Prophylactic Nasogastric Decompression after Emergency Laparotomy

Abstract

Introduction: Post-operative nasogastric intubation after emergency laparotomy is a commonpractice in many centers, with the intent of hastening the return of bowel function, relievinggastrointestinal discomfort, reducing various post-operative complications and reducing hospitalstay. However, bowel rest and gastric decompression have been re-examined in the light of morerecent data. Many studies and meta-analyses over the last 50 years have challenged the routine useof nasogastric tubes after laparotomy. The objective of this study is to evaluate the need for routinenasogastric decompression after emergency laparotomy.Methods: A prospective, randomized controlled trial was conducted for 12 months (May 1, 2007 toApr 30, 2008) in the Department of Surgery, Tribhuvan University Teaching Hospital, after ethicalapproval. Patients were enrolled as per criteria (Box 1), and subsequently allocated by simplerandomization into two groups: Group 1 and Group 2. Patients undergoing emergency laparotomyfor perforation peritonitis, intestinal obstruction and abdominal trauma were randomized to twogroups – with or without nasogastric tube after surgery. Gastric upset, return of bowel function andpostoperative complications were compared.Results: Total of 115 patients met the inclusion criteria. There was no statistically significantdifference in the occurrence of gastric upset (P: 0.38), wound complications (P: 0.30), respiratorycomplications (P: 0.30) and anastomotic leak (P: 0.64) between two groups. Bowel function returnedin comparable times in both groups (correlation coefficient: 0.14; P: 0.54). Nasogastric tube had tobe reinserted in three patients in the group with nasogastric decompression postoperatively, andfour in the group without (P: 0.43). Thus, routine nasogastric decompression neither prevented thedevelopment of gastrointestinal discomfort nor precluded the need for tube replacement once it wasdiscontinued. For every patient who required post-operative nasogastric decompression, at least 14patients were spared one. Mean hospital stay was significantly more in the decompressed group(7.52 days; correlation coefficient: 0.22; P<0.05).Conclusion: This study has shown that the prophylactic nasogastric decompression followingemergency laparotomy is ineffective in achieving any of the intended goals._______________________________________________________________________________________Keywords: complications; decompression; emergency laparotomy; flatus; nasogastric tube; prophylactic._______________________________________________________________________________________

Enhanced recovery after surgery in emergency colorectal surgery: Review of literature and current practices

“…Meanwhile, risk factors for NGT reinsertion were left-sided colon cancer, postoperative ileus and severe postoperative complications[38]. A randomized controlled trail examining the effect of prophylactic NGT decompression after emergency laparotomy for generalized peritonitis and intestinal obstruction indicated that routine NGT insertion did not prevent gastrointestinal discomfort or anastomotic leakage[39].…”

A systematic review of outcomes reported in small bowel obstruction research

“…Forced expiratory volume (1 second/forced vital capacity); 18 45. 17,19,24,[26][27][28]31,32,35,36,[41][42][43][44]48,51,54,57,60,65,67 47. Recurrences submitted to surgery/reoperation; 17,19,22,29,32,35,36,44,57 48.…”

“…Time to recurrence; 24,44,57 50. Recurrence free survival 44,54,57 Wound infection 18,21,[23][24][25][27][28][29]33,35,46,48,52 13 (25.4)…”

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

“…The advent of new guidelines and pathway driven care has resulted in fewer morbidities and shorter hospitalizations [ 65 ] [ 66 ]. Several studies dating back to 1995 report the benefits of forgoing the traditional practices of postoperative gastric decompression for the management of laparotomy, gastrectomy and minimally invasive esophagectomy patients [ 67 ] [ 68 ] [ 69 ]. Its routine use has even been questioned in the management of small bowel obstructions [ 70 ].…”