T. Junghans

Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow?

BACKGROUNDnBecause of the well-known negative effects of carbon dioxide pneumoperitoneum on the hemodynamic and respiratory system, it was questionable how pneumoperitoneum may affect hepatic and renal blood flow. Therefore the influences of different gases, different intraperitoneal pressures, and different body positions on hepatic and renal blood flow were investigated in a porcine model.nnnMETHODSnCardiac and hemodynamic function were monitored by means of implanted catheters in the pulmonary artery and the femoral vein and artery. Renal and hepatic blood flow were recorded with a transonic volume flow meter placed at the renal and hepatic arteries and the portal vein. Eighteen animals were randomly assigned to receive one of three insufflation gases (carbon dioxide [CO2], argon, or helium. After baseline recording, one of three intraperitoneal pressures (8, 12, or 16 mm Hg) and one of three body positions (supine head up, or head down) were randomly chosen. After an adaptation time of 15 minutes, all data were recorded for 15 minutes. This was repeated until all nine combinations had been investigated. The end points of the study were blood flow in the hepatic and renal arteries and the portal vein, cardial output, systemic vascular resistance, and central venous pressure.nnnRESULTSnTotal liver blood flow was reduced on relation to intraabdominal pressure, head-up position, and argon insufflation. Arterial hepatic blood flow was reduced by the head-up position and argon insufflation. Portal venous blood flow decreased with the pig in the head-up position, with increased intraabdominal pressure, and argon insufflation. Renal blood flow was reduced by the head-up position and increased pressure. There was no correlation (p < 0.6) between systemic hemodynamic parameters (cardiac output, central venous pressure, and systemic vascular resistance) and hepatic and renal blood flow.nnnCONCLUSIONSnHead-up position and intraperitoneal pressure greater than 12 mm Hg should be avoided during laparoscopic surgery because they compromise hepatic and renal blood flow. Argon insufflation impairs liver blood flow. However, helium may be advantageous compared with CO2 insufflation.

["Fast-track" colonic surgery-first experience with a clinical procedure for accelerating postoperative recovery].

ZusammenfassungEinleitungDie Rate allgemeiner Komplikationen nach elektiven Kolonresektionen und „traditioneller“ perioperativer Therapie soll durch multimodale perioperative Behandlungskonzepte reduziert werden und eine Entlassung innerhalb weniger Tage nach der Operation ermöglichen.Material und MethodenIn einer prospektiven Untersuchung wurde ein perioperatives Behandlungskonzept zur Beschleunigung der postoperativen Rekonvaleszenz („Fast-track-Programm“) mit thorakaler kombinierter Periduralanalgesie, forcierter Mobilisation und raschem Kostaufbau in der Klinik eingeführt und die Ergebnisse kritisch evaluiert.Ergebnisse64 konsekutive Patienten mit benignen oder malignen Dickdarmerkrankungen im Alter von 66 (54–71) Jahren wurden konventionell (n=30) oder laparoskopisch (n=34) reseziert und perioperativ mit dem „Fast-track-Programm“ behandelt. Die Krankenhausbasisdiät wurde am 1. (1–1) postoperativen Tag vertragen, der erste Stuhlgang erfolgte am 2. (2–3) Tag. Die Entlassung der Patienten war am 4. (4–5) Tag nach der Resektion möglich. Allgemeine und lokale postoperative Komplikationen wurden bei jeweils 5 Patienten (8%) beobachtet, darunter 2 Anastomoseninsuffizienzen (3%). SchlussfolgerungDie „Fast-track-Kolonchirurgie“ beschleunigt die Rekonvaleszenz und reduziert die Quote allgemeiner Komplikationen sowie die postoperative Verweildauer. Eine weitere Evaluation von „Fast-track-Konzepten“ nach anderen elektiven abdominellen Eingriffen erscheint deshalb sinnvoll.AbstractObjectThe aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and “traditional” perioperative therapy and to allow hospital discharge only a few days following the operation.Materials and methodsIn this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called “fast-track” program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic.ResultsSixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66xa0years (range 54–71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2ndxa0day (range 2–3). The patients could be released on the 4th postresection day (range 4–5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency.ConclusionIn colonic surgery, the “fast-track” method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of “fast-track” concepts is warranted in other types of elective abdominal surgery.

