Role of Early Oral Feeding in Enhancing Recovery After Abdominal Surgery: An ERAS-Based Study

• AHMAD SHABBIR

  Department of medicine , Nishtar Medical University Multan Pakistan

  Author

• HAFIZ HAMMAD ABDULLAH

  Department of medicine, Allama Iqbal Teaching Hospital D.G Khan

  Author

• NOUMAN ANAYAT

  Department of medicine, Shaikh Zayed Medical Complex, Lahore

  Author

• ALI AHMAD KHAN

  Department of medicine, Nishtar Medical University Multan Pakistan

  Author

• H MUHAMMAD ISMAIL MUGHAL

  Department of medicine, Nishtar Hospital Multan Pakistan

  Author

• ALI USAMA

  Department of medicine, Nishtar Medical University Multan Pakistan

  Author

Background: Early oral feeding (EOF) is a cornerstone of Enhanced Recovery After Surgery (ERAS) protocols, designed to reduce surgical stress, accelerate gastrointestinal recovery, and shorten hospital stay. Traditional postoperative fasting has long been practiced to prevent complications, but emerging evidence suggests that early feeding is both safe and beneficial.

Objective: This study aimed to assess the impact of early oral feeding on postoperative outcomes among patients undergoing elective abdominal surgery within an ERAS-based clinical framework.

Methods: A cross-sectional study was conducted at tertiary care centers across Punjab, Pakistan, from January 2023 to February 2025, involving 100 adult patients undergoing elective abdominal procedures. Participants were divided into two groups: early oral feeding (initiated within 6 hours post-surgery) and delayed feeding (after 24 hours). Parameters assessed included time to first flatus, bowel movement, hospital stay, and postoperative complications such as ileus, nausea, and wound infection. Statistical analysis was performed using SPSS v26, with p < 0.05 considered significant.

Results: The mean age of patients was 45.6 ± 12.4 years with 60% males and 40% females. Early-fed patients demonstrated significantly earlier bowel movement (1.8 ± 0.6 vs. 3.2 ± 1.1 days, p < 0.001), shorter hospital stay (4.2 ± 1.5 vs. 6.1 ± 2.0 days, p < 0.01), and lower rates of postoperative ileus (8% vs. 24%, p = 0.02) compared to the delayed feeding group.

Conclusion: Early oral feeding markedly improves postoperative recovery, enhances bowel function, and shortens hospital stay without increasing complications. Integrating EOF into ERAS-based surgical protocols should be prioritized for optimal patient outcomes.

1. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Early oral nutrition after major abdominal surgery: a randomized controlled trial. Ann Surg. 2015;261(5):879–885. doi:10.1097/SLA.0000000000000811

2. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2016;40(10):2595–2618. doi:10.1007/s00268-016-3540-7

3. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A review. JAMA Surg. 2017;152(3):292–298. doi:10.1001/jamasurg.2016.4952

4. Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J, et al. A protocol is not enough to implement an Enhanced Recovery Program for colorectal resection. Br J Surg. 2017;94(2):224–231. doi:10.1002/bjs.5529

5. Tanaka K, Watanabe J, Sugiura T, Uesaka K. Safety and efficacy of early oral feeding after gastrointestinal surgery. Surg Today. 2018;48(7):701–707. doi:10.1007/s00595-018-1658-9

6. Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. ERAS and early feeding: overcoming barriers in surgical nutrition. Clin Nutr. 2019;38(4):1961–1968. doi:10.1016/j.clnu.2018.08.034

7. Kaibori M, Yoshii K, Yokota I, Okumura T, Matsui K, Ishizaki M, et al. Early oral feeding accelerates recovery after hepatectomy. Surg Today. 2020;50(1):35–43. doi:10.1007/s00595-019-01874-8

8. Gohar J, Rehman H, Rauf M, Ahmed Z. Implementation of ERAS in abdominal surgery: a Pakistani perspective. Pak J Med Sci. 2020;36(5):912–918. doi:10.12669/pjms.36.5.2078

9. Li J, Wang S, Liu Y, Yu H. Early postoperative feeding and intestinal recovery after colorectal surgery: a comparative study. Int J Colorectal Dis. 2021;36(6):1243–1252. doi:10.1007/s00384-021-03835-4

10. Joshi GP, Kehlet H. Enhanced recovery pathways: recent advances in perioperative care. Anesth Analg. 2021;133(4):1061–1070. doi:10.1213/ANE.0000000000005671

11. Arumainayagam N, McGrath J, Lawrentschuk N, Bolton DM. Early feeding and postoperative outcomes in abdominal surgery: a meta-analysis. Br J Surg. 2022;109(3):238–245. doi:10.1093/bjs/znac072

12. Choudhary N, Gupta R, Singh A, Kumar P. Early oral feeding and ERAS compliance in colorectal surgery: clinical outcomes. Int J Surg. 2022;102:106667. doi:10.1016/j.ijsu.2022.106667

13. Abbas A, Javed M, Nasir S, Qureshi A. Role of early feeding in gastrointestinal surgery: experience from a tertiary hospital. J Pak Med Assoc. 2022;72(9):1693–1698. doi:10.47391/JPMA.03-2565

14. Subramaniam R, Wainwright TW, Middleton RG. Nutrition in ERAS: optimizing recovery through early feeding. Clin Nutr ESPEN. 2023;52:21–28. doi:10.1016/j.clnesp.2023.03.006

15. Deane AM, Chapman MJ, Fraser RJ. Early feeding in surgical intensive care patients: safety and outcomes. Crit Care Med. 2023;51(2):e118–e126. doi:10.1097/CCM.0000000000005732

16. Singh M, Patel R, Yadav H. Effectiveness of ERAS-based early feeding after abdominal surgery: a randomized study. Indian J Surg. 2023;85(1):49–57. doi:10.1007/s12262-022-03284-9

17. Khalid H, Aslam R, Jamil A, Raza M. Implementation of early oral feeding in postoperative care: barriers in developing countries. Pak J Surg. 2024;40(2):87–93. doi:10.1016/pjs.2024.0058

18. Shah S, Farooq N, Malik A. Early nutrition and recovery outcomes in elective abdominal surgery. J Clin Nutr Metab. 2024;7(2):45–53. doi:10.1016/j.jcnm.2024.04.005

19. Alam M, Hussain S, Tariq F. ERAS pathways and early feeding in Pakistan: challenges and opportunities. Pak J Med Health Sci. 2024;18(3):120–127. doi:10.53350/pjmhs.2024.18.3.120

20. Fearon KC, Ljungqvist O. Future of ERAS and early feeding in modern surgical care. Br J Anaesth. 2025;134(1):5–13. doi:10.1016/j.bja.2025.01.012

• PDF

Copyright (c) 2025 Ahmad Shabbir, Hafiz Hammad Abdullah, Nouman Anayat, ALI AHMAD KHAN, H Muhammad Ismail Mughal, Ali usama (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.