Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial

Area of Science:

• Surgical Nutrition
• Enhanced Recovery After Surgery (ERAS) protocols
• Gastrointestinal Surgery

Background:

• Surgery triggers a catabolic state, characterized by stress hormone release and insulin resistance.
• Optimizing perioperative nutrition is crucial for mitigating surgical stress and improving patient recovery.
• Pre-operative fasting is a traditional practice, but its impact on recovery is increasingly debated.

Purpose of the Study:

• To evaluate the impact of pre-operative oral carbohydrate administration on key recovery markers.
• To assess effects on postoperative grip strength, gastrointestinal function, and hospital length of stay.
• To compare outcomes between carbohydrate loading, water intake, and traditional fasting.

Main Methods:

• Randomized controlled trial involving 36 patients undergoing elective colonic resection.
• Three groups: fasting, pre-operative water, and pre-operative Maltodextrin drink.
• Measured time to first flatus, first bowel movement, hospital stay, and grip strength dynamically.

Main Results:

• Carbohydrate group had significantly shorter hospital stays (7.5 days) vs. water (13 days) and fasted (10 days) groups.
• Earlier return of bowel function observed in the carbohydrate group (first flatus 1.5 days vs. 3 days).
• Carbohydrate and water groups maintained grip strength, unlike the fasted group which showed a significant reduction.

Conclusions:

• Pre-operative oral carbohydrate administration significantly reduces postoperative hospital stay.
• A trend towards earlier return of gastrointestinal function is observed with carbohydrate loading.
• This nutritional strategy offers benefits over traditional fasting or water intake for colorectal surgery patients.