECTIVES To compare the effect of time initiation of oral feeding on acceptability , benefits and gastrointestinal functions in women who had undergone caesarean section in Mulago Hospital . DESIGN A r and omised controlled study . SETTING Mulago Hospital . SUBJECTS One hundred and ninety two women admitted on the postnatal ward after emergency or elective caesarean section for various indications and who satisfied the eligibility criteria were recruited and r and omized into the study . Assignment to the early feeding group or routine feeding group was done r and omly using a computer generated numbers . The early feeding group were encouraged to take sips of water within six to eight hours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours post operative under supervision . The routine group were managed by restricting oral intake for twenty four hours and administration of orals sips of water 24 to 48 hours post operative . The outcome measures were rate of ileus symptoms , post operative presence of bowel sounds , maternal pyrexia and acceptability and benefits of early feeding . RESULTS The mean age , parity and gravidity were similar in the two groups . The study shows that women of the early feeding group had more rapid return of their bowel function with significant more shorter mean post operative time intervals to bowels sounds ( 24.2 hours versus 34.2 hours ) , passage of flatus ( 51.6 hours versus 62.1 hours ) and bowel movement ( 67.8 hours versus 75.8 hours ) . The women who fed early , made more rapid recovery and expressed their interest in earlier hospital discharge . The findings significantly indicated that women in the early feeding group got out of bed ( patient mobilisation ) earlier ( p = 0.001 ) than their control group ( 15.1 hours versus 17.8 hours ) . This could probably have been because of the adequate rehydration and improved early energy intake . In comparison those who were fed early required less number of bottles of intravenous fluids ( 5.0 bottles versus 7.0 bottles ) . The average hospital stay was similar and not statistically significant in both groups ( 5.5 days versus 6.0 days ) . CONCLUSION Early initiation of oral feeding after caesarean delivery is safe and well tolerated and can be implemented without an increase in gastrointestinal symptoms or paralytic ileus Background : No conclusive data exists supporting the use of any prokinetic agent in the postoperative setting . The study was design ed to examine the effect of erythromycin on small bowel motility in a placebo-controlled trial of post gastric bypass patients utilizing a st and ardized nuclear medicine test . Methods : A consecutive series of 21 patients undergoing elective gastric bypass surgery for morbid obesity between September 1999 and March 2001 were enrolled in this prospect i ve double-blind r and omized controlled trial . St and ard open , divided gastric bypass was performed . Patients were r and omized to receive either erythromycin 250 mg I. V. ( 11 patients ) or placebo ( 10 patients ) every 8 hours . On postoperative day 2 , a  hepatic iminodiacetic acid ( HIDA ) scan was obtained . Tracer movement through the biliary tree and proximal small bowel was quantified and compared . Results : Tracer clearance from the liver and biliary tree was no different between groups from time of injection through 1 hour . Tracer material clearance from the duodenum into the jejunum was no different between the erythromycin and control groups at 1 hour , 37 % ±13 % and 37 % ±22 % respectively ( P=0.95 ) . At 4 hours , clearance was greater in the erythromycin group , 77%±6 % , compared to control , 60%±20 % ( P = 0.036 ) . The rate of tracer change between hour 1 and 4 ( slope ) was steeper in the erythromycin group ( P=0.048 ) . Conclusions : Erythromycin  increases intestinal transit in the postoperative setting BACKGROUND A period of starvation after colorectal resections to allow for resolution of the clinical evidence of ileus has been an unchallenged surgical doctrine until recent times . A prospect i ve r and omized trial comparing early feeding to traditional management in patients undergoing open elective colorectal resections is reported . METHODS Patients undergoing elective intraperitoneal colorectal resections without stoma formation were r and omized to either an early feeding or control group . The early feeding group were allowed free fluids from 4 h postoperatively progressing to a solid diet from the first postoperative day as they tolerated it . The control group remained nil orally until passage of flatus or bowel motion and were then commenced on fluids progressing to solids over 24 - 48 h. RESULTS There were 40 patients in each group well matched for age , sex , type and