Early versus delayed enteral nutrition after gastrointestinal anastomosis in children: A Systematic Review and Meta-Analysis

Abstract

lective intestinal anastomosis is a frequently used surgical procedure in pediatric surgery. This option is used to restore intestinal continuity (ileostomy or colostomy closure), resolve an inflammatory disease or functional or anatomic congenital malformation. Postoperative starvation until the resumption of bowel activity has been the traditional care model after GI anastomosis. The justification for this has been the need to overcome postoperative ileus and to provide rest to the bowel for secure anastomotic healing. The usual period of postoperative fasting was 3-5 days. Over the last two decades significant changes have occurred in the perioperative management of adult patients undergoing elective intestinal surgery, but similar changes have not yet been defined as new guidelines in pediatric patients undergoing operative intestinal procedures. There are a lot of justified reasons to believe that it is functionally possible to begin early feeding (EF), before the postoperative (POP) day 5 in this setting: 1) Clinical and electrophysiological studies have shown that the small bowel recovers normal function within 4 - 8 hours of laparotomy and the colon within 24 hours; 2) The electrolytic, glucose and nutrient absorption ability of the bowel is not affected after a