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.
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.
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).
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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|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