Study on the Role and Timing of Postoperative Oral Feeding Following Intestinal Anastomosis in Infants

Objective To investigate the effect of the timing of postoperative oral feeding on the postoperative recovery of infants undergoing intestinal anastomosis. Methods A retrospective analysis was conducted on the clinical data of 701 pediatric patients who underwent intestinal anastomosis in the Children’s Hospital of Nanjing Medical University from May 2018 to January 2026. The subjects were categorized into four groups based on disease type: the primary anastomosis group (n = 132, including intestinal stenosis, Meckel’s diverticulum, intestinal duplication, and intestinal atresia), the secondary anastomosis group (n = 243, comprising various stoma closures excluding those for imperforate anus), the tertiary anastomosis group (n = 102, representing stage III stoma closure for imperforate anus), and the biliary surgery group (n = 224, including choledochal cyst and biliary atresia). Clinical variables collected included surgical procedure, time to initiation of postoperative oral feeding, body weight at surgery, preoperative nutritional indicators (e.g., serum albumin), time to first postoperative enteral nutrition (feeding initiation), total length of hospital stay, incidence of postoperative feeding intolerance (e.g., vomiting, abdominal distension), and gastrointestinal decompression drainage volume from postoperative days 1 to 7. SPSS statistical software was utilized for correlation and survival analyses to evaluate the impact of the timing of feeding initiation on postoperative recovery outcomes. Results The overall average time to first postoperative enteral feeding for the 701 cases in the total sample was 68.36 ± 35.06h. The primary anastomosis group (92.04 ± 41.50h) and the secondary anastomosis group (86.12 ± 31.94h) were significantly later than the tertiary anastomosis group (45.31 ± 11.54h) and the biliary surgery group (45.63 ± 15.54h). Surgical weight was significantly negatively correlated with the postoperative time to feeding initiation (r = -0.387, P < 0.001), as were preoperative albumin levels (overall r = -0.751, P < 0.001) ; moreover, intestinal anastomoses spanning multiple segments were associated with later feeding initiation, while simple high-position or ultra-low-position anastomoses allowed for earlier feeding. A significant positive correlation was observed between the time to first postoperative feeding and the length of hospital stay (r = 0.559, P < 0.001), and the overall incidence of postoperative feeding intolerance was 1.57% (11/701). Statistical analysis of gastrointestinal decompression drainage volume from postoperative days 1 to 7 showed that the tertiary anastomosis and biliary surgery groups peaked on day 2 and showed a significant decline on day 3, whereas the primary and secondary anastomosis groups peaked on day 3 and experienced a precipitous drop on day 4. Conclusion Early enteral nutrition after gastrointestinal surgery in infants is safe and feasible. It is recommended to initiate feeding 24–48 hours postoperatively for tertiary anastomosis and biliary surgery, whereas for complex primary and secondary anastomoses, feeding should ideally commence at 72–96 hours postoperatively. Implementing individualized and proactive feeding strategies in clinical practice is suggested to accelerate patient recovery.