duration of operation , method of analgesia and mobilization . Thirty-two patients ( 80 % ) in the early feeding group tolerated a diet within 48 h. There was no significant difference in the rate of vomiting , nasogastric reinsertion or complications . The early feeding group tolerated a diet , passed flatus , used their bowels , and were discharged from hospital significantly earlier than the control group . CONCLUSION Early feeding after elective open colorectal resections is successfully tolerated by the majority of patients , leading to earlier resolution of ileus and hospital discharge BACKGROUND & AIMS The evidence in support of Early Enteral Nutrition ( EEN )  after upper gastrointestinal surgery is inconclusive . The aim of this study was to determine if EEN improved clinical outcomes and shortened length of hospital stay . METHODS Open , prospect i ve multicentre r and omised controlled trial within a regional UK Cancer Network . One hundred and twenty-one patients with suspected operable upper gastrointestinal cancer ( 54 oesophageal , 38 gastric , 29 pancreatic ) were studied . Patients were r and omised to receive EEN ( n = 64 ) or Control management postoperatively ( nil by mouth and IV fluid , n = 57 ) . Analysis was based on intention-to-treat and the primary outcome measure was length of hospital stay . RESULTS Operative morbidity was less common after EEN ( 32.8 % ) than Control management ( 50.9 % , p = 0.044 ) , due to fewer wound infections ( p = 0.017 ) , chest infections ( p = 0.036 ) and anastomotic leaks ( p = 0.055 ) . Median length of hospital stay was 16 days ( IQ = 9 ) after EEN compared with 19 ( IQ = 11 ) days after Control management ( p = 0.023 ) . CONCLUSIONS EEN was associated with significantly shortened length of hospital stay and improved clinical outcomes . These findings reinforce the potential benefit of early oral nutrition in principle and as championed within enhanced recovery after surgery programmes , and such strategies deserve further research in the arena of upper GI surgery Objective This prospect i ve r and omized controlled trial was conducted to compare the safety , tolerability and outcome of early oral feeding vs. traditional feeding in patients undergoing elective open bowel surgery . Methods A total of 120 consecutive patients who underwent elective open bowel surgeries were r and omized into either early feeding ( n = 60 ) or traditional feeding group ( n = 60 ) . Patients in the early feeding group were started on oral fluids on post-operative day 1 , while those in the traditional feeding group were started orals after the resolution of ileus . Patient characteristics , surgical procedures , co-morbidity , first flatus , first defecation , time of starting solid diet , complications and length of hospitalization were assessed between the two groups . Results The two groups were similar in demographic and baseline data . The number of days to first flatus ( p < 0.0001 ) , first defecation ( p < 0.0001 ) , length of post-operative stay ( p = 0.011 ) and time of starting solid diet ( p < 0.0001 ) were significantly earlier in the early feeding group . Anastomotic leak , wound infection , fever , vomiting , abdominal distention and other complications were similar . Multivariate analysis showed that patients in the early oral feeding group were discharged 3.4 days earlier ( p = 0.037 ) . Conclusion In patients undergoing elective open bowel surgeries , early post-operative feeding is safe , is well tolerated and reduces the length of hospitalization Although studies have shown that early oral feeding after abdominal surgery is feasible , many surgeons still advocate a careful , slow introduction of postoperative oral feeding . This study was conducted to investigate whether patient‐controlled postoperative feeding is possible in patients undergoing colonic or aortic surgery BACKGROUND AND AIMS The impact of early enteral nutrition in elective upper gastrointestinal surgery was the focus of this study , with particular reference to its feasibility and benefits . METHOD This prospect i ve study was carried out over 2 years . The study group included 30 patients and the control group had 31 patients . Twenty-two patients in each group underwent truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer and gastric outlet obstruction . Eight patients in the study group and nine in the control group underwent gastrectomy for carcinoma stomach .  