Early enteral feeding by naso-enteric tube in patients with perforation peritonitis

Background: This study was conducted to assess the feasibility, benefits and complications of early naso-enteral feeding in a patient undergone laparotomy for perforation peritonitis. Methods: This is a randomized prospective study of one year duration. Patients were randomly put into Test Group (TG) and Control Group (CG). In test group naso-enteric tube was placed intra-operatively by nasal route and advances to duodenum or jejunum. This tube was used for feeding. Another ryles tube was also placed through other nostril in stomach (naso-gastric) for decompression. In post-operative period test group was started early enteral feeding (24 hours after surgery) via naso-enteral tube placed intra-operatively. Control group patients were managed with the conventional regimen of intravenous fluid administration and started oral feed once they passed flatus. The groups were compared for incidence of complications, biochemical measurements, nutritional status, duration of hospital stay and mortality. Results: Thirty-seven (80.43%) patients well tolerated early naso-enteral feeding. In test group average time for appearance of bowel sounds, passage of flatus and passage of motion was 2.28 ± 0.68 days, 2.78 ± 0.59 days and 3.52 ± 0.69 days respectively while in control group it was 2.73 ± 1.06 days, 3.30 ± 1.40 days and 4.18 ± 1.74 days respectively. The difference was significant between two groups (P <0.05). In our study, three (6.5%) patients had wound infection in test group while it is six (13.63%) in control group. Average hospital stay in test group was 8.54 ± 2.91 days while it was11.10 ± 3.40 days in control group (P <0.05). Average Ryles tube aspirate was significantly lower in post-operative days in test group patients as compared to control group (P <0.05). Average protein and calorie intake post-operatively was comparatively higher in test group as compare to control group patients and was found significant (P <0.05). Conclusions: Early post-operative naso-enteral feeding (24 hours after surgery) after laparotomy for perforation peritonitis is well tolerated, safe, effective in decreases septicemic and other complications and improved wound healing, leading to shorter hospital stay and beneficial to patients.