Elective bowel surgery with or without prophylactic nasogastric decompression: A prospective, randomized trial

Abstract

Introduction:Routinely postoperative nasogastric decompression was done until the nasogastric drainage is minimal, reoccurrence of bowel sounds and passing flatus. But prolonged nasogastric intubation is associated with complications like basal atelectasis due to poor cough reflux, loss of electrolytes and increased patient morbidity.Aims and Objectives:To study the need for routine use of nasogastric tube post operatively in bowel surgeries with reference to (1) Return of bowel movements (2) Compare the incidence of complications (3) Duration of hospital stay.Methodology:100 patients who underwent elective bowel surgery were randomized into two groups: Study group (50): Nasogastric tube was removed immediately after operation or in the recovery room. Control group (50): Underwent nasogastric tube removal postoperatively after the patient passed flatus and audible bowel sounds on auscultation.Results:Incidence of complications were less in the study group i.e., only three patients had vomiting, and two patients had abdominal distension which lead to postponement of oral feeds. Most of our control group patients complained of discomfort and difficulty in coughing and in bringing out sputum, which was the probable cause for high incidence of pulmonary complications.Conclusion:Routine use of the nasogastric tube adjunct to patient care following bowel surgery may be safely eliminated.

Post Operative Bowel Movement

“…The time of removal of NG tube in control group ranged from 2 to 6 days., whereas, the first postoperative bowel sound was heard earlier (2.02 days) in study group as compare to the control group (2.96 days). 10 Similar results were noted with Cheadle et al 15 Which is again like what noted in our study. Bradshow BG 16 , showed one day early passage of flatus following removal of NG tube on operative day, study patients were also discharge one day before the control group.…”

“…Stimulation of the posterior pharynx often causes gagging and vomiting. 9 Many randomized control trial, like H. G. Vinay, (p<0.000) 10 , Ming-Hui Pang (p<0.05 for diet, p=0.02 for flatus) 11 , Nadia Shamil 12 , Nadim Khan (p>0.005) 13 , have revealed that nasogastric (NG) tube decompression can safely be omitted from routine postoperative care.…”

Postoperative ileus following major colorectal surgery

“…In contrast, a later study showed no improvement in defaecation or oral tolerance within a goal‐directed fluid protocol. One RCT tested the effect of avoiding routine NGT intubation, which demonstrated improved gastrointestinal function (time to oral tolerance 3·1 versus 4·8 days) and reduced complications such as pneumonia. Other interventions have included stoma stimulation with thickened saline before reversal, abdominal massage and dextromethorphan (usually a cough suppressant).…”

Post Operative Bowel Movement;

“…Vinary 10 , for elective bowel surgery with or without prophylactic nasogastric decompression also had similar demographic groups. Nasogastric tube intolerance was common complaint noted by Michele Tanguy 8 which is also the chief complaint in control group in our study.…”