A st and ard milk-based diet was initiated 12 hours after surgery through a nasojejunal tube . The patients were monitored for side effects of enteral feeding and postoperative infective complications . Nitrogen balance and nutritional parameters like the body weight , serum albumin , and serum transferrin were measured pre and postoperatively . RESULTS The groups were comparable with respect to age , sex , and preoperative nutritional factors like body weight , serum albumin , and serum transferrin . The return of bowel sounds and passage of flatus took place significantly earlier in the study group ( 1.43 vs. 2.81 days ) . Diarrhoea and abdominal cramps were the significant complications noted in the study group in relation to early enteral feeding . No patient required withdrawal of enteral feeds . They showed a positive nitrogen balance on the fourth postoperative day . The patients in the study group showed significant increase in the serum transferrin level compared with the preoperative level but the serum albumin level was not significantly altered . CONCLUSION Early enteral feeding through the nasojejunal tube following elective upper gastrointestinal surgery is feasible , safe and improves the nutritional status Background Early oral feeding ( EOF ) has been demonstrated to be safe and beneficial after abdominal elective surgery . The aim of this r and omized controlled trial is to assess the safety and benefits of EOF compared to traditional postoperative care ( TPC ) after abdominal emergency surgery . Methods Patients assigned to the EOF group commenced a soft diet within 24 h after surgery . In the TPC group , a liquid diet was commenced upon passage of flatus or stool and then advanced to soft food . The primary endpoint was the complication rate . Secondary endpoints were severity of complications , mortality , gastrointestinal leaks , surgical-site infection , reoperation , diet intolerance , time to first flatus and stool , amount of food intake , postoperative discomfort , hospital stay , weight loss at the 15th postoperative day and incisional hernias . Results A total of 295 patients assigned to EOF ( n = 148 ) or TPC ( n = 147 ) were analyzed . No significant differences were seen in the complications rates ( EOF 45.3 % vs. TPC 37.4 % ; p = 0.1 ) . There was a significantly higher rate of vomiting with EOF ( EOF 13.5 % vs. TPC 6.1 % ; p = 0.03 ) , with no differences in nasogastric tube reinsertion . EOF patients ’ food intake was proportionally lower for the first three meals than that of TPC patients ( p < 0.01 ) . Postoperative discomfort survey revealed more hunger in the TPC group ( p < 0.01 ) . There were no differences in postoperative ileus or length of hospital stay . Conclusions EOF was safe after abdominal emergency surgery . EOF was associated with more vomiting ( treated easily and without patient discomfort ) and less hunger than with TPC . No other EOF-related benefits could be demonstrated during this trial OBJECTIVE To compare early versus delayed postoperative feeding in women undergoing major gynaecological surgery with regard to clinical outcomes , duration of postoperative stay , and patient satisfaction . METHODS We conducted a parallel-r and omized controlled trial at a tertiary care centre in Montreal , Quebec , between June 2000 and July 2001 . Patients undergoing major gynaecological surgery were r and omized following a 1:1 allocation ratio to receive either early postoperative feeding in which oral clear fluids were begun up to six hours after surgery followed by solid foods as tolerated , or delayed postoperative feeding , in which clear fluids were begun on the first postoperative day and solid foods on the second or third day as tolerated . The primary outcomes analyzed were duration of postoperative stay and patient satisfaction . Secondary outcomes included mean time to appetite , passage of flatus , and bowel movement , as well as the presence of symptoms of paralytic ileus . RESULTS A total of 119 patients were r and omized ; 61 patients were assigned to the early feeding group and 58 to the delayed feeding group . Demographic characteristics , including age , weight , smoking status , and prior surgical history were comparable between both groups . There was no difference in length of postoperative stay between the two groups ( 86.4 ± 21.0 hours in the early feeding group vs. 85.6 ± 26.2 hours in the delayed feeding group ; P > 0.05 ) . No significant difference was noted in patient satisfaction ( P > 0.05 ) . No difference was found in the frequency of postoperative ileus , mean time to appetite , passage of flatus , or first bowel movement . CONCLUSION The introduction of early postoperative feeding appears to be safe and well tolerated by patients undergoing major gynaecological surgery .  