Elective colorectal surgery had remained a major component of surgical practice for the management of colorectal cancer, inflammatory bowel disease, diverticular disease, and other intestinal disorders. Despite improvements in surgical techniques, anesthesia, and perioperative care, postoperative recovery had continued to present important clinical challenges. Patients frequently experienced delayed return of bowel function, postoperative nausea and vomiting, abdominal discomfort, and prolonged hospital stays. Nutritional management had played an important role in determining recovery outcomes, particularly regarding the timing of oral feeding after surgery [1]. Traditionally, oral intake had been delayed until the return of bowel sounds, passage of flatus, or other clinical evidence of intestinal function. This approach had been based on concerns about postoperative ileus, aspiration, vomiting, and anastomotic complications. However, accumulating clinical evidence had questioned the necessity of prolonged fasting following uncomplicated colorectal procedures.

Early oral feeding had emerged as an important component of enhanced recovery after surgery (ERAS) protocols [2]. This approach involved initiating oral fluids and gradually advancing to a regular or tolerated diet within the first 24 hours after surgery, depending on the patient's clinical condition. Early nutritional intake had been associated with improved maintenance of nutritional status, preservation of intestinal mucosal integrity, and stimulation of gastrointestinal function. It had also helped reduce the metabolic consequences of prolonged fasting and supported the body's healing processes [3]. In contrast, delayed oral feeding had generally involved withholding food and fluids until clinical signs of gastrointestinal recovery became evident. Although this traditional strategy had aimed to minimize gastrointestinal complications, it had potentially contributed to unnecessary fasting, patient discomfort, and delayed discharge.

Postoperative recovery had been assessed through several clinical indicators, including the time to first bowel movement, passage of flatus, tolerance of oral intake, incidence of postoperative nausea and vomiting, occurrence of anastomotic leakage, and duration of hospitalization. Early feeding had offered potential benefits by facilitating gastrointestinal recovery and improving patient satisfaction [4]. Furthermore, earlier nutritional intake had been considered beneficial for reducing postoperative catabolism and supporting wound healing. Nevertheless, concerns regarding feeding intolerance, abdominal distension, vomiting, and the potential development of complications had continued to influence clinical decisions. These considerations had highlighted the importance of evaluating the safety and effectiveness of early feeding in patients undergoing elective colorectal surgery.

Hospital stay had represented another important outcome because prolonged hospitalization had increased healthcare expenditure, placed additional pressure on hospital resources, and exposed patients to potential hospital-acquired infections [5]. Early oral feeding had potentially shortened hospital stay by promoting earlier achievement of discharge criteria, including adequate oral intake, satisfactory pain control, independent mobility, and the absence of significant postoperative complications. However, the magnitude of these benefits had varied according to patient characteristics, the complexity of surgery, the presence of comorbidities, and adherence to standardized perioperative protocols [6]. Therefore, comparative assessment of early and delayed feeding had been necessary to determine whether earlier nutritional intake consistently improved recovery without increasing postoperative morbidity.

Although enhanced recovery protocols had increasingly supported early postoperative nutrition, differences in clinical practices and patient responses had justified further evaluation of feeding strategies. Local clinical evidence had remained particularly important because surgical outcomes could have been influenced by institutional resources, patient nutritional status, and variations in perioperative management [7]. A systematic comparison of early versus delayed oral feeding had therefore provided an opportunity to examine clinically relevant differences in postoperative recovery, gastrointestinal function, complications, and hospital stay.

The present study was designed to compare early and delayed oral feeding after elective colorectal surgery, with particular emphasis on postoperative recovery and duration of hospitalization [8]. By evaluating these outcomes, the study aimed to contribute evidence regarding the effectiveness and safety of early nutritional intake and to support the development of practical, evidence-based postoperative feeding protocols [9].

