Benefits of Early Enteral Feeding with a Locally Prepared Protein-Energy Ration after Surgery for Acute Generalised Peritonitis: A Randomised Trial in Two Hospitals in Bukavu, Eastern Democratic Republic of Congo

Abstract

Background. Acute generalised peritonitis (AGP) is a common and serious digestive surgery pathology. Undernutrition exacerbates patient condition and compromises their postoperative prognosis. Early enteral nutrition is recommended to reduce postoperative complications, but its availability and cost are problematic in low-income countries. The objective of this study was to evaluate the impact of providing early enteral feeding (EEF) to postoperative patients with intestinal perforation AGP using a locally prepared protein-energy food ration in two hospitals in Bukavu, a city of South Kivu, in the eastern part of the Democratic Republic of Congo. Methods. A prospective, randomised controlled trial with two groups of patients was conducted to investigate the effects of EEF with a local mixture versus enteral feeding after peristalsis had returned (control group) in patients who underwent laparotomy for AGP caused by ileal perforation. The local mixture consisted of soybean, maize, white rice, and pineapple. The trial included 66 patients with ileal perforation peritonitis. Results. The results comparing early enteral fed and nonfed patients showed significant differences in peristalsis recovery time (2.1 (0.6) days vs. 3.8 (1.2) days, $p<0.0001$ ) and length of hospital stay (25.5 (14.9) days vs. 39.4 (25.3) days, $p=0.0046$ ). Bivariate analyses indicated a significant early enteral feeding (EEF) reduced of 9.1% (vs. 36.4%, $p=0.0082$ ) in parietal infections and 3.4% (28.1%, $p=0.009$ ) in fistulas ( $p=0.009$ ) when EEF was included. In addition, EEF significantly reduced reintervention rates by 9.1% ( $p=0.0003$ ) and eliminated evisceration rates. EEF was also shown to reduce the incidence of malnutrition by 63.6% ( $p<0.0001$ ). Multivariate analysis showed that enteral nutrition significantly reduced the time to recovery of peristalsis ( $p=0.0278$ ) with an ORa of 0.3 and a 95% CI of 0.1-0.9. Moreover, EEF reduced malnutrition ( $p=0.0039$ ) with an ORa of 0.1 and a 95% CI of 0-0.4. Conclusion. EEF with locally sourced protein-energy rations can enhance a patient’s nutritional status and facilitate postoperative recovery. This procedure is advantageous and involved early enteral nutrition using locally manufactured rations, especially for those operated on for acute generalised peritonitis in the Democratic Republic of Congo.