• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of bmjBMJ helping doctors make better decisionsSearch bmj.comLatest content
BMJ. Apr 6, 1996; 312(7035): 869–871.
PMCID: PMC2350561

Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection.


OBJECTIVES: To assess whether immediate post-operative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective. DESIGN: Randomised trial of immediate post-operative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the reintroduction of normal diet. SETTING: Teaching hospitals in London. SUBJECTS: 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent, chronic gastrointestinal disease. Two patients did not proceed to resection. MAIN OUTCOME MEASURES: Nutritional state, nutritional intake and nitrogen balance, gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test, complications, and outcome. RESULTS: Successful immediate enteral feeding was established in all 14 patients with a mean (SD) daily intake of 6.78 (1.57)MJ (1622 (375) kcal before reintroduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P < 0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients (mean (SD) - 13.2 (11.6) g v 5.3 (2.7) g; P < 0.005). There was no difference by day 5. There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids (0.11(0.06) v 0.15 (0.12); P < 0.005). There were also fewer postoperative complications in the enterally fed group (P < 0.005). CONCLUSIONS: Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (647K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Fong YM, Marano MA, Barber A, He W, Moldawer LL, Bushman ED, Coyle SM, Shires GT, Lowry SF. Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans. Ann Surg. 1989 Oct;210(4):449–457. [PMC free article] [PubMed]
  • 2nd International Conference on Sepsis in the ICU. Maastricht, The Netherlands, 27-29 June, 1995. Abstracts. Clin Intensive Care. 1995;6(3 Suppl):1–22. [PubMed]
  • Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med. 1991 Aug 22;325(8):525–532. [PubMed]
  • Kappers-Klunne MC, Degener JE, Stijnen T, Abels J. Complications from long-term indwelling central venous catheters in hematologic patients with special reference to infection. Cancer. 1989 Oct 15;64(8):1747–1752. [PubMed]
  • Catchpole BN. Smooth muscle and the surgeon. Aust N Z J Surg. 1989 Mar;59(3):199–208. [PubMed]
  • Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma--a prospective, randomized study. J Trauma. 1986 Oct;26(10):874–881. [PubMed]
  • Ziegler TR, Smith RJ, O'Dwyer ST, Demling RH, Wilmore DW. Increased intestinal permeability associated with infection in burn patients. Arch Surg. 1988 Nov;123(11):1313–1319. [PubMed]
  • Chiarelli A, Enzi G, Casadei A, Baggio B, Valerio A, Mazzoleni F. Very early nutrition supplementation in burned patients. Am J Clin Nutr. 1990 Jun;51(6):1035–1039. [PubMed]
  • Schroeder D, Gillanders L, Mahr K, Hill GL. Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. JPEN J Parenter Enteral Nutr. 1991 Jul-Aug;15(4):376–383. [PubMed]
  • Elebute EA, Stoner HB. The grading of sepsis. Br J Surg. 1983 Jan;70(1):29–31. [PubMed]
  • Webb AR, Newman LA, Taylor M, Keogh JB. Hand grip dynamometry as a predictor of postoperative complications reappraisal using age standardized grip strengths. JPEN J Parenter Enteral Nutr. 1989 Jan-Feb;13(1):30–33. [PubMed]
  • Harris CE, Griffiths RD, Freestone N, Billington D, Atherton ST, Macmillan RR. Intestinal permeability in the critically ill. Intensive Care Med. 1992;18(1):38–41. [PubMed]
  • Roumen RM, van der Vliet JA, Wevers RA, Goris RJ. Intestinal permeability is increased after major vascular surgery. J Vasc Surg. 1993 Apr;17(4):734–737. [PubMed]
  • O'Dwyer ST, Michie HR, Ziegler TR, Revhaug A, Smith RJ, Wilmore DW. A single dose of endotoxin increases intestinal permeability in healthy humans. Arch Surg. 1988 Dec;123(12):1459–1464. [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...