Nasogastric Decompression in Cholecystectomy, Is It Necessary?

Abstract

Nasogastric decompression seems to be widely employed in cholecystectomiesdespite evidence to the contrary. Based on a questionnaire given to 100 surgeons routinely doing cholecystectomies we found decompression being employed by the majority. 43% were unwilling to change their protocol. Our prospective randomised controUed trial of 162 cholecystectomies was done to assess intubation morbidity, related complications and influence on recovery. The objective was to determine if nasogastric decompression was scientifically based or conjectural. 130 patients underwent elective surgery and 32 required surgery for acute cholecystitis or associated common bile duct exploration. Both groups were randomised into tube and no-tube groups. The incidence of nausea, vomiting, distension and respiratory complications were noted and revealed no statistically significant group differences. No tube groups had earlier return of bowel motility, required lesser parenteral support and were discharged earlier compared to intubated patients. Out of81 patients without decompression, only 7(8.6%) needed intubation due to vomiting whereas 2(3%) intubated cases required reinsertion of the tube due to ileus. Detailed analysis of these patients did not reveal any predictive criteria for selective intubation. We conclude that nasogastric decompression is used indiscriminately without scientific reasoning. Our prospective randomised trial does not favour intubation in elective or emergency setting for cholecystectomies. Intubation is needless in 92% cases and delays recovery. No criteria could be identified to preselect patients for intubation. MJAFI 2000, 56 : 17-20

Colecistectomía segura: ¿Qué es y cómo hacerla? ¿Cómo lo hacemos nosotros?

“…Recomendamos el uso de antibiótico profiláctico para prevenir infecciones postoperatorias, además del uso de medidas antitromboembólicas 15,16 . La inserción de sonda nasogástrica intraoperatoria no se recomienda de rutina, excepto en los casos de distensión gástrica, para mejor la identificación del campo quirúrgico 17 . La sonda Foley no se usa de forma rutinaria.…”