Prophylactic nasogastric decompression after abdominal surgery

Abstract

BackgroundRoutine use of nasogastric tubes after abdominal operations is intended to hasten the return of bowel function, prevent pulmonary complications, diminish the risk of anastomotic leakage, increase patient comfort and shorten hospital stay. ObjectivesTo investigate the efficacy of routine nasogastric decompression after abdominal surgery in achieving each of the above goals. Search methodsSearch terms were nasogastric, tubes, randomised, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (Central) and references of included studies, from 1966 through Sep 2009. Selection criteriaPatients having abdominal operations of any type, emergency or elective, who were randomised prior to the completion of the operation to receive a nasogastric tube and keep it in place until intestinal function had returned, versus those receiving either no tube or early tube removal, in surgery, in recovery or within 24 hours of surgery. Excluded will be randomised studies involving laparoscopic abdominal surgery and patient groups having gastric decompression through gastrostomy. Data collection and analysisData were abstracted onto a form that assessed study eligibility, as defined above, quality related to randomizations, allocation concealment, study size and dropouts, interventions, including timing and duration of intubation, outcomes that included time to flatus, pulmonary complications, wound infection, anastomotic leak, length of stay, death, nausea, vomit ting, tube reinsertion, subsequent ventral hernia. Main results37 studies fulfilled eligibility criteria, encompassing 5711 patients, 2866 randomised to routine tube use, and 2845 randomised to selective or No Tube use. Patients not having routine tube use had an earlier return of bowel function (p<0.00001), a decrease in pulmonary complications (p=0.09) and an insignificant trend toward increase in risk of wound infection (p=0.39) and ventral hernia (0.09). Anastomotic leak was no different between groups (p=0.70). Vomiting seemed to favour routine tube use, but with increased patient discomfort. Length of stay was shorter when no tube was used but the heterogeneity encountered in these analyses make rigorous conclusion difficult to draw for this outcome. No adverse events specifically related to tube insertion (direct tube trauma) were reported. Other outcomes were reported with insufficient frequency to be informative.

Naso-gastric or naso-jejunal decompression after partial distal gastrectomy for gastric cancer. Final results of a multicenter prospective randomized trial

“…Many clinical studies have suggested that this practice does not provide any benefit but could increase patient discomfort and respiratory complications [1][2][3]. Furthermore, three recent meta-analyses concluded that nasogastric or nasojejunal decompression does not promote the recovery of gastrointestinal function or reduce the incidence of postoperative complications after gastrectomy for gastric cancer and after abdominal surgery [4][5][6].…”

Ostomy Closures in Children: Variations in Perioperative Care Do Not Change the Outcome

“…In fact, some studies have shown a lower incidence of atelectasis and pulmonary complications in patients who did not undergo NG decompression [12]. The routine postoperative use of an NG catheter is reportedly unnecessary in most major abdominal operations in children [11,12]. An NG catheter was used routinely in our series, and the routine catheter withdrawal time varied depending on the surgeon's preference despite the lack of other influencing factors, such as intestinal adhesions.…”

“…Surgeons classically use an NG catheter to speed up the return of bowel function after abdominal surgery, prevent lung complications, reduce the risk of anastomotic leakage, increase patient comfort, and shorten the inpatient period [11]. These theoretical advantages have not been supported by properly planned studies.…”

Current perioperative practice in Canadian vascular surgery

“…These results are contrasted by a survey of general surgeons, who use nasogastric tubes less frequently, and are supported by more robust evidence specific to their specialty. 3,17 The use of both postoperative nasogastric tubes and nonabdominal drains are areas of perioperative management that would therefore benefit from focused research in vascular surgery.…”

“…2 Attempts in specialties such as general surgery have been made to create a perioperative practice that reflects current evidence. [3][4][5] For example, the Enhanced Recovery After Surgery (ERAS) Society was formed to aggregate various evidence-practice gaps into a "multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery." 6 The ERAS Society has published 3 specific guidelines for perioperative practice specific to the practice of general surgery.…”