Residents' Papers:Gynecology
A randomized controlled trial of early versus “traditional” postoperative oral intake after major abdominal gynecologic surgery

https://doi.org/10.1067/mob.2002.123057Get rights and content

Abstract

Objective: The purpose of this study was to compare early oral intake and the traditional timing of feeding after major gynecologic surgery and the effects on the length of hospital stay. Study Design: Gynecologic oncology and urogynecology patients who underwent major abdominal gynecologic surgery were prospectively randomized to 1 of 2 groups. The traditional feeding group (group A, 49 patients) received nothing by mouth until documentation of bowel function. They were then advanced slowly to solid diet. The patients allocated to the early feeding regimen (group B, 47 patients) began clear fluids on the first postoperative day. Once 500 mL of clear fluid was tolerated, they received a regular diet. The groups were compared with regard to length of hospital stay, postoperative day that solids were tolerated, and the incidence of adverse effects. Statistical analyses were performed with the χ2 test, the Fisher exact test, the Student t test, and analysis of variance. Results: The demographic characteristics of the 2 groups were similar. There was a statistically significant reduction in the length of hospital stay for those patients on the early feeding regimen. The median length of stay for group A was 6.0 days and for group B was 4.0 days (P =.0001). There was no difference in the incidence of emesis, ileus, or other postoperative complications between the 2 groups. Conclusion: Early postoperative dietary advancement after major abdominal gynecologic surgery results in a decreased length of hospital stay and appears to be safe, with no increased adverse effects. (Am J Obstet Gynecol 2002;186:861-5.)

Section snippets

Material and methods

After obtaining ethics committee approval and patient consent, 107 patients in gynecologic oncology and urogynecology at the Royal Alexandra Hospital Site in Edmonton, Alberta, Canada, were prospectively randomized with a computer-generated random number list. Patients were identified in the preadmission clinic from October 2000 through June 2001 and were randomized by the clinic nurses according to the computer assignment.

Exclusion criteria included pregnancy, postoperative intensive care unit

Results

There were 107 patients enrolled in this trial, and complete data were available for 96 patients. Seven women were excluded because of intraoperative injury of the gastrointestinal tract, and 4 patients were excluded because of self-withdrawal. There were no significant demographic differences between groups (Table I), and the types of surgical procedures performed were similar between the 2 groups (Table I).

Table II summarizes the intraoperative data collected.The operating time, type of

Comment

The results of this study strongly suggest that early postoperative dietary advancement after major abdominal gynecologic surgery results in a decreased LOHS. The results do not support the tradition of withholding oral intake after surgery because of the concern of postoperative ileus.1, 2, 3, 4, 5

Research in the area of gastrointestinal physiology and motility indicate that postoperative early feeding may be tolerated. The stomach and pancreas secrete 1 to 2 liters of fluid per day, which is

References (11)

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Reprint requests: Helen Steed, MD, Department of Obstetrics and Gynecology, CSC – 201, Royal Alexandra Hospital Site, 10240 Kingsway Ave, Edmonton, AB, Canada T5H 3V9. E-mail: [email protected]

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