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L. Andrew Di Fronzo, MD; Judith Cymerman, MD; Theodore X. O'Connell, MD

Arch Surg. 1999;134:941-946.

Hypothesis  If factors accounting for the inability to tolerate early postoperative feeding after elective open colon resection can be identified, then perhaps these factors can be modified to decrease future failures.

Design  Consecutive case series.

Setting  Tertiary referral center.

Patients  From 1993 to 1998, 200 consecutive patients undergoing elective open colon resection.

Intervention  Early postoperative feeding protocol consisting of clear liquids on the evening of postoperative day 2, regular diet on postoperative day 3, and discharged home as tolerated. A subgroup of patients was treated with metoclopramide.

Main Outcome Measures  The ability to tolerate early feeding. Postoperative complications. Length of hospitalization.

Results  Twenty-seven (13.5%) of the 200 patients failed to tolerate early feeding. 16 patients (8.0%) were immediately unable to tolerate oral intake, whereas 11 patients (5.5%) initially tolerated early postoperative feeding but required hospital readmission due to emesis. There were no abdominal abscesses or anastomotic leaks. In patients who failed early feeding, no significant differences were noted for age, comorbid medical illness, operative time, or additional surgical procedures, when compared with patients who tolerated early oral intake. However, 18 (20.9%) of the 86 men failed early feeding, compared with 5 (6.8%) of the 73 women (P=.01). Additionally, patients undergoing total abdominal colectomy or total proctocolectomy (n=11) failed 45.5% of the time, compared with 12.2% of the patients undergoing other types of colectomy (n=189) (P=.01). The addition of metoclopramide therapy did not significantly improve the ability to tolerate early feeding.

Conclusions  In patients undergoing elective open colon resection, early postoperative feeding is safe and effective, and produces a brief hospital stay compared with patients fed by traditional means. However, men and patients undergoing total abdominal colectomy are more likely to be intolerant of early postoperative feeding.

From the Kaiser Permanente Medical Center, Los Angeles, Calif. Dr Di Fronzo is a Senior Clinical Fellow in Surgical Oncology at the John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, Calif.

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