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Background: Commonest surgical emergency cases in developing countries isPerforativeperitonitis. These sequence of events leads to increasedmorbidity and mortality. The events can be modified to decrease mortality through early interventions like specific therapeutic procedures, these determine the outcome.. Decreasing mortality also depends on recognition of theseriousness of disease, an accurate assessment andclassification of patient’s risks,to overcome these problems, Jabalpur peritonitis index was made. Aim: To evaluate the role of Jabalpur scoringsystem among patients of peritonitis secondary to rupture of peptic ulcer in predicting mortality. Method: Prospective observational study was conducted on patients of peritonitis secondary to rupture of peptic ulcer.The study was conducted on all the patients attending the surgery out patient department and emergency department in K R Hospital under MMC &RI , Mysore, Karnataka, India, from period of January 2018 – August2019. Conclusion: There is association between all the factors used in the Jabalpur scoring and mortality and as the score increased there is increase in mortality . The score has high sensitivity and specificity in predicting mortality.
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Objective To investigate the safety and effect of none routine nasogastric decompression tube after radical gastrectomy. Methods The clinical data of 100 patients who underwent radical gastrectomy in our department from January 2013 to January 2015 were retrospectively analyzed. Among them, 50 patients did not receive postoperative nasogastric tube decompression (group A) and 50 patients received nasogastric tube decompression after operation (group B). The time to flatus, semi-liquid diet, length of hospital stay and associated postoperative complications were compared between the two groups. Results The time to have semi-liquid diet ([5.82±1.10] d vs[7.80±1.92] d) and length of hospital stay ([6.82±1.27] d vs[9.10±3.42] d) in group A were significantly shorter than those in group B (P0.05). Conclusion None routine nasogastric decompression tube is safe for patients who have received radical gastrectomy, and it may accelerate postoperative recovery and shorten the hospital stay.
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Background: Traditionally nasogastric decompression is carried out in post operatively in patients undergoing gastrointestinal surgery. The purpose of the study is to assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries. Objectives: To assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries, to assess the complications associated with nasogastric tube insertion, and to assess the effect of early nasogastric tube removal on the patients’ postoperative morbidity and comfort level. Methods: This was a randomized control trial done in the Shree Sayajirao General Hospital, Vadodara. According to patient flow and previous study details the estimated sample size was 300 patients. Patient allotment was 150 patients in each group. Patients admitted on odd dates will be followed for routine nasogastric decompression, and patients admitted on even dates will be followed for early nasogastric decompression. Inclusion criteria for the study include laparotomies performed by any abdominal incisions on emergency as well as elective bases. Variables to be studied were patient comfort (according to patient’s opinion), vomiting (episodes, type, amount, content, on which post-operative day), abdominal distension, appearance of normal bowel sounds, passage of flatus and/or stools (according to patient’s history), incidence of aspiration pneumonia and total duration of the hospital stay with wound complications. Data will be processed and analyzed by chi square test and t-test. Results: In the study total 300 patients were included. No significant difference between both the groups in case of postoperative vomiting with p- value of 0.6028 (i.e. p > 0.05) and abdominal distension with p- value of 0.5183 (i.e. p > 0.05). Significant difference seen in the appearance of the bowel sound in post-operative period with p- value of 0.0002 (i.e. p < 0.05) and passage of flatus or stool with p-value of <0.0001. In case of early decompression group mean postoperative day for the suture removal was 11.9 days and for routine decompression group it was 12.3 days, the difference was statistically significant with p- value of 0.0006 (i.e. p < 0.05). The mean for the total hospital stay for early decompressed group was 10.04 days and for routine decompression group it was 10.47 days which was highly statically significant with p- value of 0.0001 (i.e. p < 0.05). Post-operative wound complication which was statically significance with p-value of 0.0394 (i.e. p < 0.05) and respiratory complications was also significant with p-value of 0.0367 (i.e. p < 0.05). In case of early decompression post-operative nausea, vomiting and abdominal distention were higher but not significant statistically. Conclusions: Early removal of Ryle’s tube leads to less incidence of respiratory complications and wound complications ultimately early suture removal and less hospital stay. Early removal of Ryle’s tube leads to early resolution of postoperative paralytic ileus indicated by early appearance of bowel sounds and early passage of flatus and stool.
