Evaluation of the appropriate oral feeding time considering anastomotic leakage following gastrointestinal surgeries: a systematic review

Objectives: Anastomotic leakage, a serious complication of gastrointestinal (GI) surgery, necessitates determining the optimal time for initiating oral feeding to prevent further complications. This article aims to systematically review the influence of oral feeding time on postoperative anastomotic leakage in GI anastomosis surgeries. Methods: A comprehensive search was conducted considering preferred reporting items for systematic reviews and meta-analysis guidelines, to identify published publications reporting oral feeding time following GI anastomosis surgeries. The search spanned from the database’s creation date to the end of August 2024. Results: This systematic review analyzed 21 studies to compare the outcomes of early oral feeding (EOF) versus delayed oral feeding (DOF) in patients’ post-anastomotic surgery. Of the 19 studies evaluating anastomotic leakage rates, 13 found that EOF significantly reduced leakage, with rates ranging from 0.31% to 10%. The review also highlighted that EOF was associated with shorter hospital stays, as evidenced by 15 out of 18 studies, although 1 study showed no significant difference. In terms of CI recovery, 13 of 14 studies indicated that EOF led to earlier passage of stool or flatus. Furthermore, assessments of nausea, vomiting, and abdominal distension revealed that EOF patients experienced lower rates of vomiting and abdominal distension in three of five studies. Overall, the findings suggest that EOF may improve postoperative recovery metrics compared to delayed feeding strategies. Conclusions: Early initiation of oral feeding can reduce the incidence of postoperative complications, particularly anastomotic leakage in various GI anastomosis-containing surgeries, while also resulting in a shorter postoperative hospitalization period.