Study of Practices of Use of Nasogastric Tube Decompression in Gastrointestinal Tract Surgery

Abstract

BACKGROUND Since its inception by Levin in 1921 and popularisation by Wangensteen in 1933, nasogastric suction has become one of the routine procedures in postoperative abdominal surgery and yet there is little scientific justification. With the advent of fast track and day care surgery in this modern era, the search for postoperative care protocols which reduces costs, post-operative morbidity and shortens the duration of hospital stay continues to dominate surgical practice. MATERIALS AND METHODS The study design is an observational prospective one, conducted in the Department of Surgery of Krishna Hospital and Medical Sciences, Karad. Over a period of 18 months between August 2014 and May 2016, a total of 314 cases of both sexes admitted to surgical wards and underwent emergency or elective abdominal operations were collected. Inclusion criteria included all gastrointestinal tract surgeries. Exclusion criteria included patients who underwent oesophagectomy (These patients needs nasogastric tube as an absolute indication) and patients of gynaecological surgeries. Patients were allocated into two groups: Group I (Those with nasogastric tube) and Group II (Those without nasogastric tube) and in both groups patients were divided into elective and emergency cases. RESULTS The distribution of duration of hospital stay differs significantly across two study groups (P value < 0.001). Significantly higher proportion of cases from Group 1 had higher length of hospital stay compared to Group 2 cases (P value < 0.001). The distribution of duration of hospital stay differs significantly across two study groups (P value < 0.001). Significantly, higher proportion of cases from Group 1 had higher length of hospital stay compared to Group 2 cases (P value < 0.001). The distribution of duration of postoperative return of bowel sound differs significantly across two study groups (P value < 0.001). Significantly, higher proportion of cases from Group 1 had higher duration of postoperative return of bowel sound compared to Group 2 cases (P value < 0.001). The distribution of incidence of pulmonary complications did not differ significantly across two study groups (P value > 0.05). CONCLUSION The study recommends that routine use of NGT in patients undergoing abdominal surgery is unnecessary and unjustified. It should only be used in specific cases as a therapeutic measure, especially in those who present with gross abdominal distension and excessive vomiting. Postoperatively, nasogastric decompression should be continued in surgeries of upper gastrointestinal tract like intestinal perforation primary closure, resection and anastomosis of upper gastrointestinal tract, biliary tract surgeries where upper gastrointestinal tract has been used for anastomosis and adhesiolysis surgeries, where patient usually remains in postoperative ileus. In these cases, nasogastric tubes should be used as a therapeutic rather than a prophylactic tool.