Texture-optimized early enteral nutrition enhances gastrointestinal recovery and caloric intake after general surgery: A randomized controlled trial.

BACKGROUND & AIMS: Early oral feeding is recommended in enhanced recovery protocols; however, the impact of diet texture on postoperative gastrointestinal recovery remains insufficiently studied. We evaluated whether a standardized semi-solid, nutritionally complete postoperative diet improves gastrointestinal recovery and caloric delivery compared with conventional stepwise feeding after general surgery.

METHODS

In this single-center, prospective, single-blind randomized controlled trial, 120 patients undergoing noncardiothoracic surgery under general anesthesia were assigned (1:1) to receive either a semi-solid ginger-enriched nutritionally complete diet (TUPS-diet) or a conventional stepwise postoperative diet following return of bowel activity. The primary endpoint was recovery of bowel function. Secondary outcomes included caloric intake, postoperative nausea and vomiting (PONV), complications, and hospital stay. A prespecified subgroup analysis was conducted in intra-abdominal surgery.

RESULTS

Recovery of bowel function occurred significantly earlier in the semi-solid group (2.3 ± 0.4 vs 2.9 ± 0.7 days; p = 0.0003). Total caloric intake (4591 ± 2228 vs 2370 ± 1041 kcal; p < 0.001) and daily caloric intake (1118 ± 238 vs 646 ± 114 kcal/day; p < 0.001) were substantially higher in the semi-solid group. PONV scores were lower (VAS 0.5 ± 0.4 vs 0.9 ± 0.6; p < 0.001). Postoperative complications and length of hospital stay were comparable. Findings were consistent in the intra-abdominal surgery subgroup.

CONCLUSION

Within an early postoperative feeding protocol, a texture-optimized nutritionally complete semi-solid enteral diet was associated with improved caloric delivery and enhanced gastrointestinal recovery without compromising safety. Texture-modified enteral nutrition may represent a simple and physiologically sound strategy to support postoperative recovery pathways.

CLINICAL TRIALS REGISTRY: TCTR20240904004.