Prospective Randomized Study on the Necessity for Routine Nasogastric Intubation after Major Abdominal Surgery

Abstract

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.

Nasogastric Intubation After Abdominal Surgery

“…In 4 trials, 1,4,29,32 earlier return of flatus passage in favor of no NGI was reported, with a mean of a half day. In 1 of these trials, 1 this difference was not significant (0.30 days; 95% CI, −0.02 to 0.62 days).…”

“…Allocation was by means of randomization (ie, sealed envelopes) in 1 trial, 4 by day and month in 1 trial, 20 and by tables of random numbers in 2 trials 3,21 ; the method of randomization was not stated in 10 trials. 1,19,[22][23][24][25][26][27][28][29] Randomization was based on a computerized randomization table only in 3 trials. [30][31][32] Therefore, concealment of allocation was ensured only in these 3 trials.…”

“…All 17 included trials measured at least 1 end point of interest. Four of the 17 trials comprised patients with non-GI surgery, 25,30-32 3 involved gastric surgery, 1,21,26 6 contained a mix of GI and non-GI surgery, 3,19,20,24,28,29 3 focused on colon surgery, 22,23,27 and 1 included small-and large-bowel surgery 4 ( Table 2).…”

“…In the early-removal group, NGI was terminated at the end of the operation in 53% (9/17) of the trials. 3,4,20,23,[26][27][28][29]32 In 4 trials, 19,25,30,31 NGI was discontinued within 24 hours after surgery. In the remaining 4 trials, 1,21,22,24 patients received no NGI at all.…”

“…In 2 4,29 of these 4 trials, a mix of GI and non-GI surgery was studied, in 1 trial 32 only non-GI surgery, and in 1 trial 1 patients with gastric resections. Three trials 4,24,29 could be incorporated into the meta-analysis for passage of feces (Figure 1). The WMD (random effect) showed a tendency in favor of no NGI, with a WMD of 0.20 days (95% CI, −0.07 to 0.48 days) for earlier passage of feces.…”