„Fast-track-Kolonchirurgie“

ZusammenfassungEinleitungDie Rate allgemeiner Komplikationen nach elektiven Kolonresektionen und „traditioneller“ perioperativer Therapie soll durch multimodale perioperative Behandlungskonzepte reduziert werden und eine Entlassung innerhalb weniger Tage nach der Operation ermöglichen.Material und MethodenIn einer prospektiven Untersuchung wurde ein perioperatives Behandlungskonzept zur Beschleunigung der postoperativen Rekonvaleszenz („Fast-track-Programm“) mit thorakaler kombinierter Periduralanalgesie, forcierter Mobilisation und raschem Kostaufbau in der Klinik eingeführt und die Ergebnisse kritisch evaluiert.Ergebnisse64 konsekutive Patienten mit benignen oder malignen Dickdarmerkrankungen im Alter von 66 (54–71) Jahren wurden konventionell (n=30) oder laparoskopisch (n=34) reseziert und perioperativ mit dem „Fast-track-Programm“ behandelt. Die Krankenhausbasisdiät wurde am 1. (1–1) postoperativen Tag vertragen, der erste Stuhlgang erfolgte am 2. (2–3) Tag. Die Entlassung der Patienten war am 4. (4–5) Tag nach der Resektion möglich. Allgemeine und lokale postoperative Komplikationen wurden bei jeweils 5 Patienten (8%) beobachtet, darunter 2 Anastomoseninsuffizienzen (3%). SchlussfolgerungDie „Fast-track-Kolonchirurgie“ beschleunigt die Rekonvaleszenz und reduziert die Quote allgemeiner Komplikationen sowie die postoperative Verweildauer. Eine weitere Evaluation von „Fast-track-Konzepten“ nach anderen elektiven abdominellen Eingriffen erscheint deshalb sinnvoll.AbstractObjectThe aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and “traditional” perioperative therapy and to allow hospital discharge only a few days following the operation.Materials and methodsIn this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called “fast-track” program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic.ResultsSixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66xa0years (range 54–71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2ndxa0day (range 2–3). The patients could be released on the 4th postresection day (range 4–5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency.ConclusionIn colonic surgery, the “fast-track” method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of “fast-track” concepts is warranted in other types of elective abdominal surgery.

Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopic and conventional colorectal surgery

PURPOSE: This study was designed to evaluate the influence of intraoperative intermittent sequential compression (ISC) on venous blood return from the lower limbs during laparoscopic and conventional colorectal colectomy. METHODS: Fifty patients undergoing laparoscopic (n=25) or conventional (n=25) colorectal surgery were included in a prospective study. Peak venous flow (PFV) and the cross-sectional area (CSA) of the femoral vein were assessed by Doppler ultrasound examination intraoperatively. RESULTS: Age, gender, and body mass index were comparable between both groups. Baseline PFV was 21±6.6 cm/s in the conventional and 18.4±6.4 cm/s in the laparoscopic group (P=0.2). ISC increased PFV to 156±29 percent of the baseline value in the conventional group and to 161±29 percent in the laparoscopic group. PFV decreased after abdominal insufflation to 127±19 percent of the baseline value in the laparoscopic group and after laparotomy to 134±27 percent in the conventional group (P=0.3). PFV decreased slightly in both groups during surgery but remained well above the baseline value. Baseline CSA was 1.02±0.17 cm2in the conventional group and 1±0.23 cm2in the laparoscopic group. ISC decreased CSA to 0.91±0.18 cm2(conventional) and 0.85±0.18 cm2(laparoscopic) after initiation of ISC. CSA was 0.92±0.18 cm2after abdominal insufflation in the laparoscopic group, and it was 0.93±0.18 cm2after laparotomy in the conventional group (P=0.4). During surgery, there were no differences in absolute CSA or CSA changes compared with the baseline value in both groups. Postoperative circumference of the calf and thigh were not different between both groups. Postoperative thromboembolic complications did not occur. CONCLUSION: ISC effectively increases venous blood flow from the lower limbs during conventional and laparoscopic colorectal resections and may decrease the risk of postoperative deep vein thrombosis. Therefore, ISC is strongly recommended in every prolonged laparoscopic procedure.

Influence of acute hemorrhage and pneumoperitoneum on hemodynamic and respiratory parameters

