Nasogastric tubes and dietary advancement after laparoscopic and open colorectal surgery

Historically, all patients having abdominal procedures routinely awoke with a nasogastric tube, which remained until the resolution of the postoperative ileus as defined by the passage of flatus or feces per rectum. Dietary advancement was accomplished in a stepwise fashion, starting with clear liquids, progressing to full liquids, and finally a regular diet. Recently, the postoperative nutritional management of elective colorectal surgical patients has undergone several modifications and advancements. With the advent of the laparoscopic technique, attention was focused on the reported benefits of decreased postoperative pain, length of ileus, and consequently faster return to tolerance of diet. Surgeons then began to wonder if these benefits were really unique to laparoscopic surgery, or if laparotomy patients were merely treated differently than laparoscopy patients during the postoperative course. The next logical question was whether, after laparotomy, patients could be treated in the same manner as laparoscopic patients and enjoy the same postoperative benefits. The avoidance of a nasogastric tube and hence the subsequent rapid advancement of diet may shorten the length of hospitalization.