Study Design and Setting A comparative observational study was conducted at Shahida Islam Teaching Hospital from September 2025 to February 2026. The study included 90 patients who underwent elective colorectal surgery. The primary objective was to compare the effects of early and delayed oral feeding on postoperative recovery, gastrointestinal function, postoperative complications, and length of hospital stay. Patients were categorized into two groups according to the timing of oral feeding after surgery. Study Population and Sample Size A total of 90 eligible patients were enrolled in the study. The sample was divided equally into two groups, with 45 patients in each group. Group A comprised patients who received early oral feeding, which was initiated within 24 hours after surgery, provided that their clinical condition permitted oral intake. Group B comprised patients who received delayed oral feeding, which was initiated after 48 hours or when clinical evidence of gastrointestinal recovery was observed, according to the treating team's routine practice. Inclusion and Exclusion Criteria Patients aged 18 years or older who underwent elective colorectal surgery, including colectomy, anterior resection, and other planned colorectal procedures, were included. Patients were required to have adequate preoperative clinical assessment and postoperative monitoring records. Both male and female patients were eligible for participation. Patients who underwent emergency colorectal surgery, had pre-existing intestinal obstruction requiring urgent intervention, or presented with severe hemodynamic instability were excluded. Patients with major postoperative complications requiring prolonged bowel rest, pre-existing gastrointestinal motility disorders, or incomplete medical records were also excluded. Patients who required immediate reoperation or developed complications that prevented meaningful assessment of feeding outcomes were not included in the final analysis. Data Collection Procedure Data were collected using a structured proforma developed for the study. Demographic characteristics, including age and sex, were recorded alongside clinical information such as presenting diagnosis, comorbidities, type of surgical procedure, operative duration, and relevant preoperative laboratory findings. The timing of the first oral intake was documented from postoperative records. Postoperative recovery was assessed using predefined clinical indicators, including the time to first passage of flatus, time to first bowel movement, tolerance of oral feeding, occurrence of nausea and vomiting, abdominal distension, and other gastrointestinal complications. The length of hospital stay was calculated from the date of surgery to the date of discharge. Postoperative complications, including wound infection, anastomotic leakage, and postoperative ileus, were recorded when documented in the medical record. Outcome Measures The primary outcome was the length of postoperative hospital stay. Secondary outcomes included the time to first passage of flatus, time to first bowel movement, tolerance of oral feeding, postoperative nausea and vomiting, and the incidence of postoperative complications. Feeding intolerance was identified by documented inability to tolerate oral intake or the need to discontinue feeding because of significant gastrointestinal symptoms. All outcomes were assessed using the same definitions in both groups. Statistical Analysis Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 26.0. Continuous variables, including age, time to bowel function recovery, and length of hospital stay, were expressed as mean and standard deviation or median and interquartile range, depending on the distribution of the data. Categorical variables, including sex, feeding intolerance, and postoperative complications, were presented as frequencies and percentages. Independent-samples t-tests or Mann–Whitney U tests were used to compare continuous variables, while chi-square or Fisher's exact tests were applied to categorical variables, as appropriate. A p-value of less than 0.05 was considered statistically significant. Ethical Considerations Approval was obtained from the relevant institutional ethics review committee before data collection. Informed consent was obtained from participating patients where required. Patient confidentiality was maintained by using coded study records, and the collected information was used exclusively for research purposes.

The study evaluated a total population of 90 patients who underwent elective colorectal surgery at Shahida Islam Teaching Hospital between September 2025 and February 2026. Participants were assigned into two equal groups: the Early Oral Feeding (EOF) group (n = 45), where oral intake was initiated within 24 hours postoperatively, and the Delayed Oral Feeding (DOF) group (n = 45), where oral feeding was delayed until the clinical resolution of postoperative ileus.

Baseline Demographic and Clinical Characteristics:

Baseline characteristics were recorded and compared across both study cohorts to ensure comparability. Parameters including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status score, and surgical indication showed no statistically significant differences between the two groups (p > 0.05).

Table 1. Baseline demographic and clinical characteristics of the study participants:

Primary outcomes measuring postoperative gastrointestinal recovery, complication rates, and total length of hospital stay demonstrated clinically meaningful and statistically significant advantages in the Early Oral Feeding cohort. Patients in the EOF group experienced a significantly faster return of bowel function compared to those in the DOF group. The mean time to first passage of flatus was 38.4 ± 7.2 hours in the EOF group versus 62.1 ± 9.8 hours in the DOF group (p < 0.001). Similarly, the mean time to first bowel movement was reduced to 51.6 ± 8.5 hours in the EOF group compared to 78.3 ± 11.4 hours in the DOF group (p < 0.001).

Table 2: Comparison of Postoperative Outcomes and Hospital Stay (N = 90):

The demographic distribution in Table 1 confirmed that both treatment arms were well-balanced at baseline. No statistically significant variations were identified regarding age, gender distribution, body mass index, baseline health status, surgical indication, or operative approach (laparoscopic versus open surgery). This uniformity established that baseline factors did not confound the primary outcome measures. As presented in Table 2, early oral intake post-surgery exerted a clear physiological benefit on gastrointestinal motility. Initiating early nutrition stimulated the enter salivary circuit and promoted gut peristalsis, resulting in a statistically significant reduction in the time required for patients to pass flatus and achieve full bowel evacuation. Importantly, early oral feeding was well-tolerated and did not cause a statistically significant increase in adverse gastrointestinal events. The incidence of postoperative nausea and vomiting remained comparable between the EOF and DOF cohorts (15.6% vs13.3%, p = 0.762). Moreover, instances requiring nasogastric tube re-insertion due to severe abdominal distension or persistent vomiting were low in both groups (6.7% vs 4.4%, p = 0.646). In addition, overall complication rates and wound infection rates demonstrated no significant elevation in the early feeding group. Most importantly, early restoration of gut function contributed directly to a major reduction in total hospitalization length. Patients who received early oral feeding were discharged significantly earlier (4.2 ± 1.1 days) than those managed with delayed oral feeding (6.8 ± 1.5 days, p < 0.001), demonstrating that early oral feeding accelerated overall recovery and reduced overall hospital resource utilization without compromising patient safety.

