The effect of early feeding into the gut on gut function after major colorectal surgery

Participants enrolled in the intervention arm will receive trophic (very low rate) enteral nutrition via a nasogastric tube. The nasogastric tube will be inserted during time of surgery (standard practice). Feeds will commence within 24 hours of surgery using a standard polymeric enteral feed which is already used frequently throughout the hospital. Enteral feeds will run for 20mL/hr (equivalent to one tablespoon every hour) over 24 hours until the participant’s diet is upgraded to full fluids, which will take approximately 3-5 days. Participants will commence TPN (standard practice at this site) the same time enteral nutrition starts. In most patients, the TPN infusion can be commenced at 60mL/h, or at the charted goal infusion rate if the patient has been receiving 5% dextrose at that goal rate for 4 hours and blood glucose levels have been stable. 40mL/h will be used if the patient is suspected to be at risk of Refeeding Syndrome or glucose intolerance, or if the patient’s body weight is low. If this happens, biochemistry will be monitored every 4 hours and TPN will be increased as determined by the clinician, using their clinical judgement, at this time point until it reaches goal rate. A combination of TPN and enteral nutrition will meet the participant’s nutritional requirements as determined by the dietitian. TPN will be increased as per standard practice. It should be noted there is currently no evidence for best feeding practice after pelvic exenteration surgery which is why this study is being implemented. If patients do not tolerate enteral feeds indicated by large aspirates identified by nursing staff, enteral feeding will cease.