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The effect of diets delivered into the gastrointestinal tract on gut motility after colorectal surgery—a systematic review and meta-analysis of randomised controlled trials

European Journal of Clinical Nutrition volume 73, pages 1331–1342 (2019)Cite this article

Subjects

Abstract

Background/objectives

Despite best practice guidelines, feeding methods after colorectal surgery vary due to the difficulties translating evidence into practice. The aim was to determine the effectiveness of diets delivered into the gastrointestinal tract (GIT) on gut motility following colorectal surgery.

Subjects/methods

EMBASE, MEDLINE, CINAHL, Web of Science and PubMed were systematically searched. Randomised controlled trials investigating effectiveness of a diet on gut motility after colorectal surgeries were included. Outcomes included postoperative ileus, length of stay, mortality, nausea and vomiting.

Results

A total of 756 potential studies were identified; of these, 10 trials reporting on 1237 unique patients were included. There is evidence that early feeding reduces time (days) to first flatus (mean difference (MD):−0.64; 95% CI:−0.84 to −0.44) and bowel movements (MD:−0.64; 95% CI:−1.01 to −0.26), when compared to traditional postoperative fasting. Introducing solids versus the progression of fluids to solids had no effect on time (days) to first flatus (MD:0.13; 95% CI:−1.99 to 1.74) or bowel movement (MD:0.20; 95% CI:−0.50 to 0.98). Complete nutrition compared to hypocaloric nutrition had no effect on time to first flatus (MD:−0.60; 95% CI:−1.66 to 0.46) or bowel movement (MD:−0.20; 95% CI:−1.59 to 1.19), whereas coffee and diet compared to water and diet significantly decreased time (days) to first bowel movement (MD:−0.60; 95% CI:−0.97 to −0.19) but had no effect on time to first flatus (MD:−0.20; 95% CI:−0.57 to 0.09).

Conclusions

Any form of early postoperative diet provided into the GIT early after colorectal surgery is likely to stimulate gut motility, resulting in earlier return of bowel function and shorter length of stay.

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Author information

Authors and Affiliations

  1. Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Sophie Hogan, Daniel Steffens, Michael Solomon & Sharon Carey

  2. University of Sydney, Sydney, NSW, Australia

    Daniel Steffens, Anna Rangan, Michael Solomon & Sharon Carey

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Contributions

All authors made substantial contributions to conception and design of the study. SH and SC completed the review protocol, the search strategy, screening of potentially eligible studies and extracting and analysing data. SH and DS conducted the meta-regression analysis and created the ‘Summary of Findings’ tables. All authors analysed and interpreted the results. SH was a major contributor of drafting the manuscript and all other authors were involved in revising it critically for important intellectual content. All authors provided final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Sophie Hogan.

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Search Strategy

Search Strategy

EMBASE and MEDLINE via Ovid

1. (‘colorectal surgery’/exp OR ‘colorectal surgery’ OR ‘rectum’/exp OR ‘rect*’ OR ‘rect* surgery’).mp.

 

2. (‘gastrointestinal motility’/exp OR ‘gastrointestinal motility’ OR ‘recovery of function’/exp or ‘recovery of function’ OR ‘enhanced recovery’ OR ‘fast track’).mp.

 

3. (‘ileus’/exp OR ‘ileus’ OR ‘postoperative ileus’).mp.

Web of Knowledge via Web of Science

1. TOPIC: ‘colorectal surgery’ OR TITLE: ‘colorectal surgery’ OR TOPIC: ‘rect*’ OR TITLE: ‘rect*’ OR TOPIC: ‘rect* surgery’ OR TITLE: ‘rect* surgery’

 

2. TOPIC: ‘gastrointestinal motility’ OR TITLE: ‘gastrointestinal motility’ OR TOPIC: ‘recovery of function’ OR TITLE: ‘recovery of function’ OR TOPIC: ‘enhanced recovery’ OR TITLE: ‘enhanced recovery’ OR TOPIC: ‘fast track* OR TITLE: ‘fast track*’

 

3. TOPIC: ‘ileus’ OR TITLE: ‘ileus’ OR TOPIC: ‘postoperative ileus’ OR TITLE: ‘postoperative ileus’

Cinahl via Ebsco

1. ‘colorectal surgery’ OR (MH ‘rectum’) OR ‘rect*’ OR ‘rect* surgery’

 

2. (MH ‘gastrointestinal motility;) OR ‘gastrointestinal motility’ OR ‘recovery of function’ OR ‘enhanced recovery’ OR ‘fast track*’

 

3. ‘ileus’ OR ‘postoperative ileus’

PubMed https://www.ncbi.nlm.nih.gov/pubmed/

1. ‘colorectal surgery’[MeSH] OR ‘colorectal surgery’[tiab] OR ‘rectum’[MeSH] OR ‘rect*’ OR ‘rect* surgery’

 

2. ‘gastrointestinal motility’[MeSH] OR ‘gastrointestinal motility’ OR ‘recovery of function’[MeSH] OR ‘recovery of function’ OR ‘enhanced recovery’ OR ‘fast track’

 

3. ‘ileus’[MeSH] OR ‘ileus’ OR ‘postoperative ileus’

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Hogan, S., Steffens, D., Rangan, A. et al. The effect of diets delivered into the gastrointestinal tract on gut motility after colorectal surgery—a systematic review and meta-analysis of randomised controlled trials. Eur J Clin Nutr 73, 1331–1342 (2019). https://doi.org/10.1038/s41430-019-0474-1

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