AbstractBackground: We examined the questions of whether resuscitated (compensated) acute hemorrhage enhances the negative effects of carbopneumoperitoneum on hemodynamic and respiratory parameters and whether pneumoperitoneum with helium has any advantages under these circumstances. Our investigation focused on the influence of acute hemorrhage with different gases on the cardiovascular and respiratory system as well as on hepatic and renal blood flow in a porcine model.nMethods: Cardiac and hemodynamic function were monitored via implantation of catheters in pulmonary artery, femoral vein, and artery. Renal and hepatic blood flow were recorded using a transonic volume flow meter placed at the renal and hepatic artery and portal vein. Twelve animals were randomly assigned to one insufflation gas (carbon dioxide [CO2] or helium [He]). Following baseline recordings, acute hemorrhage (20 ml/kg) was induced by continuous bleeding over 30 min. Animals then received a colloidal solution (20 ml/kg 6% hydroxyethylstarch solution) over 30 min. Pneumoperitoneum of 12 mmHg was established, and all parameters were measured after 30 min of adaptation. The major endpoints of the study were cardiac output (CO), arterial pressure (MAP), systemic vascular resistance (SVR), and central venous pressure (CVP), as well as blood flow in hepatic and renal artery and portal vein.nResults: While CO and hemodynamic parameter as well as hepatic and renal blood flow were markedly reduced after hemorrhage, they returned nearly to their previous levels after resuscitation. Pneumoperitoneum with 12 mmHg did not further depress the cardiovascular system or reduce hepatic and renal blood flow. Pneumoperitoneum did not alter hepatic or renal blood flow. Pneumoperitoneum with helium did not substantially change the reaction of the cardiovascular system after resuscitated hemorrhage.nConclusions: If hemorrhage is compensated by proper resuscitation and hypovolemia is avoided, laparoscopic surgery with pneumoperitoneum of 12 mmHg appears to be not harmful. Using helium as the insufflating gas had no clear advantage over the carbon dioxide model.

Cardiopulmonary changes during laparoscopy and vessel injury: comparison of CO2 and helium in an animal model.

Abstract. Background: Injury of venous vessels during elevated intraperitoneal pressure is thought to cause possible fatal gas embolism, and helium may be dangerous because of its low solubility. Methods: Twenty pigs underwent laparoscopy with either CO2 (n=10) or helium (n=10) with a pressure of 15xa0mmHg and standardized laceration (1xa0cm) of the vena cava inferior. After 30xa0s, the vena cava was clamped, closed endoscopically by a running suture and unclamped again. During the procedure changes of cardiac output (CO), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP), end tidal CO2 pressure (PETCO2), and arterial blood gas analyses (pH, pO2 and pCO2) were investigated. Results: No animal died during the experimental course (mean blood loss during laceration: CO2, 157±50xa0ml; helium, 173±83xa0ml). MAP and CO values showed a decrease after laceration of the vena cava in both groups that had already been completely compensated for before suturing. PETCO2 increased significantly after CO2 insufflation (P<0.01), while helium showed no effect. Laceration of the vena cava caused no significant changes in PETCO2 values in either group. Significant acidosis and an increase of pCO2 were only found in the CO2 group. Conclusions: The incidence of gas embolism during laparoscopy and accidental vessel injury seems to be very low. With the exception of acidosis and an increase of PETCO2 in the CO2 group, there were no differences in cardiopulmonary function between insufflation of CO2 and helium.

Fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resection: data from a randomized controlled trial

BackgroundA reduced peritoneal fibrinolytic capacity after surgery is currently accepted to be the main cause for postoperative adhesions. The aim of this prospective randomized trial was to determine the fibrinolytic activity in peritoneal fluid after laparoscopic as compared to conventional colorectal resection.MethodsA randomized controlled trial in parallel with the multicenter trial Lapkon II was conducted. Peritoneal fluid was sampled via drain at 2, 8, and 24xa0h after elective laparoscopic (n=14; LAP) and conventional (n=16; CON) colorectal resections. Activities and concentrations of tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1) and t-PA/PAI complex were determined in all specimen by ELISA kits.ResultsThere was no difference in age, sex or body mass index between both groups. Postoperatively, t-PA activity decreased in both groups and was lower 2xa0h after closing the abdomen in the laparoscopic group (p<0.05). PAI-1 activity and concentration increased in both groups. Difference between the groups was measured for PAI-1 concentration after 24xa0h (p<0.05). There were no differences between the groups regarding t-PA concentrations, PAI-1 activity and t-PA/PAI complex.ConclusionsAfter closing the abdominal cavity, postoperative changes in fibrinolytic capacity of peritoneal fluid can be determined in samples collected by a drain. However, there were no major differences in the postoperative course of fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resections.

