Postoperative Nasogastric Decompression: A Prospective Randomized Trial

Systematic review of prophylactic nasogastric decompression after abdominal operations

“…One9 was a follow‐up report with a new outcome (ventral hernia) from a group of patients reported previously7. A broad range of abdominal surgery was covered in these papers; there were seven on colorectal surgery3, 7, 10–14, seven on gastroduodenal surgery2, 15–20, two each on biliary21, 22 and gynaecological23, 24 surgery, one each on vascular25 and emergency trauma26 surgery, and seven that included all facets of abdominal surgery1, 4, 6, 27–30. The included publications described 4195 participants, 2108 randomized to prophylactic nasogastric tube insertion for postoperative decompression, and 2087 randomized to no tube in the postoperative period.…”

“…With such a short‐term intervention in patients confined to hospital, drop‐outs should have been rare. Only four studies reported a drop‐out rate that was greater than 10 per cent1, 2, 15, 19. Inclusion criteria were poorly specified or absent in several papers6, 17, 18 and comparability of the two participant groups was difficult to assess in several3, 6, 15, 17, 28.…”

“…The reason for such an activity may be either therapeutic, as in patients with distension and vomiting from bowel obstruction, diagnostic, as in the case of gastrointestinal bleeding or peptic ulcer disease, or prophylactic, as in patients having major abdominal surgery. The prophylactic use of nasogastric tubes, flexible tubes inserted through the nose, pharynx, oesophagus and into the stomach, after abdominal operations has happened only in the past century, becoming so prevalent that it has been variously described up to 2002 as ‘the standard of care’1, ‘traditionally used by most surgeons’2, ‘common practice’3–5, ‘unquestioned’6, and ‘routine’7. What is to be achieved by this prophylaxis is gastric decompression, a decreased likelihood of nausea and vomiting, decreased distension, less chance of pulmonary aspiration and pneumonia, less risk of wound separation and infection, less chance of fascial dehiscence and hernia, earlier return of bowel function, and earlier discharge from hospital.…”

“Fast Track” nasogastric decompression of rectal cancer surgery

“…The treatment is useful in decreasing abdominal distension, relieving nausea and vomiting, while serving as a marker for gastrointestinal hemorrhage. In the past century, it was widely accepted as routine for abdominal operations [10]. However, controversies regarding the necessity of such intervention for all abdominal operations, especially in the lower digestive tract, have arisen [11].…”

Antibiotikaprophylaxe und endoluminäre Sonden

“…Trotz Berichten über eine gesteigerte Aspirationsgefahr [18] sehen verschiedenste Autoren die Verwendung von Magensonden als "Therapiestandard" [19] oder "übliche Praxis" [18] an. In einer 1995 publizierten Metaanalyse kamen die Autoren zu dem Schluss, dass die Verwendung von Magensonden lediglich die Wahrscheinlichkeit des postoperativen Erbrechens reduziert.…”