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Reduction of Postoperative Ileus by Early Enteral Nutrition in Patients Undergoing Major Rectal Surgery: Prospective, Randomized, Controlled Trial

Boelens, Petra G. MD, PhD*; Heesakkers, Fanny F. B. M. BSc (NursStud); Luyer, Misha D. P. MD, PhD; van Barneveld, Kevin W. Y. MD; de Hingh, Ignace H. J. T. MD, PhD; Nieuwenhuijzen, Grard A. P. MD, PhD; Roos, Arnout N. MD, PhD; Rutten, Harm J. T. MD, PhD

doi: 10.1097/SLA.0000000000000288
Randomized Controlled Trials

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 designed 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 randomly 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.

Randomized controlled trial investigating the effect of early enteral nutrition after major rectal surgery. Early enteral nutrition was compared with early parenteral nutrition, both as bridge to normal oral intake. Early enteral nutrition reduced postoperative ileus, the incidence of anastomotic leakage.

*Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

Department of Surgery, Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands

Department of Surgery, Research Institute Growth and Development of the Maastricht University Medical Centre, Maastricht, The Netherlands.

Reprints: Petra G. Boelens, MD, PhD, Department of Surgery, Leiden University Medical Center, Department of Surgery, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail: drboelens@hotmail.com.

Disclosure: This study was supported with an unconditional and nonrestrictive research grant by Nutricia Netherlands BV, Zoetermeer, The Netherlands, designated to this specific project. No other conflicts of interest are declared by the authors.

© 2014 by Lippincott Williams & Wilkins.