What is the protocol for advancing a diet after an appendectomy (appendix removal)?

From the Guidelines

After an appendectomy, oral nutritional intake should be continued without interruption, as recommended by the ESPEN guideline, which suggests that early feeding is safe and may promote faster recovery by stimulating bowel motility, reducing infection risk, and shortening hospital stays 1.

Key Considerations

• The ESPEN guideline recommends continuing oral nutritional intake after surgery without interruption, with a strong consensus of 90% agreement 1.
• Early oral feeding has been shown to be safe and effective in promoting faster recovery, reducing infection risk, and shortening hospital stays, as supported by multiple studies 1.
• Patients can progress to a regular diet as tolerated, usually within 1-2 days post-operation, with no need to follow a strict progression through full liquid and soft diets.
• Signs of returning bowel function include passing gas, bowel sounds on examination, and the absence of nausea or vomiting.

Recommendations

• Patients should be instructed to start with small, frequent meals and increase portion sizes gradually while staying well-hydrated.
• If nausea, vomiting, or increased pain occurs, patients should return to clear liquids temporarily before trying to advance again.
• Most patients can resume their normal diet within 3-5 days after surgery, though some may need to temporarily avoid high-fiber foods or gas-producing foods if they cause discomfort during the initial recovery period.

Evidence-Based Practice

• The ESPEN guideline provides a strong recommendation for early oral feeding after surgery, based on high-quality evidence 1.
• Multiple studies support the safety and effectiveness of early oral feeding in promoting faster recovery and reducing complications 1.
• The ERAS society recommendations also support early oral intake, with a strong recommendation grade 1.

From the Research

Protocol for Advancing a Diet after an Appendectomy

The protocol for advancing a diet after an appendectomy is a topic of interest in the field of surgery and nutrition. According to the available evidence, the traditional approach to postoperative nutrition involves a gradual progression from a clear liquid diet to a full liquid diet, and then to a soft diet before returning to regular meals 2, 3. However, recent studies suggest that this approach may not be the most effective way to promote recovery and reduce hospital stay.

Patient-Controlled Nutrition

A study published in 2018 found that patient-controlled nutrition (PCN), where patients are allowed to choose their own diet, may be a feasible and effective concept in postoperative nutrition 2. The study found that PCN was associated with a shorter time to tolerance of a regular diet and a shorter postoperative hospital stay compared to the traditional nutrition pattern.

Early Enteral Feeding

Another study published in 2011 found that early enteral feeding, which involves administering nutrients through the gut as soon as possible after surgery, may be beneficial for patients undergoing abdominal surgery 3. The study found that early enteral feeding was safe and well-tolerated, and was associated with a reduction in wound morbidity and healing, fewer septic complications, and improved protein kinetics.

Clear Liquid Diet vs. Regular Diet

A study published in 2023 found that starting a regular diet immediately after abdominal colorectal surgery was not superior to a clear liquid diet in terms of diet tolerance by postoperative day 2 4. However, the study found that significantly more patients in the clear liquid diet group tolerated their diet on postoperative day 0 compared to the regular diet group.

Nutritional Implications of Bariatric Surgery

A study published in 2007 found that anatomical changes in the gastrointestinal tract after bariatric surgery require modification of dietary patterns to adapt to new physiological conditions 5. The study found that a restrictive diet after bariatric surgery, which involves a gradual progression from clear liquids to soft foods and eventually to a normal diet, is necessary to ensure adequate nutrition and prevent complications.

Effects of Oral Probiotics

A study published in 2024 found that oral probiotics may be beneficial for patients after appendectomy, as they may modulate the inflammatory response and restore intestinal function 6. The study found that patients who received probiotics had lower levels of inflammatory markers and a shorter time to first flatus compared to those who did not receive probiotics.

• Key findings:
  • Patient-controlled nutrition may be a feasible and effective concept in postoperative nutrition 2
  • Early enteral feeding may be beneficial for patients undergoing abdominal surgery 3
  • Clear liquid diet may be tolerated better than regular diet on postoperative day 0 4
  • Restrictive diet after bariatric surgery is necessary to ensure adequate nutrition and prevent complications 5
  • Oral probiotics may be beneficial for patients after appendectomy 6