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Objective To investigate the effects of nasojejunal feeding plus nasogastric tube decompression in severe hypertensive intracerebral hemorrhage complicated with gastroparesis.Methods Fifty-six cases of severe hypertensive intracerebral hemorrhage complicated with gastroparesis admitted to hospital from January 2011 to June 2014 were chosen as study group, while the 52 cases of similar patients admitted to hospital from January 2007 to December 2010 were chosen as control group.Nasojejunal feeding and nasogastric tube decompression were given to the study group.Nasogastric enteral nutrition support therapy was firstly given to the control group conventionally,after 15 days if they still could to be tolerant of the enteral nutrition,then parenteral nutrition therapy were adopted.The weight, serum albumin, prealbumin and hemoglobin circumstances of the two groups were determined and the complications were recorded.The patients were followed up according to activity of daily liying(ADL) after 3 months.Results There was no significant difference on the average body weigh between two groups before treatment.The average body weight of the study group was significantly higher than that of the control group after 4 weeks treatment((57.2±5.3) kg vs.(52.8±4.9) kg,t=4.33,P＜0.01).The serum albumin, pre albumin and hemoglobin of 3 week, four week after treatment were significantly higher than those of the control group(serum albumin of 3 week: (34.5±3.3) g/L vs.(30.7±3.1) g/L;erum albumin of four week:(37.8±3.8) g/L vs.(34.1 ± 3.4) g/L;serum prealbumin of 3 week:(202.3± 16.7) g/L vs.(179.6 ±15.2) g/L;serum prealbumin of four week: (216.9±17.1) g/L vs.(203.1±15.4) g/L;hemoglobin of 3 week : (119.4± 12.1) g/L vs.(107.7 ± 11.3) g/L;hemoglobin of four week : (126.2± 12.8) g/L vs.(113.5 ±11.9) g/L).Nutritional status of study group was significantly better than that of the control group(t=6.16, 5.32,7.37,4.85,5.18,5.32;P＜0.01), and complications was significantly less than that of the control group (P＜0.05).After three months, the good prognosis rate of study group (80.36％ (45/56)) was significantly higher than that of the control group (6 1.54％ (32/52)), the difference was statistically significant (x2 =4.67, P ＜0.05).Conclusion Nasojejunal feeding plus nasogastric tube decompression for patients with severe hypertensive intracerebral hemorrhage with gastroparesis can improve nutritional status, enhance their body resistance, reduce the incidence of complications, and improve their prognosis.
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Objective To evaluate the effectiveness and safety of nasogastric decompression after elective surgery for colon and rectum neoplasms. Methods A comprehensive search of Chinese and English-language medical literatures was performed to identify all published randomized controlled trials (RCTs) evaluating the nasogastric decompression after elective surgery for colon and rectum neoplasms. Selection of literatures was done according to the inclusion and exclusion criteria, and the clinical data were extracted from each trial to perform the meta-analysis. Results Six RCTs (736 patients) fulfilling the inclusion criteria were included in the present analysis, and most trials showed comparable characteristics in their patient groups at baseline. Patients in non-NGD group had a shorter recovery time of gastrointestinal function (WMD= -1. 15, 95% CI [-1.87-0. 43], P=0. 002), shorter hospital stay (WMD= -2. 43, 95%CI[-3. 75--1. 10], P = 0. 000 3), and less respiratory infection (RR=0. 17, 95%CI[0. 03-0. 95], P = 0. 04), though more vomiting (RR=2. 12, 95%CI[1. 19-3. 78], P = 0. 01). No significant differences were noted in wound infection (RR=0. 76, 95%CI[0. 29-1. 99], P = 0. 58) or nasogastric tube replacement (RR=1. 85, 95%CI[0. 89-3. 88], P = 0. 10). Conclusion It is safe to give up NGD after elective surgery for colon and rectum neoplasms; routine use of NGD is not necessary because it does no more benefits to patients but increases the complications such as respiratory infection.
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PURPOSE: Traditionally, nasogastric decompression has been a routine procedure following major abdominal surgery or gastrointestinal surgery. This prospective, randomized controlled trial was performed in order to evaluate the usefulness of nasogastric decompression following elective gastric cancer surgery. METHODS: This study was carried out prospectively. A total of 95 patients were randomly divided into two groups, group I (45 patients with nasogatric tube) and group II (50 patients without nasogastric tube). Patients receiving emergency surgery due to gastric outlet obstruction were excluded from this study. The data was analysed by chi-square test, T-test and Mann-Whitney U test with the level of significance set at P<0.05. RESULTS: No significant differences were found between the two groups in regards to nausea, vomting, distension, anastomotic leak or wound dehiscence. However, longer hospital stay, delayed passage of flatus, delayed initiation of ambulation, delayed start of feeding and sore throat occurred more often in group I patients than in group II patients. CONCLUSION: The result showed that the routine prophylactic use of nasogastric decompression following gastric cancer surgery is an unnecessary procedure and does not offer any considerable advantage.
