***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND In our clinical setting , patients with perforative peritonitis are frequently malnourished . Immediate postoperative enteral feeding has been shown effective in reducing septic morbidity in patients with abdominal trauma . This study was design ed to investigate the feasibility and efficacy of immediate postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis . STUDY DESIGN A prospect i ve study spanning 1 year was conducted on patients with nontraumatic intestinal perforation and peritonitis . After laparotomy , patients were assigned r and omly to a control or study group . The study group underwent a feeding jejunostomy and received enteral feeding from 12 hours postoperatively . A low-residue , milk-based diet was used . All patients underwent assessment for severity of sepsis and nutritional status at admission . Studies of nutritional status and nitrogen balance were repeated on days 4 and 7 . RESULTS Forty-three patients ( 21 in the study group ; 22 in the control group ) were included . The two groups were comparable except for a higher sepsis score in the study group ( p < 0.05 ) . Patients in the study group achieved a positive nitrogen balance by the third postoperative day ; patients in the control group remained in negative nitrogen balance throughout the study . Abdominal distention ( four patients ) required temporary withdrawal of feeding . Diarrhea occurred in four patients but was controlled easily . The mortality rate was similar in the control and study groups ( 18.2 % versus 19.1 % ) . The control group had a total of 22 septic complications , versus eight in the study group ( p < 0.05 ) . CONCLUSIONS Immediate postoperative feeding is feasible in patients with perforative peritonitis and reduces septic morbidity Background A r and omized controlled trial was performed to assess the outcome of early oral postoperative feeding ( EOF ) compared with traditional oral feeding ( TOF ) in gynecologic oncology patients undergoing a complex laparotomy , including upper abdominal surgery . Methods Patients aged 18–75 years , undergoing an elective laparotomy and with a preoperative suspicion of gynecologic malignancy , were eligible . Exclusion criteria included infectious conditions , intestinal obstruction , severe malnutrition , American Society of Anesthesiologists score ≥4 , intestinal resection , and postoperative stay in the intensive care unit lasting > 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet . Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet . The primary end-point of the trial was length of hospital stay . Results Between January 1 , 2007 , and November 17 , 2007 , a total of 143 patients were r and omized to receive either EOF or TOF . Hospital stay for patients who received EOF ( n = 71 ) was 4.7 vs. 5.8 days for the TOF group ( n = 72 ) ( P = 0.006 ) . The mean level of postoperative satisfaction was significantly higher in the EOF group ( 82.8 vs. 71.7 mm , P ≤ 0.001 ) . Patients who received the TOF scheme had significantly higher overall postoperative complications ( 39 vs. 17 % in EOF group , P = 0.003 ) and infective complications ( 14 % in TOF group vs. 3 % in EOF group , P = 0.017 ) . Variables such as nausea and vomiting , analgesic and antiemetic requirement as well as level of pain and quality of life were not different between groups . Conclusions On the basis of these findings , the policy of EOF should be used after a complex gynecologic oncologic laparotomy Postoperative ileus following gynecologic surgery can prolong hospitalization and may predispose patients to mechanical obstruction . Our objective was to study the safety and efficacy of a water-soluble , hyperosmolar , radiocontrast material in the management of postoperative ileus in patients having gynecologic surgery . Of 115 cases , 57 were studied prospect ively and received water-soluble radio-opaque contrast material via a nasogastric tube if bowel function had not returned by the third day . Fifty-eight well-matched control cases were managed without this material and received a suppository on the third day . The contrast material was well tolerated . Return of bowel function , day of oral intake , subsequent postoperative recovery , and duration of hospital stay were similar in the two groups . Water-soluble , hyperosmolar , radio-opaque contrast material given on the third postoperative day was safe , but of no apparent clinical benefit in resolving ileus following gynecologic surgery Background A r and omized controlled trial was performed to assess the outcome of early oral postoperative feeding ( EOF ) compared with traditional oral feeding ( TOF ) in gynecologic oncology patients undergoing laparotomy with associated intestinal resection . Methods Patients aged 18–75 years , undergoing elective laparotomy , and with preoperative diagnosis of gynecologic malignancy , were eligible . Exclusion criteria included infectious conditions , intestinal obstruction , severe malnutrition , American Society of Anesthesiologists ( ASA ) score ≥4 , and postoperative stay in the intensive care unit lasting > 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet . Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet . The primary end-point of the trial was length of hospital stay . Results Between January 1st , 2007 and March 15th , 2008 , 40 patients were r and omized to receive either EOF or TOF  . Hospital stay in patients who received EOF ( n = 18 ) was 6.9 days versus 9.1 days in the TOF group ( n = 22 ) ( P = 0.022 ) . Requirements for analgesic and antiemetic drugs , intensity of pain , intestinal function recovery , mean levels of postoperative satisfaction , postoperative complications , and quality -of-life scores did not differ between the two groups . Conclusion Early resumption of oral intake is feasible and safe in gynecologic oncology patients undergoing intestinal resection as part of a planned surgical procedure . Moreover , significant reduction in length of hospital stay was demonstrated Objective To compare early feeding with traditional postoperative dietary management for development of postoperative gastrointestinal symptoms , including ileus after major gynecologic surgery for benign conditions . Methods Women who had major gynecologic surgery for benign conditions were r and omly allocated to early feeding of low residue diets 6 hours postoperatively or traditional dietary management of clear liquids with normal bowel sounds , and regular diet with passage of flatus . Demographic and perioperative data were collected , and patients answered question naires on their perception of bowel function and pain using the McGill Pain Scale . Power analysis found that 130 women were needed to find a twofold greater incidence of ileus in the early feeding group with 80 % power and & agr ; = .05 . Results Complete data were available for 139 women , 67 allocated to the early feeding group and 72 to the late feeding group . The incidence of postoperative ileus for the study population was 4.4 % and did not differ between groups ( early 3 % versus late 5.8 % , P = .68 ) . There were no differences in patient demographics , surgical procedures , anesthesia used , and intraoperative complications between groups . With the exception of more complaints of nausea in the late feeding group ( 23 % versus 13 % , P = .04 ) , there were no differences in other postoperative variables , including other perioperative complications , pain medicine requirements , fluid and caloric intake , median pain scores , and gastrointestinal function . The low incidence of perioperative complications made the power to detect differences between groups low . Conclusion Low residue diet 6 hours after major gynecologic surgery for benign indications was not associated with increased postoperative gastrointestinal complaints , including ileus To explore and evaluate the safety and efficacy of early oral intake following major abdominal gynecological oncology surgery . During an 11-month period , 60 gynecological oncology patients undergoing major intra-abdominal surgery were enrolled in a r and omized controlled clinical trial of semiliquid diet ( experimental group ) compared with clear feeds ( control group ) 6 hours after operation . Patients were evaluated for nausea , vomiting , bowel sound , passage of flatus , body weight difference before and after operation , urine acetone , fasting blood sugar , and prealbumin level , and need for nasogastric tube decompression . There were significantly higher incidences of nausea , shorter time of regular diet resumption , and higher level of prealbumin on postoperative day 7 in patients from the experimental group than those from the control group ( P < .05 ) . No significant differences were found in vomiting , the time to development of bowel sound and passage of flatus , body weight difference before and after operation , urine acetone and fasting blood sugar on postoperative day 1 , and prealbumin level on postoperative day 2 between the 2 groups . Early oral intake with semiliquid diet 6 hours after major intra-abdominal gynecological oncology surgery is safe and well tolerated OBJECTIVE To prospect ively evaluate the safety and efficacy of a regular diet as the first meal after intraabdominal surgery in gynecologic oncology patients . METHODS During a 20‐month period , 254 gynecologic oncology patients undergoing intraabdominal surgery were enrolled in a r and omized controlled trial of a clear liquid diet compared with a regular diet as the first postoperative meal . All patients received their first meal on the first postoperative day in the absence of nausea , vomiting , or symptomatic abdominal distension . St and ard criteria for discharge were used for all study patients . RESULTS The clear liquid and the regular diet groups were similar in age , disease , surgical procedure distribution , surgery length , and estimated blood loss . The incidence of nausea , vomiting , abdominal distention , frequency and duration of nasogastric tube use , passage of flatus before discharge , and percentage of patients who tolerated their diets on the first attempt were comparable for both groups . For those patients who were intolerant of the first attempt at either a clear liquid or regular diet , the time to tolerance was comparable for both groups . The time to development of bowel sounds , passage of flatus , and hospital stay were comparable for both groups . Febrile morbidity , pneumonia , wound complications , and atelectasis occurred equally in both groups . There were no known anastamotic complications or aspirations in either group . Postoperative changes in hematologic indices and electrolytes were comparable in both groups . CONCLUSION A regular diet as the first meal after intraabdominal surgery in gynecologic oncology patients is safe and efficacious OBJECTIVE To evaluate the feasibility , safety , and tolerance of early feeding in patients undergoing surgery for gynecologic malignancies . METHODS Patients were stratified according to operative time and type of tumor and were r and omized into two arms : A ) early oral feeding and B ) nasogastric decompression followed by feeding at the first passage of flatus . Variables assessed included nausea , vomiting , time to first passage of flatus and stool , time elapsed before adequate tolerance of a regular diet , postoperative stay , and complications . RESULTS Sixty-one patients were r and omized into each arm . The types of tumor , the surgical procedures performed , and the operative times were similar in both groups . Early oral feeding in patients in arm A was associated with a significantly faster resolution of postoperative ileus ( P < .01 ) , with a more rapid return to a regular diet ( P < .01 ) , with an earlier first passage of stool ( P < .01 ) , and with a shorter postoperative stay ( P < .05 ) than patients in arm B. Rates of nausea and vomiting were similar in both arms . Hindered deglutition and nasal soreness caused by the nasogastric tube were observed in 88 % of patients in arm B. Insertion of a nasogastric tube was necessary in six patients in arm A ( 10 % ) , and three of these had postoperative complications . Thus , early feeding was feasible in 95 % of patients and did not seem to be related to preoperative chemotherapy , tumor type , or lymphadenectomy . CONCLUSION Early feeding is feasible and well tolerated and is associated with reduced postoperative discomfort and a more rapid recovery in patients undergoing major surgery for gynecologic malignancies INTRODUCTION Postoperative traditional feeding protocol s are not based on scientific studies , but rather on anecdotal evidence . We present the first prospect i ve trial of aggressive postoperative bowel stimulation following radical hysterectomy in an attempt to determine its effect on the length of hospital stay . METHODS Twenty consecutive patients undergoing radical hysterectomy were entered onto a prospect i ve trial of aggressive postoperative bowel stimulation , which consisted of 30 cc milk of magnesia p.o . b.i.d . starting on postoperative day 1 and biscolic suppositories q.d . starting on day 2 . A clear liquid diet was begun following flatus or bowel movement and patients were discharged 12 h after tolerating a clear liquid diet . Diet was slowly advanced at home . RESULTS Median time to flatus was 3 days , bowel movement 3 days , and clear liquid diet 3 days . Median time to discharge was 4 days . No patients developed ileus or bowel obstructions and there were no readmissions for bowel complications . Our median time to discharge of 4 days represents a 5 
    Output:
    
Early postoperative feeding after major abdominal gynaecologic surgery for either benign or malignant conditions appeared to be safe without increased gastrointestinal morbidities or other postoperative complications .
The benefits of this approach include faster recovery of bowel function , lower rates of infectious complications , shorter hospital stay , and higher satisfaction