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    Feeding frenzy

    Immediate post-op intake of food by abdominoplasty patients is safe, beneficial


    Dr. Matarasso
    NEW YORK "To feed or not to feed?" that is the question. Traditionally, patients who undergo an abdominoplasty are not allowed oral intake of food until bowel activity can be audibly verified post-operatively. According to one plastic surgeon, however, the practice of withholding food following an abdominal surgery is not as perilous as once thought to be. In fact, according to the results of a recent study, this practice may soon be a thing of the past.

    "There is a steadily growing trend for surgeons to feed patients immediately following a full abdominoplasty surgery without any increase in danger to the patient or any increase in post-operative nausea and vomiting when compared to the traditional approach of initially withholding oral intake of food until bowel activity is heard," says Alan Matarasso, M.D., F.A.C.S., at the Department of Plastic Surgery at the Manhattan Eye, Ear & Throat Hospital in New York. Dr. Matarasso and colleagues conducted a prospective study in 22 patients who underwent a full abdominoplasty. In the study, 10 patients received nil per os (NPO) until bowel sounds were heard and 12 received oral intake of food immediately following the surgery.

    OUT WITH THE OLD "What my colleagues Drs. Sameer Jejurikar and Michael Orseck did was try to look at a conventional teaching in plastic surgery and abdominoplasties, which was that patients were kept NPO until they had active bowel sounds. In this study, we challenged that dogma to see if the withholding of food was really necessary," Dr. Matarasso tells Cosmetic Surgery Times . "We found that there was no real difference between the two study groups in respect to post-op nausea and vomiting, which is arguably one of the most disagreeable experiences for a patient following a surgery, and can lead to other problems." The post-op effects of the general anesthesia, as well as dehydration, can all contribute to post-op nausea and vomiting. Also, if patients are not moving their bowels adequately, this could also be a contributing factor.

    According to Dr. Matarasso, one of the major advantages of this new approach is that those patients who immediately begin diet post-op may, theoretically, be able to have their I.V. removed sooner and could also be discharged sooner, which could save patients in hospital-related costs. Several factors would determine just how soon patients who are fed immediately following a full abdominoplasty can be discharged and would vary from case to case. But according to Dr. Matarasso, some patients could conceivably go home the same day. "The point here is that by having these patients fed, you have those options," he explains. "Each patient and each situation is different, but...from our study, we found that early feeding in patients undergoing abdominoplasty was clearly feasible and safe."

    THOUGHT SHIFT? The traditional approach and a rule of thumb in surgery dictate that patients who undergo abdominal surgery should not be sent home until they pass gas and only then should they be fed and/or discharged. The rationale behind the practice of NPO following abdominoplasty is to diminish the effects of nausea and vomiting caused by paralytic ileus. According to Dr. Matarasso, however, it has not been demonstrated that abdominoplasty slows gastrointestinal motility. "I think like many things in medicine, we see incremental changes in behavior in surgery — and very often it is not a paradigm shift — that, taken together, can advance the science of surgery." In fact, he says that this early post-op feeding movement could make shorter hospitalizations and out-patient surgery a reality. "I believe that many surgeons may even be using this approach already," he adds.

    According to Dr. Matarasso, who was the senior author on the paper, "the group that we compared where we did not feed them [the patients] has made me a believer." He now uses this approach with his patients and believes that surgeons should consider possibly adopting it as a new dogma in post-op care. "In the end," he states, "it is advantageous and safe."

    HYDRATION IS KEY According to Dr. Matarasso, this new approach is safe, assuming the patients are getting adequate hydration — an important point. He says that some people choose not to eat, despite the fact that they are allowed to eat. "This is probably because these patients may be uncomfortable, might not want to eat, may be fearful of eating post-op or may be tired. Here, it is important to continue their I.V. But in those patients who want to eat and can maintain adequate hydration, it allows them to," he says.

    Reference

    Jejurikar SS, Orseck MJ, Matarasso A. Reevaluating resumption of oral intake after abdominoplasty. Aesthetic Surg J. 2007;27:233-238.

    For more information
    Alan Matarasso, M.D., F.A.C.S.
    [email protected]

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