What We Know: Postoperative feeding after gynecologic surgery: Early vs. traditional approach

March 1, 2009

Despite conventional wisdom, you can tell patients that they can safely eat and drink after major abdominal surgery, but warn them that they may experience some nausea.

Traditionally, both surgeons and gynecologists have withheld postoperative oral intake until bowel function has returned, as evidenced by active bowel sounds or passage of flatus. It is a common belief that intestinal stasis or at least a temporary inhibition of bowel function occurs with major abdominal surgeries, and in the past we've been worried that early oral intake might cause vomiting, severe paralytic ileus with subsequent aspiration pneumonia, wound dehiscence and potential anastamotic breakdown.1 But the scientific evidence to support this concern is not convincing.

More recent studies have refuted the practice of delayed postoperative feeding. It has been shown that gastric emptying and small intestine absorptive capacity resume on the first postoperative day, while colonic contractive activity returns within 48 hours.2-4 These data indicate that the concept of postoperative ileus as paralysis of the entire bowel with complete absence of functional contractile activity is misleading.5 In addition, the stomach secretes 1 to 2 L of fluid each day that are absorbed by the small intestine.6 This implies that postoperative patients who are not eating are still tolerating high volumes of fluid. Reviews of both general surgical patients and patients undergoing cesarean delivery indicate that early oral intake is safe and doesn't cause complications.7-9

After reviewing the recent literature, you can tell the patient that she may safely eat and drink but she may experience nausea. She should also know that early feeding may shorten her hospital stay. In short, the decision on when to feed postoperative patients should be individualized.12

DR. MARTIN is a Fellow in Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.

REFERENCES

1. Fanning J, Andrews S. Early postoperative feeding after major gynecologic surgery: evidence-based scientific medicine. Am J Obstet Gynecol. 2001;185:1-4.

2. Wells C, Tinckler LF, Rawlinson K, et al. Post-operative gastrointestinal motility. Lancet. 1964;1:4-10.

3. Wilson JP. Post-operative motility of the large intestine in man. Gut. 1975;16:689-692.

4. Woods JH, Erickson LW, Condon RE, et al. Post-operative ileus: a colonic problem? Surgery. 1978;84:527-533.

5. Pearl ML, Valea FA, Fischer M, et al. A randomized controlled trial of early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery. Obstet Gynecol. 1998;92:94-97.

6. Bufo AJ, Feldman S, Daniels GA, et al. Early postoperative feeding. Dis Colon Rectum. 1994;37:1260-1265.

7. Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg. 1995;222:73-77.

8. Singh G, Ram RP, Khanna SK. Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. J Am Coll Surg. 1998;187:142-146.

9. Mangesi L, Hofmeyer GJ. Early compared with delayed oral fluids and food after cesarean section. Cochrane Database Syst Rev. 2003, (3):CD003516.

10. Amatyakul P, Suprasert P. Length of hospital stay after major gynecologic operation: a comparison between traditional and early oral feeding. Dissertation thesis for the diploma in Obstetrics and Gynecology. The Royal Thai College of Obstetricians and Gynecologists, 2001.

11. Steed HL, Capstick V, Flood C, et al. A randomized control trial of early versus "traditional" postoperative oral intake after major gynecologic surgery. Am J Obstet Gynecol. 2002;186:861-865.

12. Charoenkwan K, Phillipson G, Vutyavanich T. Early versus delayed (traditional) oral fluids and food for reducing complications after major abdominal gynaecologic surgery. Cochrane Database Syst Rev. 2007;(4):CD004508.