Is nil per os still appropriate for patients undergoing upper gastrointestinal surgery?

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Nil per os (NPO) is the traditional postoperative approach for patients undergoing abdominal surgery. Data have shown that withholding oral intake in patients undergoing colorectal, gynecologic, urologic and vascular surgery is unnecessary; however, NPO is still widely practiced in patients undergoing major upper gastrointestinal surgery. In this Practice Point commentary, I discuss the findings and limitations of a study by Lassen and colleagues, which investigated the impact of routine NPO with enteral tube feeding compared with allowing normal food at will in patients undergoing upper gastrointestinal surgery. The results revealed that allowing normal food at will after surgery did not increase morbidity, and that a lower number of complications were associated with this approach. I hope that these findings will encourage fellows and residents not to be hidebound by their clinician colleagues' attitudes and approaches that have not changed in 25 years. The NPO approach is unnecessary in patients undergoing upper gastrointestinal surgery.

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