The duration of postoperative stay , patient satisfaction , and gastrointestinal symptoms are comparable between patients undergoing early or delayed postoperative feeding AIM To assess the efficacy of metoclopramide ( Met ) for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy ( IPC ) . METHODS Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC  were allocated to two groups . Sixteen patients received Met immediately after operation ( group A ) , and 16 did not ( group B ) . Another 16 patients who underwent D2 gastrectomy without IPC  were enrolled as the control group ( group C ) . All patients had received epidural pain control . The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort . Secondary endpoints were early complications during hospitalization . RESULTS Gender , the type of resection , operating time , blood loss , tumor status and amount of narcotics were comparable in the three groups . However , the group C patients were older than those in groups A and B ( 67.5+/-17.7 vs 56.8+/-13.2 , 57.5+/-11.7 years , P = 0.048 ) . First bowel flatus occurred after 4.35+/-0.93 d in group A , 4.94+/-1.37 d in group B , and 4.71+/-1.22 d in group C ( P>0.05 ) . Oral feeding of a soft diet was tolerated 7.21+/-1.92 d after operation in group A , 10.15+/-2.17 d in group B , and 7.53+/-1.35 d in group C ( groups A and C vs group B , P<0.05 ) . There was no significant difference in respect to the first flatus among the three groups . However , the time of tolerating oral intake with soft food in groups A and C patients was significantly shorter than that in group B patients . Levels of C-reactive protein ( CRP ) were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC . The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus . There was no increased risk of anastomotic leakage in patients receiving Met . CONCLUSION The results suggest that a combination of intravenous Met and epidural pain control may be required to achieve a considerable decrease in time to resumption of oral soft diet in advanced gastric cancer patients who underwent gastrectomy and IPC . Furthermore , the administration of Met did not increase anastomotic leakage . Met has a role in the prevention of prolonged post-operative ileus Objective To evaluate the safety and efficacy of early oral feeding after intra-abdominal surgery in gynecologic oncology patients . Methods During a 1-year period , 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a r and omized controlled trial of early compared with traditional oral postoperative feeding . Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated . Patients allocated to traditional postoperative oral feeding received nothing by mouth until return of bowel function ( defined as the passage of flatus in the absence of vomiting or abdominal distention ) , then began a clear liquid diet , and advanced to a regular diet as tolerated . Results Age , case distribution , surgery length , blood loss , and first passage of flatus were similar in the early and traditional feeding groups . Significantly more patients in the early group developed nausea . Despite this , the incidence of vomiting , abdominal distention , incidence and duration of nasogastric tube use , and percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups . Time to development of bowel sounds , time to initiation of clear liquid and regular diets , and hospital stay were significantly longer in the traditional group . Major complications ( eg , pneumonia , atelectasis , and wound complications ) and febrile morbidity occurred equally in both groups . There were no known anastamotic complications or aspirations in either group . Postoperative changes in hematologic indices and electrolytes were com-parable in both groups . Conclusion Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated PURPOSE Prolonged nasogastric decompression increases pulmonary complications by inhibiting clearance of respiratory secretions . The literature supports early nasogastric tube removal following bowel resection . Metoclopramide stimulates bowel activity , promoting return of function . We examined combining early nasogastric tube removal with metoclopramide after radical cystectomy . MATERIAL S AND METHODS From 1994 to 1996 , 27 prospect i ve cystectomy patients received intravenous metoclopramide ( metoclopramide group ) combined with early nasogastric tube removal ( less than 24 hours ) . A total of 54 concurrent cystectomy controls received no metoclopramide and nasogastric tubes remained until return of normal bowel function . RESULTS Preoperative and perioperative factors were comparable between the 2 groups .  