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BACKGROUND: Therole of early postoperative enteral nutrition after gastrointestinal surgery iscontroversial. Traditional management consist of 'nil by mouth', where patientsreceive fluids followed by solids when tolerated. Although several trials haveimplicated lower incidence of septic complications and faster wound healingupon early enteral feeding, other trials have shown opposite results. Theimmediate advantage of caloric intake could be a faster recovery with fewercomplications, to be evaluated systematically. OBJECTIVES: To evaluate whetherearly commencement of postoperative enteral nutrition compared to traditionalmanagement (no nutritional supply) is associated with fewer complications inpatients undergoing gastrointestinal surgery SEARCH STRATEGY: We searched theCochrane Central Register of Controlled Trials, PUBMED, EMBASE, and LILACS from1979 (first RCT published) to March 2006. We manually scanned the referencesfrom the relevant articles, and consulted primary authors for additionalinformation. SELECTION CRITERIA: We looked for randomised controlled trials(RCT's) comparing early commencement of feeding (within 24 hours) with nofeeding in patients undergoing gastrointestinal surgery. Early enteralnutrition is defined as all oral intakes (i.e. registered oral intake,supplemented oral feeding) and any kind of tube feeding (gastric, duodenal orjejunal) containing caloric content. No feeding is traditional management,defined as none caloric oral intake or any kind of tube feeding before bowelfunction. The definition 'no nutrition' includes non caloric placebo and water.DATA COLLECTION AND ANALYSIS: The three authors independently assessed theidentified trials, and extracted the relevant data using a specificallydeveloped data extraction sheet. Primary end points of interest were: Woundinfections and intraabdominal abscesses, postoperative complications such asacute myocardial infarction, postoperative thrombosis or pneumonia, anastomoticleakages, mortality, length of hospital stay, and significant adverse effects.We combined data to estimate the common relative risk of postoperativecomplications, and calculated the associated 95% confidence intervals. Foranalysis, we used fixed effects model (risk ratios to summarise the treatmenteffect) whenever feasible. The treatment effect on length of stay was estimatedusing effect size (presented as mean +/- SD). Some outcomes were not analysedbut presented in a descriptive way. We used a random effects model to estimateoverall risk ratio and effect size. MAIN RESULTS: We identified thirteenrandomised controlled trials, with a total of 1173 patients, all undergoinggastrointestinal surgery.Individual clinical complications failed to reachstatistical significance, but the direction of effect indicates that earlierfeeding may reduce the risk of post surgical complications. Mortality was theonly outcome showing a significant benefit, but not necessarily associated withearly commencement of feeding, as the reported cause of death was anastomoticleakage, reoperation, and acute myocardial infarction. AUTHORS' CONCLUSIONS:Although non-significant results, there is no obvious advantage in keepingpatients 'nil by mouth' following gastrointestinal surgery, and this reviewsupport the notion on early commencement of enteral feeding.Leggil'articolo: è full text!