Early postoperative enteral feeding increases anastomotic strength in a peritonitis model

Background: Tumor necrosis factor alpha (TNF-α) has been shown to decrease collagen synthesis and increase collagenase activity leading to impaired wound healing. Our hypothesis was that immediate postoperative feeding would decrease TNF-α, therefore increasing anastomotic healing in a peritonitis model. Methods: Twelve Sprague-Dawley rats underwent cecal ligation and puncture to induce peritonitis. Six hours after induction of peritonitis an ileocecectomy and ileocolostomy was performed. Group 1 animals (n = 6) had immediate access to food and water, whereas group 2 (n = 6) had free access to water only. At 48 hours, weight loss, nitrogen loss, anastamotic bursting strength (ABS), TNF-α, interleukin-6 (IL-6), and IL-10 were measured. Results: Weight loss was similar in the two groups. Group 1 rats had a significantly lower mean TNF-α level (17.3 ± 10 versus 17.3 ± 10 mcg/Dl, P = 0.05). ABS was also significantly higher in group 1 rats when compared with group 2 rats (81 ± 34 versus 39 ± 13 mm HG, P = 0.03). Conclusions: These data suggest that immediate postoperative feeding results in a beneficial change in the cytokine profile.