The word anastomosis which is a Greek word which means meaning “outlet” or “opening”. Gut anastomosis is joining two openings of gut and it is one of the most frequently performed surgeries in emergency setup.

Anastomosis following gut resections in emergency set up is generally done due to blunt abdominal trauma causing perforation, benign or malignant perforation or obstruction and in some other condition like inflammatory conditions. Generally, after gut anastomosis, patients are kept "NIL PER ORAL" till bowel sounds return. Until this time the patient remains with nasogastric tube for decompression of stomach.

Recently significant emphasis has been given on early enteral feeding within 6 to 24 hours after operation. However, in post-operative period, sometimes patient is put on Total Parenteral Nutrition to maintain nutrition. Other than being costly, TPN causes complications like infection, metabolic disturbances and immunological problem.

Studies are getting conduct to know the feasibility and role of early enteral feeding in patient recovery. Emergency gastrointestinal (GI) surgeries are associated with significant physiological stress, postoperative complications, and prolonged recovery periods. Traditionally, patients undergoing such procedures were kept nil per os (NPO) until the return of bowel function, based on concerns of anastomotic leakage, aspiration, and ileus. However, growing evidence suggests that early enteral feeding (EEF), typically initiated within 24–48 hours postoperatively, can be both safe and beneficial, even in emergency settings [1,2]. Enteral nutrition maintains gut integrity, modulates immune response, reduces bacterial translocation, and supports wound healing, all of which are critical in the postoperative period [3,4].

The Enhanced Recovery after Surgery (ERAS) protocols advocate for early resumption of oral or enteral nutrition to minimize catabolic stress and support faster convalescence [5]. While ERAS has been widely adopted in elective surgeries, its application in emergency GI surgeries remains limited and under-evaluated due to the heterogeneity of cases and patient instability [6]. Despite these challenges, multiple studies have demonstrated improved outcomes with early feeding in terms of reduced infectious complications, shorter hospital stays, and better nutritional status without increasing the risk of anastomotic leaks [7,8]. Furthermore, meta-analyses and randomized controlled trials underscore the safety and feasibility of EEF in selected emergency surgical patients [9,10]. Thus, assessing the role of early enteral nutrition in the context of emergency GI surgeries is vital for optimizing patient care and recovery. Aim of the study is on role of early enteral feeding following emergency gastrointestinal Surgery.

Study Design: Prospective, randomized, single-blind study.

Study Duration: Conducted over 18 months (November 2023 to January 2025).

Study Setting: Department of General Surgery, Burdwan Medical College and Hospital, Burdwan.

Study Population: Patients presenting with acute abdomen emergencies requiring gastrointestinal surgery.

Surgical Procedures Included:

• Laparotomy followed by entero-enteric anastomosis
• Stoma formation

Indications for Surgery:

• Blunt abdominal trauma
• Benign and malignant perforations
• Obstructions

Sample Size: Total of 54 patients who met the inclusion and exclusion criteria.

Data Collection: Clinical and demographic data collected preoperatively, intraoperatively, and postoperatively.

Data Entry and Management: Data entered into Microsoft Excel spreadsheet for organization and analysis.

Statistical Analysis:

For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Numerical variables were summarized using means and standard deviations, while Data were entered into Excel and analyzed using SPSS and GraphPad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table: 1. Distribution of Study Population According to Body Mass Index (BMI)

Table: 2. Distribution of Cancer Surgeries According to Operative Procedure

Table: 3. Distribution of Anastomosis Types Among Patients

Table: 4. Distribution of Post-Operative Hospital Stay Duration (in Days)

In this study, the majority of patients (76%) had a normal BMI (18.5–24.9), while 13% were underweight (BMI <18.5) and 11% were overweight (BMI 25–29.9). Out of the total 54 patients, most fell within the normal BMI range. This indicates that nutritional status was generally adequate at baseline for the majority of the cohort.

Among the 54 patients, 17 (31.5%) underwent emergency cancer surgeries. The most common procedure was loop colostomy (11.1%), followed by right hemicolectomy (7.4%), left hemicolectomy (5.6%), extended right hemicolectomy (3.7%), and low anterior resection (3.7%). This reflects a varied surgical approach based on tumour location and clinical urgency.

Out of 29 patients who underwent gastrointestinal anastomosis, 86.2% had sutured anastomosis, while 13.8% received stapled anastomosis. Sutured technique was clearly preferred in the majority of cases. The choice likely reflected surgeon preference and intraoperative considerations.

Postoperative hospital stay ranged from 6 to more than 10 days among the 54 patients. The majority stayed for 6 to 8 days, with 22.22% staying 6 days, 27.78% staying 7 days, and 16.67% staying 8 days. Only 16.67% had a prolonged stay beyond 10 days, indicating generally favourable recovery times.

In our study, the majority of patients (76%) had a normal BMI (18.5–24.9), while 13% were underweight and 11% were overweight. This distribution suggests that the baseline nutritional status of most patients was adequate. A comparable study by Choi et al. (2013) on patients undergoing gastrointestinal surgery noted a similar trend, with 72% of their cohort falling within the normal BMI range, indicating that optimal baseline nutrition is common even in emergency surgical settings [11]. However, in contrast, Sarin et al. (2008) reported a higher proportion of underweight patients (22%) in emergency gastrointestinal surgeries, likely due to chronic illness or malignancy-related cachexia [12].

Among the 54 patients in our study, 17 (31.5%) underwent emergency cancer surgeries. Loop colostomy was the most frequent procedure (11.1%), followed by various colectomies and low anterior resections. These findings reflect surgical diversity influenced by tumor location and clinical urgency. Similar procedural variations were observed in a study by Biondo et al. (2010), which noted that emergency colorectal surgeries are increasingly heterogeneous, with loop colostomy and segmental resections forming the bulk of interventions [13].

Of the 29 patients who underwent gastrointestinal anastomosis in our study, 86.2% received sutured anastomosis, while only 13.8% underwent stapled anastomosis. This marked preference for sutured techniques is consistent with findings from Kracht et al. (2011), who reported that in low-resource or emergency settings, hand-sewn anastomoses are often favored due to surgeon familiarity and cost considerations [14]. Conversely, Gustafsson et al. (2015) highlighted an increasing trend toward stapled anastomoses in elective procedures due to consistency and reduced operative time, though this is less frequently adopted in emergencies [15].

The postoperative hospital stay ranged from 6 to more than 10 days, with the majority of patients staying between 6–8 days. Only 16.67% had prolonged hospitalization (>10 days). These results suggest a generally favorable recovery period. Comparable outcomes were reported in Boelens et al. (2014), where early enteral feeding after gastrointestinal surgery reduced the mean hospital stay to approximately 7.2 days, aligning closely with our findings [16]. Lewis et al. (2009) also observed similar recovery trends in patients managed with early enteral nutrition, emphasizing the role of postoperative feeding protocols in reducing hospital stay [17].

Early enteral feeding (EEF) following emergency gastrointestinal surgery has emerged as a safe and effective approach that enhances postoperative recovery, minimizes infectious complications, and supports early restoration of gut function. This strategy, when initiated within 24 to 48 hours postoperatively in hemodynamically stable patients, contributes significantly to improved nutritional status, reduced hospital stay, and overall morbidity without increasing the risk of anastomotic dehiscence or other complications. The findings of this study underscore the importance of integrating early enteral nutrition into standard postoperative care protocols in emergency surgical settings, thereby promoting better patient outcomes and resource utilization.

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4. Kudsk KA. Current aspects of mucosal immunology and its influence by nutrition. Am J Surg. 2002;183(4):390–398.

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