بررسی اثر تغذیه زودرس بر علائم گوارشی بیماران تحت اعمال جراحی سزارین و هیسترکتومی

Traditionally, surgeons believe that patients should receive a physician-dieted regimen for gradual expansion of their diets following major gynecologic surgeries including cesarean section and hysterectomy. Nowadays, based on clinical trials, this belife is under serious questions. Some studies have specially shown that early oral feeding is safe and additionally reduces cost and hospital stay in gastrointestinal and colorectal surgeries. However, there is upset about the probable ileus after early oral feeding. The objective of the present study was to compare gastrointestinal symptoms and tolerance to early oral feeding after cesarean section and hysterectomy. By a randomized controlled trial, 122 women under cesarean section and/or hysterectomy were studied in gynecology department of Firoozgar Hospital during 7 months. They were randomly allocated to two groups of early(60 subject), and late(62 subject) oral feeding. Subjects in early oral feeding group, received clear liquid diet within 6 hours of delivery or operation. Once 500cc was tolerated, a regular diet was given. The same protocol during 12 to 24 hours after surgery was given to late group. Exclusion criteria were: history of malignancy, bowel obstruction or inflammatory bowel disease and current or previous surgeries with extensive lysis or adhesion of the bowel. Patients were evaluated on a daily basis for bowel sounds, flatus, bowel movement, hunger, nausea, and vomiting. Two groups were compared in terms of hospital stay, nausea and vomiting and post surgery complications. T-test, chi-square, and Fisher’s exact tests were used for analyzing data. The demographic characteristics of two groups were similar statistically. There was not any significant difference between groups with regard to hospital stay, and mild ileus incidence. There was more nausea and vomiting proportion in early oral feeding group than that of late group (40% versus 19%). On average, regular regimen is tolerated 4 hours earlier in early oral feeding group than late group (20.9 versus 24 hour), and this difference was statistically significant. Early oral feeding group were earlier in first bowel movement, first post operation flatus and defecation, although these differences were not statistically significant. In conclusion, early oral feeding after cesarean delivery and abdominal hysterectomy is tolerated earlier with a more rapid return to a normal diet and bowel habit.