The reinstitution of oral intake in patients who have undergone intra-abdominal surgery has traditionally progressed in a stepwise fashion. Various retrospective studies and anecdotal reports have suggested that a "regular" diet as the first postoperative meal is well tolerated. Although clear liquids are accepted as the standard first postoperative meal, there appears to be little scientific data to support their use. The current study was undertaken to determine whether there is any difference in tolerance to clear liquids versus a regular diet as the first postoperative oral intake. This study is not intended to suggest that clear liquid diets harm patients but to attempt to support our hypothesis that a regular diet as the first postoperative meal is not associated with and increased morbidity. A total of 241 patients undergoing abdominal operations were prospectively randomized to receive either routine clear liquids (N=135) or regular diet (N=106) as the first oral intake. They were followed for any symptoms or signs of dietary intolerance. The group receiving a regular diet was not found to have any statistically significant increase in dietary intolerance in comparison with the clear liquid group. Nutritional data collected in a subset of patients revealed a higher caloric intake in those assigned to a regular diet. These results suggest that the routine use of clear liquids as the initial postoperative diet may be unnecessary and nutritionally suboptimal when compared with a regular diet.