The necessity for routine postoperative nasogastric intubation was studied in a group of 149 patients. All patients underwent major abdominal surgery. The patients were randomized preoperatively in a group without a nasogastric tube (group A, n = 74), or in a group with a nasogastric tube for at least 36 h postoperatively (group B, n = 75). No differences between the groups were found in postoperative physical signs as first bowel sounds, passage of first flatus, first defecation, and resumption of normal oral feeding. The incidence of postoperative nausea (group A: 23%, group B: 25.3%) and vomiting (group A: 20.3%, group B: 20.1 %) did not differ between the groups. Postoperative insertion of a nasogastric tube because of severe nausea or vomiting was necessary in only 5 patients in group A (6.8%). Nausea occurred in 12 of the 19 patients in group B despite the presence of a nasogastric tube; 83% of the patients in group B complained about moderate to severe discomfort caused by the tube. It is concluded that the routine use of postoperative nasogastric drainage after major abdominal surgery does not prevent symptoms attributed to gastroparesis like nausea and vomiting. Therefore, the rationale for routine postoperative nasogastric intubation is lacking.