From the Guidelines
Feeding should be initiated within 24 hours after small bowel resection, as recommended by the ESPEN guideline 1. This approach is supported by the most recent and highest quality study, which emphasizes the importance of early enteral nutrition in promoting intestinal adaptation, stimulating blood flow to the remaining bowel, maintaining gut barrier function, and reducing the risk of bacterial translocation 1. Some key points to consider when initiating feeding after small bowel resection include:
- Starting with clear liquids and advancing to a regular diet as tolerated, guided by the patient's clinical response 1
- Using trophic enteral nutrition at 10-20 mL/hour via a feeding tube for patients with extensive resections or high-risk anastomoses, and gradually increasing as tolerated 1
- Monitoring for signs of feeding intolerance, such as abdominal distension, vomiting, or increased nasogastric tube output, which may necessitate temporary reduction or cessation of feeds 1
- Considering parenteral nutrition only if enteral feeding is not feasible or tolerated after several attempts, as enteral nutrition is generally preferred for its physiological benefits and fewer complications 1. It is also important to note that early feeding can help prevent mucosal atrophy and preserve the gut microbiome 1. Overall, the key is to initiate feeding early, while also being mindful of the patient's individual tolerance and clinical response 1.
From the Research
Timing of Feeds after Small Bowel Resection
- The optimal timing for starting feeds after small bowel resection is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 3 mentions that the median time to resume oral intake was 3 days (range, 1-7 days) after single-incision laparoscopic-assisted surgery for small bowel obstruction.
- Study 4 does not provide specific information on the timing of feeds after small bowel resection, but it discusses the laparoscopic management of acute small bowel obstruction and the need for resection.
- Study 2 reports that patients who underwent near total enterectomy were discharged on full total parenteral nutrition infused over a 10- to 16-hour period, but it does not specify when oral feeds were started.
- Studies 5 and 6 do not provide relevant information on the timing of feeds after small bowel resection, as they focus on the incidence of short bowel syndrome after Roux-en-Y gastric bypass and the clinical presentation, diagnosis, and treatment of small bowel obstruction, respectively.
Factors Influencing Feeding Decisions
- The decision to start feeds after small bowel resection may depend on various factors, including the extent of resection, the patient's overall health, and the presence of complications 2, 3, 4.
- Study 6 highlights the importance of early diagnosis and aggressive medical therapy, including rehydration, antibiotics, and nil per os, in the management of small bowel obstruction.
- The timing of feeds may also be influenced by the surgical approach used, such as laparoscopic or open surgery 3, 4.