A comparative study between early and late oral feeding post one stage sigmoidectomy for uncomplicated sigmoid volvulus at university teaching adult hospital, Lusaka, Zambia.

Abstract

Background: Sigmoid volvulus accounts for more than 50% of colon obstruction here in Africa are usually associated with significant morbidity, and prolonged hospital stay post-operative. Traditionally, nil by mouth 4-5 days has been the practice post one stage sigmoidectomy and primary anastomosis for most surgical units at UTH for fear of anastomotic leakage, while others advocates for early oral feeding. Therefore, this study was conducted to compare outcomes between early oral feeding and late oral feeding (conventional) method post one stage sigmoidectomy and primary anastomosis for uncomplicated sigmoid volvulus. Methods: A prospective block randomized comparative study was done at UTH for ten months (May 2019-February 2020). All patients who presented with intestinal obstruction secondary to uncomplicated sigmoid volvulus post one stage sigmoidectomy, and primary anastomosis were recruited in the study. Allocations of 48 patients were block randomized to either early oral feeding group 24-48 hours or under late oral feeding group 4-5 days post-operative respectively. Reinsertion of NGT was done for patients who could not tolerate oral feeds. The discharge criteria from the hospital were the same for both groups until the patient was able to tolerate a normal diet. The research was approved by ERES CONVERGE IRB Ethics Committee. Results: Forty-eight patients were recruited in this study with the age range 22 to 72 years with the mean being 44.9±14.4 years, the majority of participants were male 47 (97.9%) except one female (2.1%), and all were black Africans. The length of hospital stay for early oral feeding was 5.833 days and 8.583 days for late oral feeding with an overall mean of 7.2±1.78 days, difference 2.75 days p-value 0.005, which was statistically significant. Majority of patients passed flatus on day one 22 (45%) day two 21 (43.6%) respectively, and it was noted that resolution of ileus was shorter in early oral feeding group, most patients opened bowels on day three 22(45.8%), about 39 (81.25%) had no abdominal distension while 9 (18.75%) had 22 (91.67%) patients under early oral feeding tolerated feeds well while 18 (75%) under late with the overall tolerability of 40 (83.33%) for both groups, 4 (8.3%) participants had surgical site infection, and all were from the late oral feeding group, there were two cases (4.2%) of anastomotic leakage all from the conventional group. Conclusion: This study demonstrated that early oral feeding post one stage sigmoidectomy and primary anastomosis for uncomplicated sigmoid volvulus is safe, tolerated by majority patients, reduced length of hospital stay significantly and no anastomotic leakage, reduced morbidity or mortality. Therefore, early oral feeding is feasible, tolerable and beneficial to patients as compared to conventional approach nil by mouth 4-5 days.