Impact of Coffee Versus Orange Juice on Enhancing Bowel Recovery After Laparoscopic Colorectal Surgery: A Randomized Controlled Trial

Background Postoperative ileus remains a common issue after colorectal surgery, even with minimally invasive techniques and enhanced recovery after surgery (ERAS) pathways. Simple, low-cost oral interventions such as coffee may help accelerate bowel recovery (1–3). Objective To compare the effect of standardized postoperative coffee intake versus fresh orange juice on bowel recovery after elective laparoscopic colorectal resection. Methods In this multicenter randomized controlled trial, 476 adults undergoing elective laparoscopic colorectal resection with primary anastomosis were randomized 1:1 to receive either black coffee or fresh orange juice (150 mL three times daily) starting on postoperative day (POD) 1 for two days. All patients were managed within ERAS-aligned pathways. The primary endpoint was time to first bowel movement. Secondary endpoints included time to first flatus, number of bowel movements until discharge, laxative use, postoperative nasogastric tube insertion, length of hospital stay (LOS), and postoperative complications. Analyses followed an intention-to-treat approach with a per-protocol sensitivity analysis (4, 5). Results Of 476 randomized patients (238 coffee, 238 orange juice), baseline and operative characteristics were comparable. Coffee significantly shortened time to first bowel movement (median 47.5 vs 73 h; p < 0.001) and time to first flatus (median 23 vs 36 h; p < 0.001), and reduced LOS (mean 3.16 vs 5.10 d; p < 0.001). Findings were consistent in the per-protocol cohort. Rates of postoperative ileus, surgical site infection, reoperation, readmission, and anastomotic leakage (grade A/B) were low and similar between groups. Conclusion Standardized postoperative coffee intake within an ERAS framework significantly accelerates bowel recovery and shortens LOS after laparoscopic colorectal surgery compared with fresh orange juice, without increasing complications. Coffee is a simple, safe, and inexpensive adjunct that may be incorporated into ERAS protocols for colorectal surgery.