Although fast track protocols for elective lower gastrointestinal tract surgery commonly include an early feeding component, the most recent meta-analyses looking at studies in this area have failed to show a conclusive improvement in patient outcomes (2). However, this and previous analyses have pooled the assessment of protein-containing and non-protein liquid diets. This recently published meta-analysis by Pu et al. (1), which examined outcomes after an early oral protein-containing diet, suggests that current guidelines should be upgraded to a grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults.
(1) Pu, Hong, Philippa T. Heighes, Fiona Simpson, Yaoli Wang, Zeping Liang, Paul Wischmeyer, Thomas J. Hugh, and Gordon S. Doig. 2021. “Early Oral Protein-Containing Diets Following Elective Lower Gastrointestinal Tract Surgery in Adults: A Meta-Analysis of Randomized Clinical Trials.” Perioperative Medicine (London, England) 10 (1): 10. https://doi.org/10.1186/s13741-021-00179-3.
(2) Herbert, Georgia, Rachel Perry, Henning Keinke Andersen, Charlotte Atkinson, Christopher Penfold, Stephen J. Lewis, Andrew R. Ness, and Steven Thomas. 2019. “Early Enteral Nutrition within 24 Hours of Lower Gastrointestinal Surgery versus Later Commencement for Length of Hospital Stay and Postoperative Complications.” Cochrane Database of Systematic Reviews 7 (July): CD004080. https://doi.org/10.1002/14651858.CD004080.pub4.