Evaluate the effect of Early vs Standard Enteral Feeding in cases of small and large bowel surgeries

A prospective interventional case control study will be conducted for 64 patients of small and large bowel surgeries in a tertiary care centre in central India.

The patients will be randomised alternatively in each group.

In control group patients, Standard enteral feeding will not be started until resolution of postoperative ileus i.e. until the appearance of bowel sounds on auscultation and passage of flatus, then followed by clear liquid diet, followed by regular diet.

In cases group patients, Early enteral feeding will be started within 12-24 hours after surgery at the rate of 20-50 ml/hour until the first postoperative morning, starting with sips of water, oral rehydration solution, orange juice, tea and fat free milk, advance to regular diet within the next 24 - 48 hours, and increase as tolerated to the target rate on 2nd and 3rd postoperative day.

Intolerance to feeding (usually abdominal distension and vomiting) to be managed by decreasing and discontinuing feeding as required for few hours until clinical resolution.

All the patients are to be monitored clinically and investigations (lab investigations and radiological studies) are to be sent accordingly for vomiting, abdominal distension, length of ileus, tolerance to regular diet, length of hospitalisation, septic complications like pneumonia (fever, leukocytosis, purulent sputum, new pulmonary infiltrates), intra-abdominal abscess, empyema, line sepsis, necrotising fasciitis and wound infection associated with wound dehiscence are considered, diarrhoea i.e. unformed, watery stool occurring for more than 3-4 times for a period of 24 hours.

The timing of enteral feeding post-bowel surgery is crucial due to potential impacts on healing, complications, and patient outcomes. Early enteral feeding aims to maintain gut integrity, reduce inflammation, and prevent complications like ileus. Delayed enteral feeding may be considered to mitigate potential risks, balancing the benefits of early nutrition with individual patient factors and surgical considerations. The rationale involves optimising recovery while minimising postoperative complications. These parameters are taken into consideration along with certain important things like propped up position feeding and feeding tolerated or not.