Subject(s)
Humans , Anastomotic Leak , Decompression , Emergencies , Flatulence , Gastric Outlet Obstruction , Length of Stay , Nausea , Pharyngitis , Prospective Studies , Stomach Neoplasms , Unnecessary Procedures , Walking , Wounds and InjuriesABSTRACT
There is a widespread belief that nasogastric decompression in gastric cancer surgery allows better surgical field and leads to the reduction of postoperative complications. The aim of this study was to evaluate whether gastric cancer surgery can be safely performed without nasogastric decompression. From March to June 2000, 119 patients with gastric adenocarcinoma were randomized into either a tubeless group (n=56) or an intubated group (n=63). Exclusion criteria included a history of upper gastrointestinal bleeding and pyloric obstruction. No remarkable difference was found in the incidence of complications in the tubeless and intubated groups (mean 10.9%, p=0.945). The incidence of nasogastric tube insertion in the tubeless group was similar to the incidence of nasogastric tube reinsertion in the intubated group (p=0.747). Time to pass flatus was not different in the two groups (p=0.054), nor was the length of hospital stay (p=0.148). These results suggest that gastric cancer surgery can be performed safely without nasogastric decompression.
Subject(s)
Adult , Aged , Female , Humans , Male , Comparative Study , Intubation, Gastrointestinal , Middle Aged , Postoperative Complications/etiology , Prospective Studies , Stomach Neoplasms/surgeryABSTRACT
PURPOSE: Nasogastric (NG) decompression has traditionally been used following gastrectomy with extended lymph node dissection in patients with gastric cancer. A prospective randomized study of 133 patients undergoing gastric cancer surgery was performed in order to determine the necessity of routine NG decompression. METHODS: Between July 1999 and July 2000, 133 patients with gastric cancer were randomly assigned to one of two groups: NG group (n=69)-NG decompression was maintained postoperatively until a resumption of bowel function; No-NG group (n=64)-NG tube was not inserted at all, either pre- or postoperatively. RESULTS: The times to return of bowel sounds, passage of flatus and start of oral intake were all significantly (P<0.001) shortened in the No-NG group. The length of operating time and postoperative hospital stay were also decreased in the No-NG group (P<0.001). Two patients in each group (2.9% in NG and 3.1% in No-NG group) required subsequent NG decompression. There were no significant differences between the two groups concerning the presence of postoperative fever, nausea, vomiting, anastomotic leakage, pulmonary or wound complications between the two groups. There was no postoperative mortality in either group. CONCLUSION: We concluded that routine NG decompression is not necessary in elective gastric cancer surgery, even in the presence of gastric outlet obstruction.
Subject(s)
Humans , Anastomotic Leak , Decompression , Fever , Flatulence , Gastrectomy , Gastric Outlet Obstruction , Length of Stay , Lymph Node Excision , Mortality , Nausea , Prospective Studies , Stomach Neoplasms , Vomiting , Wounds and InjuriesABSTRACT
BACKGROUND : Prophylactic nasogastric decompression is used routinely after elective gastric surgery in spite of many disadvantages and complications - discomfort, pain, especially postoperative atelectasis. The aim of this study was to determine whether routine nasogastric decompression benefitted patients undergoing elective stomach operations. METHODS : Two hundreds forty patients were studied prospectively. All patients underwent elective gastric surgery from January 1994 to March 1996 by one surgeon at Gospel Hospital. In the intubated group, 120 consecutive patients were treated with a nasogastric tube (silastic, 16 French) just before or during the operation, it being removed on the 1st or the 2nd postoperative day. In the tubeless group, a nasogastric tube was not inserted at all in 120 consecutive patients. We compared the differences between two groups with respect to the mean duration of flatus passing, the incidence of postoperative pulmonary complication, leakage, reoperation, wound dehiscence, and operation mortality. RESULTS : The two groups showed no significant differences in age, sex and operation methods. Flatus passed earlier in the tubeless group, but the difference was statistically insignificant. The patients suffering from atelectasis were much larger in number in the intubated group (p<0.03). There were no significant differences in the incidence of anastomotic leakage, wound dehiscence, reoperation and operation mortality. CONCLUSIONS : The routine omission of nasogastric intubation was not associated with increased risks, such as leakage, wound dehiscence, reoperation, postoperative pulmonary complication, delayed flatus passing or diet intake, operative morbidity and motality. Conversely, the incidence of postoperative atelectasis was twice as high in the intubated group. We conclud that routine nasogastric intubation should be used only in specific cases and routine use of nasogastric intubation is not justified.