Fast-track-KolonchirurgieErste Erfahrungen mit einem clinical pathway zur Beschleunigung der postoperativen Rekonvaleszenz

ZusammenfassungEinleitungDie Rate allgemeiner Komplikationen nach elektiven Kolonresektionen und „traditioneller“ perioperativer Therapie soll durch multimodale perioperative Behandlungskonzepte reduziert werden und eine Entlassung innerhalb weniger Tage nach der Operation ermöglichen.Material und MethodenIn einer prospektiven Untersuchung wurde ein perioperatives Behandlungskonzept zur Beschleunigung der postoperativen Rekonvaleszenz („Fast-track-Programm“) mit thorakaler kombinierter Periduralanalgesie, forcierter Mobilisation und raschem Kostaufbau in der Klinik eingeführt und die Ergebnisse kritisch evaluiert.Ergebnisse64 konsekutive Patienten mit benignen oder malignen Dickdarmerkrankungen im Alter von 66 (54–71) Jahren wurden konventionell (n=30) oder laparoskopisch (n=34) reseziert und perioperativ mit dem „Fast-track-Programm“ behandelt. Die Krankenhausbasisdiät wurde am 1. (1–1) postoperativen Tag vertragen, der erste Stuhlgang erfolgte am 2. (2–3) Tag. Die Entlassung der Patienten war am 4. (4–5) Tag nach der Resektion möglich. Allgemeine und lokale postoperative Komplikationen wurden bei jeweils 5 Patienten (8%) beobachtet, darunter 2 Anastomoseninsuffizienzen (3%). SchlussfolgerungDie „Fast-track-Kolonchirurgie“ beschleunigt die Rekonvaleszenz und reduziert die Quote allgemeiner Komplikationen sowie die postoperative Verweildauer. Eine weitere Evaluation von „Fast-track-Konzepten“ nach anderen elektiven abdominellen Eingriffen erscheint deshalb sinnvoll.AbstractObjectThe aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and “traditional” perioperative therapy and to allow hospital discharge only a few days following the operation.Materials and methodsIn this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called “fast-track” program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic.ResultsSixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66xa0years (range 54–71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2ndxa0day (range 2–3). The patients could be released on the 4th postresection day (range 4–5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency.ConclusionIn colonic surgery, the “fast-track” method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of “fast-track” concepts is warranted in other types of elective abdominal surgery.

DIE BEDEUTUNG DER LAPAROSKOPISCHEN TECHNIK BEIM PRIMAREN COLORECTALEN CARCINOM

Summary. Patients who had undergone elective resection for primary colorectal cancer were included in a prospective study. The purpose of the study was to specify the current role of laparoscopic surgery in the treatment of colorectal cancer. Therefore, the reasons for performing the resection conventionally were documented under the general guideline that all colorectal cancer should be resected laparoscopically. Of 111 patients treated in 1995, only 22 underwent a laparoscopic resection and 4 patients a laparoscopic-assisted resection. Age, sex and tumor stage were comparable between groups. Operative time was longer in the laparoscopy group; duration of postoperative ileus and postoperative hospital stay were shorter. The most frequent indications for using a conventional approach were rectal cancer (n = 29), adhesions (n = 15), randomly selected patients (n = 14) and advanced cancer (n = 12). Cardiovascular risk factors were not so important. Laparoscopic techniques were only applied in a minority of patients with colorectal cancer (24–37 %). Laparoscopic sphincter-preserving surgery is currently not recommended for rectal cancer in the middle and lower rectum. General risk factors are rarely a contraindication for a laparoscopic approach.Zusammenfassung. Bei Patienten, die wegen eines primären colorectalen Carcinoms elektiv reseziert wurden, wurde in einer prospektiven Studie untersucht, aus welchen Gründen die Operation konventionell durchgeführt wurde, wenn bei allen Patienten die laparoskopische Operation grundsätzlich angestrebt wird. Damit sollte die gegenwärtige Bedeutung der laparoskopischen Technik in der elektiven Behandlung des primären colorectalen Carcinoms geklärt werden. Von 111 Patienten, die innerhalb von 12 Monaten operiert wurden, wurde bei 22 Patienten der Tumor laparoskopisch reseziert und bei 4 Patienten ein laparoskopisch-assistiertes Verfahren gewählt. Alter, Geschlecht und Tumorstadien waren vergleichbar zwischen den Gruppen. Die Operationszeiten waren in der laparoskopischen Gruppe deutlich länger, die des postoperativen Ileus und Verweildauer waren kürzer. Die häufigste Indikation zur konventionellen Resektion waren Rectumcarcinome (n = 29), gefolgt von Verwachsungen (n = 15), randomisierten Patienten (n = 14) und infiltrierenden Tumoren (n = 12). Allgemeine Risikofaktoren waren weniger bedeutend. Die laparoskopischen Operationstechniken spielen zur Zeit noch eine untergeordnete Rolle in der primären Behandlung des colorectalen Carcinoms (24–37 %). Operationstechnische Gesichtspunkte lassen eine sphinctererhaltende Resektion von Rectumcarcinomen im mittleren und unteren Drittel noch nicht empfehlen. Allgemeine Risiken sind selten eine alleinige Kontraindikation zur laparoskopischen Resektion.

