Is routine nasogastric decompression after hepatic surgery necessary? A systematic review and meta-analysis

Wen, Zunjia; Zhang, Xin; Liu, Yingfei; Bian, Lanzheng; Chen, Junyu; Li, Wei

doi:10.1016/j.ijnurstu.2019.103406

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…However, the current evidence shows that routine NGT use does not reduce these complications, but it could actually increase their occurrence [31,33,38,41,42]. Some authors, indeed, showed a higher rate of respiratory complications, increase of POI and length of stay in patients with NGT [29,31,38,[41][42][43].…”

Section: Discussionmentioning

confidence: 85%

“…Recently, the development of minimally invasive surgery, the improvement of the anesthetic prevention of PONV and rehabilitation protocols have opened a debate about the real need of routine placement of a NGT [27]. There are several studies evaluating the use of the NGT in colorectal, hepatic, urologic, thoracic, otorhinolaryngology, gastric and esophageal surgery [28][29][30][31][32][33][34]. However, there are no studies about NGT in achalasia patients undergoing LHD.…”

Section: Introductionmentioning

confidence: 99%

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Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

Palomba

Basile

Capuano

et al. 2023

Preprint

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Background Achalasia is a rare esophageal motor disorder. Laparoscopic Heller-Dor myotomy (LHD) is among the most effective treatments. The use of nasogastric tube (NGT) following LHD is still controversial. The aim of our study was to evaluate the role of NGT in achalasia patients undergoing LHD. Methods We prospectively enrolled achalasia patients treated with LHD from January 2019 until June 2022 at our institution and randomly assigned them to two groups: one group with NGT and group without (noNGT). Perioperative outcomes were compared between the two groups. ClinicalTrials.gov Identifier: NCT05729971. Results Seventy-nine patients who underwent LHD myotomy were prospectively enrolled. Patients were divided in two groups: 38 with NGT and 41 noNGT. There were no significant differences between two groups in terms of demographic data, preoperative characteristics, length of stay, start of liquid and solid diet, intraoperative and postoperative complications. First flatus was shorter in the noNGT group (p: 0.03). Conclusion Nasogastric tube placement following LHD myotomy does not reduce nausea, vomiting and chest pain, while it increased patients discomfort and time of first flatus.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

Palomba

Basile

Capuano

et al. 2023

Preprint

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“…The benefits of this approach, however, were questionable. Two recent studies focusing on hepatectomy patients have added to the body of literature that speaks against routine prophylactic nasogastric intubation [ 162 , 163 ]. The first is a RCT that showed no difference in the rates of overall morbidity, pulmonary complications, postoperative vomiting, time to oral intake, and hospital LoS between patients randomized to a NGT group vs .…”

Section: Resultsmentioning

confidence: 99%

“…a no-NGT group [ 162 ]. The second is a systematic review and meta-analysis with over 1300 hepatectomy patients from 7 RCT and likewise demonstrated no benefits to NGT with regard to return of bowel function [ 163 ]. In fact, NGT was associated with greater LoS and delay to starting diet.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022

et al. 2022

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Background Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. Methods A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. Results A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. Conclusions These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.

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“…Previous studies have shown that nasogastric/nasojejunal decompression after gastrointestinal surgery may result in an increased incidence of pulmonary complications, including atelectasis and pneumonia [ 4 , 15 - 17 ]. This holds true in our case as our patient developed bilateral atelectasis and a considerable left-sided pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

Supradiaphragmatic Jejunal Perforation Following Total Gastrectomy With Esophagojejunostomy Reconstruction for Gastric Adenocarcinoma

Eldeib,

Alshammari

et al. 2024

Cureus

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Nasogastric tube decompression is a common technique used after abdominal surgery as it is widely accepted to play a role in the management of postoperative ileus and possibly reduce anastomotic leaks after gastrointestinal surgery. However, the routine practice of nasogastric/nasoenteric tube decompression in elective abdominal surgeries has been challenged due to the increased incidence of pulmonary complications and the argued lack of expected benefit. Here, we present a rare complication of nasogastric tube drainage following a routine total gastrectomy for signet-ring cell adenocarcinoma of the cardia in a 43-year-old female. Her postoperative course was complicated with a supradiaphragmatic jejunal perforation presumably from nasogastric tube decompression resulting in a left pleural effusion. The workup included an endoscopy showing the perforation, after which the nasojejunal tube was removed and the patient was managed conservatively. She was eventually discharged on postoperative day 28.

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Is routine nasogastric decompression after hepatic surgery necessary? A systematic review and meta-analysis

Cited by 6 publications

References 21 publications

Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

Nasogastric tube after laparoscopic Heller-Dor myotomy: do you really need it?

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022

Supradiaphragmatic Jejunal Perforation Following Total Gastrectomy With Esophagojejunostomy Reconstruction for Gastric Adenocarcinoma

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