PRE-OPERATIVE ORAL CARBOHYDRATE LOADING VERSUS TRADITIONAL FASTING ON POST-OPERATIVE ILEUS IN ELECTIVE COLORECTAL SURGERY: A RANDOMIZED CONTROLLED TRIAL

Background: Prolonged post-operative ileus is a common complication following elective colorectal surgery, leading to delayed recovery, increased morbidity, and prolonged hospital stay. Traditional fasting protocols may exacerbate gut paralysis, while pre-operative oral carbohydrate loading has been proposed to enhance gastrointestinal recovery and reduce metabolic stress. Objective: To evaluate the impact of pre-operative oral carbohydrate loading compared with traditional fasting on the duration of post-operative ileus in patients undergoing elective colorectal surgery. Methods: A randomized controlled trial was conducted on 100 patients scheduled for elective colorectal surgery. Participants were randomly assigned to either the carbohydrate loading group (n=50), receiving a standardized carbohydrate-rich drink 2 hours before surgery, or the traditional fasting group (n=50). Post-operative outcomes measured included time to first flatus, time to first bowel movement, length of hospital stay, and incidence of post-operative nausea. Data were analyzed using standard statistical methods to compare outcomes between groups. Results: Patients in the carbohydrate loading group experienced significantly earlier return of bowel function, with mean time to first flatus of 28 ± 6 hours versus 36 ± 8 hours in the fasting group (p<0.001), and mean time to first bowel movement of 40 ± 9 hours versus 52 ± 10 hours (p<0.001). Length of hospital stay was reduced in the carbohydrate group (5.2 ± 1.1 days) compared with the fasting group (6.8 ± 1.4 days; p<0.001). Incidence of post-operative nausea was lower in the carbohydrate group (18% vs 32%, p=0.04). Conclusion: Pre-operative oral carbohydrate loading effectively reduces the duration of post-operative ileus, shortens hospital stay, and decreases post-operative nausea in patients undergoing elective colorectal surgery. These findings support the incorporation of modern fasting guidelines with carbohydrate supplementation to optimize perioperative recovery.