Early vs Conventional Oral Feeding after Pancreaticoduodenectomy: A Prospective Observational Study

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive System Surgery

Background:

• Enhanced recovery after surgery (ERAS) protocols are increasingly adopted for pancreaticoduodenectomy (PD).
• Previous ERAS studies initiated oral feeding on postoperative day 1.
• This study aimed to evaluate the impact of initiating oral feeding as early as 6 hours post-surgery.

Purpose of the Study:

• To assess the feasibility and safety of initiating oral feeding (liquid and soft) at 6 hours post-pancreaticoduodenectomy.
• To compare postoperative outcomes between patients receiving early oral feeding (EOF) and conventional oral feeding (COF).

Main Methods:

• A prospective cohort of 26 patients (Group-I) received EOF starting 6 hours after PD.
• A retrospective cohort of 40 patients (Group-II) received COF starting on postoperative day 1.
• Key outcomes including time to diet advancement, nasogastric tube removal, first stool passage, and hospital stay were compared.

Main Results:

• The EOF group showed significantly shorter times to start liquid diet (0 days vs 1.5 days), soft diet (0 days vs 3.8 days), and solid diet (3.1 days vs 7.2 days) (p < 0.001).
• Earlier nasogastric tube removal (1.6 days vs 3.9 days) and reduced reinsertion rates were observed in the EOF group (p < 0.001).
• Patients in the EOF group experienced earlier first stool passage (3.7 days vs 5.9 days) and earlier cessation of intravenous fluids (3.4 days vs 5.2 days), leading to a shorter hospital stay (5.9 days vs 8.8 days) (p < 0.007).

Conclusions:

• Early oral feeding (EOF) initiated 6 hours after pancreaticoduodenectomy is feasible and safe.
• EOF significantly accelerates postoperative recovery, including diet progression and gastrointestinal function.
• This approach leads to a reduced length of hospital stay without increasing complications or mortality.