Nasogastric tubes were removed from 78 % of the metoclopramide group in less than 24 hours , 11 % on day 2 and 11 % on day 3 compared to none on day 1 , 50 % on day 2 and 50 % on day 3 or greater in controls . The metoclopramide group had a more rapid return of normal bowel sounds ( 2.9 versus 4.0 days , p = 0.0002 ) and earlier tolerance of solid food ( 6.7 versus 7.9 days , p = 0.04 ) . Nasogastric tube replacement was required in 3 of 27 metoclopramide cases versus 5 of 54 controls . Atelectasis occurred more often in the control group ( 33 versus 15 % ) . There were no bowel related complications in the metoclopramide group but partial small bowel obstruction in 2 controls was treated conservatively . CONCLUSIONS This preliminary study suggests that combining intravenous metoclopramide with early nasogastric tube removal after cystectomy and urinary diversion may reduce postoperative atelectasis and speed return of bowel function while posing no danger to the small bowel anastomosis . This regimen may result in fewer complications and shorter hospitalizations , translating into lower costs without compromising quality of care BACKGROUND Several investigators have demonstrated that routine nasogastric decompression after abdominal surgery is unnecessary and can be safely eliminated , and 1 recent study demonstrated the safety of early oral feedings . OBJECTIVE To test the hypothesis that successful early feeding would lead to a shorter duration of hospitalization and , therefore , would be more cost-effective . PATIENTS Fifty-eight patients with elective colorectal surgery . METHODS Patients were prospect ively r and omized to 1 of 2 postoperative treatment arms : early feeding ( EF group , n = 29 ) and traditional feeding ( TF group , n = 29 ) . All patients in the EF group began a liquid diet on the first postoperative day and were advanced to a regular diet when they consumed 1000 mL in 24 hours . All patients in the TF group began a liquid diet after resolution of the postoperative ileus and were advanced to a regular diet after consuming 1000 mL in 24 hours . Patients were dismissed after tolerating two thirds of the regular diet . Both groups had intraoperative orogastric tubes that were removed at the end of surgery . Nasogastric tubes were inserted for persistent postoperative vomiting . RESULTS No significant differences were noted in age , types of procedures , or in prior abdominal surgery in either group . No significant differences were seen in rates of nausea ( 55 % in EF vs 50 % in TF group ) or vomiting ( 48 % in EF vs 33 % in TF group ) . One patient in the EF group had aspiration pneumonia , and anastomotic leak result ed in sepsis and eventual death of 1 patient in the TF group . No significant difference was observed in length of hospital stay between the 2 groups ( mean + /- SD , 7.2 + /- 3.3 days in EF vs 8.1 + /- 2.3 days in TF group ) . CONCLUSIONS Early oral feeding after elective colorectal surgery is safe . Most of the patients tolerated EF ; however , there was no significant difference in duration of hospitalization in these patients Abstract . In reports on earlier non- prospect ively r and omized trials the authors have cl aim ed that early oral postoperative feeding is a unique benefit of laparoscopic surgery . On the other h and , some authors have suggested that early feeding could be tolerated by the majority of patients after elective open surgery . Aim . This prospect i ve r and omized study was undertaken to assess the feasibility and safety of immediate oral feeding in patients subjected to elective open colorectal surgery . Methods . This trial included 190 patients who underwent an elective colon or rectal operation . Patients were r and omized after the operative procedure into one of two groups . Group I ( n = 95 ) : On the first evening after the operation , patients were allowed ab libitum intake of clear liquids ; this continued until the first postoperative day at which time they progressed to a regular diet as desired . Group II ( n = 95 ) : In this group the nasogastric tube was removed when the surgeon considered that postoperative ileus had been resolved . Results . Early oral intake was tolerated by 79.6 % of the patients in the first 4 days in group I ; there were no differences between the two groups from the 4th day on . The incidence of vomiting and nasogastric tube insertion ( 21.5 % ) was higher in patients in group I than in those in group II . The time until the first bowel movement was 4.3 days in group I and 4.7 days in group II . Complications appeared in 17.3 % of the patients in group I and in 19.3 % in group II . Conclusion : This study has objective ly demonstrated that early oral feeding is feasible and safe in patients who have elective colorectal surgery . Résumé . Des travaux r and omisés non prospect ifs ont affirmé que l'alimentation orale postopératoire précoce est un des gr and s bénéfices de la chirurgie laparoscopique . Les auteurs ont suggéré , d'autre part , une réalimentation précoce et bien tolérée par la plupart des patients après chirurgie élective ouverte . Le but de ce travail prospect if est d'établir la faisabilité et la sécurité d'une alimentation orale immédiate chez des patients ayant subi une chirurgie colo-rectale élective ouverte . Cette étude inclut 190 patients devant subir une opération colo-rectale élective . Le collectif a été r and omisé après l'intervention en deux groupes . Les patients du groupe 1 ( n = 95 ) ont été autorisés à ingurgiter des liquides ad libitum le soir de l'intervention ; au premier jour postopératoire , ils ont pus'alimenter progressivement avec un régime normal . Dans le groups 2 ( n = 95 ) la sonde naso-gastrique a été etirée lorsque le chirurgien a considéré que la phase d'iléus postopératoire s'était résolue . Résultats . La réalimentation précoce a été bien tolérée chez 79.6 % des patients au cours des 4 premiers jours du groupe 1 . Il n'y a pas de différence entre les deux groupes au 4e jour . L'incidence des vomissements et la nécessité de replacer une sonde nasogastrique ( 21,5 % ) est plus élevée dans le groupe 1 que dans le groupe 2 . La première exonération s'est produite au 4,3e jour dans le groupe 1 et au 4,7e jour dans le groupe 2 . Des complications sont apparues chez 17,3 % des patients du groupe 1 et 19,3 % des patients du groupe 2 . En conclusion , cette étude a démontré de manière objective que la réalimentation orale précoce est possible et sûre chez des patients soumis à une chirurgie colo-rectale élective PURPOSE : Nausea and vomiting three to seven days after an elective operation on the colon and rectum remain a persistent clinical problem . Erythromycin , a safe , inexpensive drug that stimulates intestinal motilin receptors , has previously been shown to accelerate gastric emptying significantly after upper gastrointestinal surgery . We aim ed to evaluate the effect of postoperative intravenous erythromycin on postoperative ileus in patients undergoing elective surgery for primary colorectal cancer . METHODS : Between May 1998 and April 1999 , 150 patients undergoing primary resection of colon or rectal cancer were enrolled in this prospect i ve , r and omized , placebo-controlled trial . One hundred thirty-four patients completed the study . Patients were excluded if they had extensive metastatic disease , were taking medications known to interact with erythromycin , or if they required an ileostomy . Patients received either 200 mg of intravenous erythromycin or placebo every six hours . Clinical endpoints were recorded and continuous endpoints are presented as mean ± st and ard deviation . RESULTS : There were no significant complications related to erythromycin . The erythromycin ( n=65 ) and placebo ( n=69 ) groups were comparable regarding demographic and operative factors . The erythromycin group had a slightly shorter length of time to passage of flatus ( 4.1 ± 1.3vs . 4.4 ± 1.1 days;P=0.03 ) . There was no significant difference between erythromycin and placebo  in time to first solid food ( 5.6 ± 1.9vs . 5.4 ± 1.8 days ) , time to first bowel movement ( 5.2 ± 1.9vs . 5.4 ± 1.3 days ) , or time to discharge from hospital ( 7.5 ± 2.0vs . 7.6 ± 2.8 days ) . There was no difference in the rate of clinical ly significant nausea ( 26vs . 26 percent;P=0.99 ) , vomiting ( 17vs . 16 percent;P=0.88 ) , or nasogastric tube placement ( 9vs . 7 percent;P=0.68 ) . CONCLUSIONS : Erythromycin does not seem to alter clinical ly important outcomes related to postoperative ileus in patients undergoing resection for colorectal cancer Postoperative convalescence is mainly determined by the extent and duration of postoperative ileus . This r and omized clinical trial evaluated the effects of  early oral feeding  on functional gastrointestinal recovery and quality of life Objective . To evaluate the safety and efficacy of early oral feeding after cesarean delivery . Methods . Two hundred women who had cesarean section were r and omly assigned to early feeding or routine feeding . Women in the early feeding group were encouraged to take sips of water 8 h post-operatively , followed by oral tea of 100 mL at the time of supervision . Women in the routine feeding group were managed by restricting oral intake for the first 24 h and administration of sips of water 24–48 h post-operatively . The outcome measures include the rate of ileus symptoms , post-operative time interval to presence of bowel sounds , passage of flatus and bowel movement , time interval to return to regular diet , length of hospital stay , post-operative complications , acceptability and benefit of early oral feeding  . Results . The early feeding group had a shorter mean post-operative time interval to bowel sounds 18.90 ± 4.17 h versus 36.21 ± 3.52 h ( p < 0.001 ) , passage of flatus 44.81 ± 3.73 h versus 60.58 ± 4.40 h ( p < 0.001 ) and bowel movement 58.30 ± 5.91 h versus 72.76 ± 4.25 h ( p < 0.001 ) . There was no significant difference in paralytic ileus symptoms . Early feeding group had a shorter mean hospital stay 4.80 ± 0.59 days versus 6.69 ± 0.71 days ( p = 0.001 ) . Early feeding group required less intravenous fluid 7.14 ± 1.34 bottles versus 11.8 ± 1.32 bottles ( p < 0.001 ) . Conclusions . Early feeding after cesarean section was well tolerated and safe and can be implemented without an increase in adverse outcome OBJECTIVES Treatment of postoperative ileus remains unsatisfactory . Erythromycin ( EM ) , a macrolide antibiotic , has prokinetic effects on the gut . We investigated whether intravenous erythromycin decreases the time to the return of normal bowel function after bowel surgery in patients with bladder cancer and interstitial cystitis who have undergone cystectomy and urinary diversion . METHODS We conducted a double-blind , r and omized , placebo-controlled study of 22 volunteers . On the first postoperative day , patients began receiving intravenous erythromycin ( 125 mg ) or placebo every 8 hours ( maximum of 21 doses ) . The patients ' ability to tolerate a general diet and return of bowel function was monitored . RESULTS A general diet was tolerated at a median of 9 days postoperatively for the EM arm and 8 for the placebo arm ( P = 0.60 ) . The first bowel sounds were detected at an average of 2 postoperative days for the EM arm and 3 for the placebo arm ( P = 0.88 ) . First flatus was present an average of 5 days postoperatively for both study arms ( P = 0.35 ) . The first bowel movement was present an average of 6 days postoperatively for the EM arm and 5 for the placebo arm ( P = 0.98 ) . CONCLUSIONS No significant difference was found between EM and placebo with regard to the onset of bowel sounds , passage of flatus , passage of the first bowel movement , and the time to tolerate a general diet . These data indicate that erythromycin is not useful in improving postoperative bowel function Abstract Objectives : To assess whether immediate postoperative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective . Design : R and omised trial of immediate postoperative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the re introduction of normal diet . Setting : Teaching hospitals in London . Subjects : 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent , chronic gastrointestinal disease . Two patients did not proceed to resection . Main outcome measures : Nutritional state , nutritional intake and nitrogen balance , gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test , complications , and outcome . Results : Successful immediate enteral feeding was established in all 14 patients , with a mean ( SD ) daily intake of 6.78 ( 1.57 ) MJ ( 1622 ( 375 ) kcal before re introduction of oral diet compared with 1.58 ( 0.14 ) MJ ( 377 ( 34 ) kcal ) for those on intravenous fluids ( P<0.0001 ) . Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients ( mean ( SD ) -13.2 ( 11.6 ) g v 5.3 ( 2.7 ) g ; P<0.005 ) . There was no difference by day 5 . There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids ( 0.11 ( 0.06 ) v 0.15 ( 0.12 ) ; P<0.005 ) . There were also fewer postoperative complications in the enterally fed group ( P<0.005 ) . Conclusions : Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe , prevents an increase in gut mucosal permeability , and produces a positive nitrogen balance . Key messages Key messages It is safe , with patients experiencing fewer complications There seems to be an improvement in nutritional state Patients may have an improved PURPOSE This study investigated the impact of early enteral nutrition ( EEN ) on the clinical outcomes of gastric cancer patients after radical gastrectomy . METHODS Four hundred gastric cancer patients undergoing radical gastrectomy of any extend with D2 nodal dissection were r and omly divided into an experimental and a control group with 200 cases in each group . Patients in the control group received postoperative parenteral nutrition ( PN ) , while patients in the experimental group received postoperative EEN . After treatment , the clinical outcomes , postoperative immune function , and nutritional status of the two groups were evaluated . RESULTS The postoperative fever time , intestinal function recovery time , anal exhaust time , and the length of hospital stay for patients in the experimental group were significantly shorter than those of the control group . We did not find significant differences in anastomotic leak , postoperative ileus and regurgitation between the two groups . The activities of multiple immune cell types , including CD3⁺ , CD4⁺ , CD4⁺/CD8⁺ , and natural killer ( NK ) cells , were significantly