The present study compared the effects of early versus delayed oral feeding after elective colorectal surgery, focusing on postoperative recovery, gastrointestinal function, postoperative complications, and length of hospital stay. Early oral feeding was considered an important component of enhanced recovery after surgery (ERAS) protocols, as it potentially supported intestinal function, improved nutritional intake, and facilitated earlier mobilization. In contrast, delayed oral feeding traditionally involved withholding food and fluids until the return of bowel sounds or passage of flatus [9]. The comparison highlighted the clinical importance of selecting an appropriate feeding strategy to optimize postoperative outcomes and reduce hospital resource utilization. Early oral feeding was associated with the potential advantage of promoting earlier recovery of gastrointestinal function. Initiating oral intake soon after surgery may have supported intestinal motility and reduced the consequences of prolonged fasting. Delayed feeding, although historically adopted to minimize gastrointestinal discomfort and aspiration concerns, could have unnecessarily prolonged nutritional deprivation in patients who were otherwise clinically stable [10]. These observations were consistent with contemporary colorectal surgical practices, which increasingly favored early feeding according to patient tolerance rather than waiting for complete resolution of postoperative ileus. However, the benefits depended on individual clinical circumstances and the absence of contraindications to oral intake. Postoperative recovery represented another important outcome of the comparison. Early feeding could have contributed to improved energy intake, reduced weakness, and facilitated mobilization during the initial postoperative period [11]. Adequate nutritional support was particularly relevant after colorectal surgery because surgical stress increased metabolic demands and could have contributed to muscle loss and delayed functional recovery. Patients receiving delayed feeding might have experienced a longer period of nutritional insufficiency, particularly when oral intake remained restricted for several days. Nevertheless, recovery also depended on factors such as surgical technique, perioperative fluid management, pain control, preoperative nutritional status, and the presence of comorbidities. Therefore, feeding strategy alone could not have explained all differences in recovery outcomes [12]. Length of hospital stay was a particularly important measure because it reflected both clinical recovery and healthcare resource utilization. Earlier tolerance of oral intake, improved gastrointestinal function, and timely mobilization could have facilitated discharge among patients assigned to early feeding. Reduced hospitalization could also have lowered treatment costs and decreased exposure to hospital-associated complications [13]. However, discharge decisions were influenced by additional factors, including pain control, wound condition, bowel function, availability of home support, and institutional discharge protocols. Consequently, any observed reduction in hospital stay needed to be interpreted alongside these clinical and organizational considerations. The safety of early oral feeding also required careful evaluation. Potential concerns included nausea, vomiting, abdominal distension, feeding intolerance, and postoperative complications. However, early feeding did not necessarily increase these risks when patients were appropriately selected and monitored. A gradual approach, beginning with small amounts of oral fluids or food according to tolerance, could have helped clinicians identify patients who required additional assessment [14]. Delayed feeding might have remained appropriate for selected patients with persistent vomiting, significant gastrointestinal dysfunction, hemodynamic instability, or other contraindications. Thus, individualized clinical judgment remained essential throughout postoperative management. The findings of this comparison needed to be interpreted in light of methodological limitations. If the study involved a relatively small sample, its statistical power to detect uncommon complications might have been limited. Differences in surgical procedures, baseline characteristics, and postoperative care could also have influenced the outcomes [15]. Furthermore, a single-center design could have restricted the generalizability of the results to other healthcare settings. In conclusion, early oral feeding appeared to offer a practical approach to supporting postoperative recovery and potentially shortening hospital stay after elective colorectal surgery. Its benefits needed to be balanced against individual tolerance and clinical safety. Larger, well-designed randomized controlled trials were warranted to establish its comparative effectiveness and identify patients most likely to benefit from early postoperative nutritional intake.

The study concluded that early oral feeding after elective colorectal surgery was associated with improved postoperative recovery and a shorter hospital stay compared with delayed oral feeding. Patients who received early oral feeding demonstrated earlier restoration of gastrointestinal function, better tolerance of oral intake, and potentially reduced postoperative complications related to prolonged fasting. Early feeding also supported nutritional recovery and contributed to enhanced patient comfort and satisfaction. In comparison, delayed oral feeding prolonged the period of nutritional deprivation and could have contributed to slower recovery in some patients. The findings supported the incorporation of early oral feeding into postoperative care protocols for suitable patients undergoing elective colorectal surgery. However, feeding initiation required individualized assessment based on clinical stability, gastrointestinal tolerance, and the presence of postoperative complications. Overall, early oral feeding appeared to be a safe and beneficial approach that facilitated recovery and reduced hospitalization when implemented with appropriate monitoring and clinical judgment.