Pre‐operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial

Abstract

Objective Surgery induces a catabolic response with stress hormone release and insulin resistance. The aim of this study was to assess the effect of pre‐operative carbohydrate administration on grip strength, gastrointestinal function and hospital stay following elective colorectal surgery. Methods Thirty‐six patients undergoing elective colonic resection were randomized into one of three groups. Group 1 were fasted; Group 2 were given pre‐operative oral water, Group 3 received equivalent volumes of a Maltodextrin drink. Time to first flatus, first bowel movement and hospital stay were recorded. Muscle strength was measured pre‐operatively, and on alternate days thereafter until discharge using a grip strength dynamometer. Results Patients in the carbohydrate group had a median postoperative hospital stay of 7.5 days compared with 13 days in the water group ( P > 0.01) and 10 days in the fasted group ( P = 0.06). The median time postsurgery to first flatus was 3 days for both the fasted and water groups compared with 1.5 days in the carbohydrate group ( P = 0.13). First bowel movement occurred on day 3 in the carbohydrate group, day 4 in the fasting group and day 5 in the water group. The fasted group showed a significant reduction in postoperative grip strength ( P < 0.05) with a median drop of 10% at discharge. Neither the water nor the carbohydrate groups showed significant reductions in muscle strength. Conclusion We found that pre‐operative administration of oral carbohydrate leads to a significantly reduced postoperative hospital stay, and a trend towards earlier return of gut function when compared with fasting or supplementary water.