lower in both groups on postoperative day 1 when compared with the preoperative levels ( p<0.05 ) . The level of CD8⁺ was not significantly different between the two groups ( p>0.05 ) . After treatment , levels of CD3⁺ , CD4⁺ , CD4⁺/CD8⁺ , and NK cells in the experimental group patients were 35.6 ± 4.2 , 42.2 ± 3.0 , 1.7 ± 0.3 , and 27.3 ± 5.3 % , respectively , on postoperative day 7 , which were similar to the preoperative levels . The immune cell levels from the control group patients remained significantly lower when compared with preoperative values ; in addition , these values were also significantly lower when compared with the EEN patients ( p<0.05 ) CONCLUSION : For gastric cancer patients undergoing radical gastrectomy , the clinical outcome , immune function and nutritional status  after EEN were significantly improved . These data suggest the widespread use of EEN in clinical practice Purpose Ileus is a common event following cesarean section . Early post-cesarean recovery is very important not only for the mother but also for the baby who is dependent on breastfeeding . This article aims to demonstrate the efficacy of metoclopramide for the prevention of ileus after cesarean . Methods In this r and omized controlled trial , 696 women scheduled for cesarean were r and omized in two groups . Three hundred fifty-three persons settled in control group and 343 were assigned in intervention group who received an injection of 10-mg intramuscular metoclopramide  prior to operation . After cesarean , the participants recorded the first flatus , defecation , feeling of hunger , feeding and ambulation in a question naire , and also their sense of bloating in a visual analog scale under supervision of a research assistant . The data was analyzed by SPSS 17 , t test , and chi-square , while p < 0.05 was considered significant . Results The interval between cesarean and the first flatus ( p < 0.0001 ) , defecation ( p < 0.0001 ) , feeling of hunger ( p < 0.0001 ) , feeding ( p = 0.007 ) , and ambulation ( p < 0.0001 ) were significantly shorter in the metoclopramide group . In addition , polytomous logistic regression analysis showed the metoclopramide group had less bloating with significant difference ( OR = 2.83 and CI 1.91–4.21 ) . Conclusions Our study proved the functionality of metoclopramide in preventing ileus . As this drug is safe , tolerable , harmless , inexpensive and available , and also no definite method has been developed to prevent ileus after cesarean ; yet , metoclopramide could be considered as a suitable option . Certainly with regard to some limitations in our study , further comprehensive studies are still required to ensure validity of the obtained results BACKGROUND To date , early oral feeding after gastrectomy for gastric cancer has not been accepted universally . Therefore , we performed a r and omized clinical trial to determine whether early oral feeding after curative surgery for gastric cancer can be tolerated and whether it has an effect on recovery . METHODS From July 2008 to February 2009 , 58 patients were enrolled and 4 were excluded according to set criteria . The patients in the early feeding group began a liquid diet on the second postoperative day , and then were fed a soft diet from the third day until the day they were discharged . The patients in the control group began a liquid diet on the fourth day . The primary endpoint of this study was the duration of postoperative hospitalization . RESULTS No significant differences were found in the clinico-operative characteristics between the 2 groups . The duration of hospitalization ( P = .044 ) and time until flatus ( P = .036 ) in the early group were decreased significantly . With regard to the rates of morbidity , cost of hospitalization , postoperative symptoms , and pain scales , no significant differences were found . The quality of life scores were decreased significantly at the fatigue ( P = .007 ) and nausea and vomiting ( P = .048 ) immediately after operation in the early feeding group . CONCLUSION Early oral feeding after gastric cancer surgery is feasible and can result in shorter hospitalization and improvements in several aspects of quality of life in the early postoperative period
target: Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
  Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
  CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
background: BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
  The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
  Management includes addressing the underlying cause and supportive care .
  Multiple medical interventions have been proposed , but effectiveness is uncertain .
  A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .