J.Jpn. Surg. Soc.. 111(1): 13-17, 2010

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Feature topic

A NEW CONCEPT OF THE POSTOPERATIVE ORAL FEEDING REGIMEN AFTER UPPER GASTROINTESTINAL SURGERY IN THE LAPAROSCOPIC ERA

"Nil by mouth" after abdominal surgery has well been accepted by gastrointestinal surgeons for many years. The tradition was that when patients passed flatus, they were ready to consume a liquid diet, and then a solid food diet was gradually introduced. This approach was taken to avoid aspiration, gastric and intestinal distension, and anastomotic dehiscence. Although studies demonstrated that the conventional strict feeding regimens were not necessary, many surgeons, especially upper gastrointestinal surgeons, still hesitated to allow early oral feeding. However, after the introduction of laparoscopic surgery, early feeding became more common as it was claimed that laparoscopic surgery reduced the occurrence of postoperative ileus and made the early initiation of an oral diet possible. Influenced by this, many surgeons now permit early oral feeding after open surgery with equal success. At present, an early postoperative oral diet has become more the standard of care in those undergoing major gynecologic and colorectal surgery. Although it is supported by few randomized clinical trials, it is assumed that early or immediate oral feeding is equally safe or even superior after upper gastrointestinal procedures such as hepatectomy and gastrectomy. Patient-controlled feeding in which patients consume food according to their preference even in the early postoperative period is another concept that appears promising.

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