Biblioteca Virtual en Salud

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.