Abstract: Rates of developing postoperative ileus were comparable between study groups (RR 0.47, 95% CI 0.17 to 1.29, P = 0.14, 3 RCTs, 279 women, I² = 0%, moderate-quality evidence). When we considered the rates of nausea or vomiting or both, there was no evidence of a difference between the study groups (RR 1.03, 95% CI 0.64 to 1.67, P = 0.90, 4 RCTs, 484 women, I² = 73%, moderate-quality evidence). There was no evidence of a difference between the study groups in abdominal distension (RR 1.07, 95% CI 0.77 to 1.47, 2 RCTs, 301 women, I² = 0%) or a need for postoperative nasogastric tube placement (RR 0.48, 95% CI 0.13 to 1.80, 1 RCT, 195 women). Early feeding was associated with shorter time to the presence of bowel sound (MD -0.32 days, 95% CI -0.61 to -0.03, P = 0.03, 2 RCTs, 338 women, I² = 52%, moderate-quality evidence) and faster onset of flatus (MD -0.21 days, 95% CI -0.40 to -0.01, P = 0.04, 3 RCTs, 444 women, I² = 23%, moderate-quality evidence). In addition, women in the early feeding group resumed a solid diet sooner (MD -1.47 days, 95% CI -2.26 to -0.68, P = 0.0003, 2 RCTs, 301 women, I² = 92%, moderate-quality evidence). There was no evidence of a difference in time to the first passage of stool between the two study groups (MD -0.25 days, 95% CI -0.58 to 0.09, P = 0.15, 2 RCTs, 249 women, I² = 0%, moderate-quality evidence). Hospital stay was shorter in the early feeding group (MD -0.92 days, 95% CI -1.53 to -0.31, P = 0.003, 4 RCTs, 484 women, I² = 68%, moderate-quality evidence). Infectious complications were less common in the early feeding group (RR 0.20, 95% CI 0.05 to 0.73, P = 0.02, 2 RCTs, 183 women, I² = 0%, high-quality evidence). In one study, the satisfaction score was significantly higher in the early feeding group (MD 11.10, 95% CI 6.68 to 15.52, P < 0.00001, 143 women, moderate-quality evidence). 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.

Plain-language summary: We assessed evidence on the following outcomes: 1. Nausea, vomiting, cramping abdominal pain, bloating, abdominal distension, wound complication, deep venous thrombosis, urinary tract infection, pneumonia. 2. Time to first: bowel sound, gas, stool, start of regular diet. 3. Length of hospital stay Early feeding was defined as having fluids or food within 24 hours of surgery. Delayed feeding was defined as having fluids or food 24 hours after surgery, and only if there are bowel sounds, passage of gas or stool, and a feeling of hunger. The evidence is current to April 2014 We included five published studies of 631 women, mainly with gynaecologic cancer. Recovery of bowel function was faster in those with early feeding. There was no difference in rates of nausea or vomiting, abdominal distension, need for a postoperative nasogastric tube or time to first bowel movement, but early feeding was associated with a shorter time to bowel sounds and onset of gas. The early feeding group resumed a solid diet 1½ days sooner than those having delayed feeding and the hospital stay was one day shorter. Also, the early feeding group were more satisfied with the feeding schedule, although only one study reported this. Early feeding appeared safe, without increased postoperative complications and with fewer infectious complications overall. Most of the evidence was moderate quality. The main limitation was lack of blinding, which could influence the findings for subjective outcomes such as self-reported symptoms, hospital stay, patients' satisfaction and quality of life. The evidence suggests that eating and drinking on the first day after abdominal gynaecologic surgery is safe and could reduce the length of hospital stay.