Kelulut Honey as an Alternate Source of Carbo-Loading in Abdominal Surgery Involving the Digestive System: A Randomised Blinded Comparative Study.

Abstract

Background: Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care programme aimed at expediting recovery, reducing complications and minimising hospital stay by mitigating the metabolic stress response to surgery. One key shift in ERAS protocols is the replacement of traditional overnight fasting with carbohydrate-loading. Prolonged fasting increases insulin resistance, reduces cellular glucose uptake and glycogen formation, and may lead to hyperglycaemia. While maltodextrin is commonly used for carbohydrate-loading, it has a high glycaemic index and limited nutritional value. Kelulut Honey, a natural product rich in Trehalulose (a low-GI sugar), antioxidants, proteins, and vitamins may serve as a beneficial alternative.

Methods: A randomised double-blind controlled trial involving 64 patients was conducted to evaluate the safety and efficacy of Kelulut Honey as a carbohydrate-loading agent in patients undergoing elective intra-abdominal surgery. Participants received either Kelulut Honey or commercial maltodextrin (Carborie^®) according to ERAS protocol. Outcomes assessed included insulin resistance, residual gastric volume (RGV) and post-operative recovery parameters.

Results: No significant difference was observed in blood glucose levels between the two groups. Average blood glucose at induction ranged from 5.3 to 5.6 mmol/L, with post-operative levels remaining below 10 mmol/L. Most participants passed flatus within 12 hours post-operatively, with over half ambulating and tolerating clear fluids within the same period. No significant differences were noted between groups in terms of complications, length of stay, pain control, or functional recovery. Intention-to-treat analysis confirmed comparable outcomes across all primary and secondary endpoints.

Conclusion: Kelulut Honey is a safe and effective alternative to conventional carbohydrate drinks for pre-operative carbo-loading in abdominal surgery. It supports a modern shift away from the traditional surgical dogma of overnight fasting, with equivalent outcomes in glynaecmic control, RGV, and recovery compared to maltodextrin-based solutions.