Our data should encourage people to question current practice

Dr Steven Thomas

The gut is naturally paralysed for several hours after it is manipulated during surgery.

Post-operative infection of damaged tissues can be fatal.

However, there is no evidence that bowel rest and a period of starvation aid the healing process.

In fact, some doctors now think that the presence of a small amount of food may help to increase the strength of the tissues.

Researchers compared patients who were denied food with those who were fed within 24 hours of surgery.

Shortened stay

Not only was there little evidence that keeping patients nil by mouth is beneficial after surgery, but early feeding reduced the risk of infection and shortened hospital stay.

Lead researcher Dr Steven Thomas, of the University of Bristol, told BBC News Online: "It has been common practice to slowly reintroduce food as the gut starts working again, but this research shows that perhaps this conservative approach is not really necessary.

"Experimental data suggests feeding into the gut may improve wound healing and stimulate the gut by producing local effects in the gut and more generally in the rest of the body.

"Our data should encourage people to question current practice."

Dr Thomas said a larger clinical trial was needed before it could be determine whether current practice should be changed.

Compelling argument

His view was reflected in an accompanying BMJ editorial, in which two eminent gastroenterologists argue that the findings provide compelling arguments in favour of a change of clinical practice.

Mr David Silk and Mr Neil Menzies Gow, both based at the Central Middlesex Hospital, back calls for further a follow-up trial to test the results.

Professor John Primrose, chairman of the British Society of Gastroenterology's surgical committee, told BBC News Online that studies conducted in his own unit at Southampton General Hospital had shown that patients who had undergone surgery on their liver and pancreas could be fed by tube almost immediately after their operations without ill effect.

He said: "Currently our most ill patients on intensive care are given tube feeding immediately after operation because of the theoretical advantages shown I presume in the BMJ article.

"The problem is that the studies to date are now large enough to prove that enteral (tube) feeding saves life, although it may."

However, Professor Primrose said only seriously ill patients were likely to derive substantial benefit from tube feeding.

"Many intensive care units do this already without conclusive proof that it works."