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POSTOPERATIVE NIL BY MOUTH – SIMPLY A SURGICAL DOGMA OR SCIENTIFICALLY SOUND PRACTICE?
Author(s) -
Ashrafi A. N.,
Pochin R.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04119_25.x
Subject(s) - medicine , randomized controlled trial , medline , ileus , evidence based medicine , perforation , cochrane library , evidence based practice , early feeding , intensive care medicine , quality of evidence , postoperative ileus , general surgery , surgery , alternative medicine , materials science , pathology , political science , law , punching , metallurgy
Purpose Traditionally, the postoperative management of patients undergoing gastrointestinal (GI) surgery has been to keep them ‘nil by mouth’ (NBM) until the postoperative ileus resolves. There is an evolving viewpoint that this practice is not based on sound evidence. This review examines the recent literature addressing this issue and aims to evaluate the role of early commencement of postoperative feeding compared to traditional NBM management. Methodology Three electronic databases (Ovid Medline, PubMed and Cochrane Reviews) were searched for randomised controlled trials (RCTs), reviews or meta‐analyses. Key words used included ‘nil by mouth’, ‘postoperative feeding’, and ‘early feeding’. Reference lists were crosschecked for additional studies. Results and Conclusions The practice of mandatory postoperative starvation and bowel rest is not supported by evidence. There is evidence from several RCTs that early postoperative feeding in patients is safe and tolerable. Some studies have shown that early feeding is beneficial in terms of postoperative complications, ileus and hospital stay. Although most of the literature is on colon surgery, similar evidence also exists for gut perforation and upper GI surgery with a trend towards reduced hospital stay and postoperative complications. In summary, this review identifies an important disparity between common clinical practice in New Zealand and evidence from several small RCTs. There does not appear to be any obvious clinical benefit in keeping patients NBM following GI surgery. The authors suggest that patients and the surgical community alike would benefit from a large scale, high quality, high‐powered RCT to address this issue definitively.