Verträglichkeit eines frühen oralen Kostaufbaus nach Operationen am unteren Gastrointestinaltrakt

Zusammenfassung.Einleitung: Nach Operationen am unteren Gastrointestinaltrakt wird häufig erst bei klinischen Zeichen der Normalisierung der Darmmotilität mit dem Kostaufbau begonnen, obgleich einige Studien bereits auf eine gute Verträglichkeit und geringe Komplikationsrate bei frühem oralen Kostaufbau hinweisen. Methode: In einer prospektiven Beobachtungsstudie sollte überprüft werden, ob ein früher oraler Kostaufbau für die Patienten verträglich ist, wenn er nach einem standardisierten Stufenschema im Klinikalltag durchgeführt wird. 100 konsekutive Patienten erhielten nach operativen Eingriffen mit Anastomosierung des Dünn- oder Dickdarms bereits am 1. Tag Flüssigkeit, am 2. Tag Suppe, am 3. Tag pürierte Kost und am 4. Tag eine Basisdiät. Eine parenterale Substitution erfolgte nur nach Bedarf. Bei täglichen 2maligen Visiten wurden die Verträglichkeit und das exakte Ausmaß des Kostaufbaus bestimmt. Zielkriterien der Studie waren Übelkeit (VAS-Score von 1–100), Erbrechen ( > 200 ml), Reinsertion der Magensonde, erreichte Stufe des Kostaufbaus, substituierte Infusionsmenge, eingenommene Nahrungsmenge, Appetit und Befindlichkeit. Ergebnisse: Bei 21 Patienten wurde ein doppelläufiges Ileostoma zurückverlegt, bei 32 Patienten eine Colonresektion und bei 47 eine Sigma- oder Rectumresektion vorgenommen. Das Durchschnittsalter aller Patienten betrug 63 ± 13 Jahre. Der Anteil der Patienten, die über Übelkeit klagten, betrug weniger als 30 %. Weniger als 10 % klagten über Erbrechen. Nur 2mal wurde eine Magensonde gelegt. 43 % der Patienten konnten nach dem Schema ernährt werden, bei 57 % war der Kostaufbau geringgradig verzögert. Am 3. Tag erhielten bereits mehr als 60 % eine feste orale Nahrung, am 4. Tag 74 % und am 5. Tag 88 %. Am 4. postoperativen Tag benötigten nur noch 22 % Infusionen. Der erste Stuhlgang trat nach 2,8 ± 1,1 Tagen auf. Chirurgische Komplikationen traten bei 18 Patienten und allgemeine Komplikationen bei 6 Patienten auf. Schlußfolgerung: Die meisten Patienten haben den frühen Kostaufbau nach dem angegebenen Schema bei geringer Komplikationsrate sehr gut vertragen. Das Stufenschema zur frühen oralen Ernährung ist zum festen Bestandteil der postoperativen Behandlung nach Eingriffen am Dünn- und Dickdarm geworden.Abstract.Introduction: Oral feeding is usually offered following surgery of the lower gastrointestinal tract when clinical signs of normal intestinal motility are present. However, some studies have shown that early oral feeding is well tolerated with low morbidity. Methods: A prospective cohort study was performed to evaluate whether early oral feeding according to a standardized schedule is tolerated under normal clinical circumstances. One hundred consecutive patients following small- or large-bowel resection with anastomosis were offered fluids on post-operative day 1, soup on post-operative day 2, mashed food on post-operative day 3 and a regular diet on post-operative day 4. Parenteral nutrition was only given if necessary. Tolerance of oral feeding and the amount of food were checked twice a day. End points of the study were nausea (VAS score 1–100), vomiting ( > 200 ml), reinsertion of a nasogastric tube, level of food intake, parenteral nutrition (ml), appetite and well-being. Results: Loop ileostomies were done in 21 patients, colonic resections above the sigmoid in 32, and sigmoid and rectal resections in 47. The average age was 63 ± 13 years. The frequency of nausea was less than 30 % and of vomiting less than 10 %. Only in two cases was a nasogastric tube inserted. Forty-three percent of all patients tolerated feeding very well according to the schedule. On post-operative day 3 more than 60 % tolerated oral intake, on post-operative day 4, 74 % and on post-operative day 5, 88 %. Only 22 % of the patients needed parenteral fluids on post-operative day 4. The first bowel movement was noted after 2.8 ± 1.1 days. Surgical complications were documented in 18 patients and general complications in 6 patients. Conclusion: Most patients tolerated early oral feeding very well according to the schedule with low morbidity. Therefore, early feeding is now a substantial component of the postoperative treatment following small- or large-bowel resections.