Advertisement

World Journal of Surgery

, Volume 31, Issue 1, pp 122–127 | Cite as

Is Nasogastric or Nasojejunal Decompression Necessary after Gastrectomy? A Prospective Randomized Trial

  • Nicolas CarrèreEmail author
  • Patrick Seulin
  • Charles Henri Julio
  • Eric Bloom
  • Jean-Luc Gouzi
  • Bernard Pradère
Article

Abstract

Background

Nasogastric decompression has been routinely used in most major abdominal operations to prevent the consequences of postoperative ileus. The aim of the present study was to assess the necessity for routine prophylactic nasogastric or nasojejunal decompression after gastrectomy.

Methods

A prospective randomized trial included 84 patients undergoing elective partial or total gastrectomy. The patients were randomized to a group with a postoperative nasogastric or nasojejunal tube (Tube Group, n = 43) or to a group without a tube (No-tube Group, n = 41). Gastrointestinal function, postoperative course, and complications were assessed.

Results

No significant differences in postoperative mortality or morbidity, especially fistula or intra-abdominal sepsis, were observed between the groups. Passage of flatus (P < 0.01) and start of oral intake (P < 0.01) were significantly delayed in the Tube Group. Duration of postoperative perfusion (P = 0.02) and length of hospital stay (P = 0.03) were also significantly longer in the Tube Group. Rates of nausea and vomiting were similar in the two groups. Moderate to severe discomfort caused by the tube was observed in 72% of patients in the Tube Group. Insertion of a nasogastric or nasojejunal tube was necessary in 5 patients in the No-tube Group (12%).

Conclusions

Routine prophylactic postoperative nasogastric decompression is unnecessary after elective gastrectomy.

Keywords

Nasogastric Tube Total Gastrectomy Postoperative Ileus Partial Gastrectomy Radical Gastrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Levin AL. A new gastroduodenal catheter. JAMA 1921;76:1007–1009Google Scholar
  2. 2.
    Wangensteen OH, Paine JR. Treatment of acute intestinal obstruction by suction with the duodenal tube. JAMA 1933;101:1532–1539Google Scholar
  3. 3.
    Sagar PM, Kruegener G, MacFie J. Nasogastric intubation and elective abdominal surgery. Br J Surg 1992;79:1127–1131PubMedGoogle Scholar
  4. 4.
    Wolff BG, Pembeton JH, van Heerden JA, et al. Elective colon and rectal surgery without nasogastric decompression. A prospective, randomized trial. Ann Surg 1989;209:670–673PubMedCrossRefGoogle Scholar
  5. 5.
    Cunningham J, Temple WJ, Langevin JM, et al. A prospective randomized trial of routine postoperative nasogastric decompression in patients with bowel anastomosis. Can J Surg 1992;35:629–632PubMedGoogle Scholar
  6. 6.
    Savassi-Rocha PR, Conceicao SA, Ferreira JT, et al. Evaluation of the routine use of the nasogastric tube in digestive operation by a prospective controlled study. Surg Gynecol Obstet 1992;174:317–320PubMedGoogle Scholar
  7. 7.
    Cheatham ML, Chapman WC, Key SP, et al. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995;221:469–476PubMedCrossRefGoogle Scholar
  8. 8.
    Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005;92:673–680PubMedCrossRefGoogle Scholar
  9. 9.
    Wu CC, Hwang CR, Liu TJ. There is no need for nasogastric decompression after partial gastrectomy with extensive lymphadenectomy. Eur J Surg 1994;160:369–373PubMedGoogle Scholar
  10. 10.
    Yoo CH, Son BH, Han WK, et al. Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg 2002;168:379–383PubMedCrossRefGoogle Scholar
  11. 11.
    Lee JH, Hyung WJ, Noh SH. Comparison of gastric cancer surgery with versus without nasogastric decompression. Yonsei Med J 2002;43:451–456PubMedGoogle Scholar
  12. 12.
    Doglietto GB, Papa V, Tortorelli AP, et al. Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial. Arch Surg 2004;139:1309–1313PubMedCrossRefGoogle Scholar
  13. 13.
    Cancer Research Campaign Working Party. Trials and tribulations: thoughts on the organization of multicentre clinical studies. Br Med J 1980;281:918–920CrossRefGoogle Scholar
  14. 14.
    Nathan BN, Pain JA. Nasogastric suction after elective abdominal surgery: a randomised study. Ann R Coll Surg Engl 1991;73:291–294PubMedGoogle Scholar
  15. 15.
    Pearl ML, Valea FA, Fischer M, et al. A randomized controlled trial of postoperative nasogastric tube decompression in gynecologic oncology patients undergoing intra-abdominal surgery. Obstet Gynecol 1996; 88:399–402PubMedCrossRefGoogle Scholar
  16. 16.
    Otchy DP, Wolff BG, van Heerden JA, et al. Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia? Results of a prospective, randomized trial. Dis Colon Rectum 1995;38:604–608PubMedCrossRefGoogle Scholar
  17. 17.
    Inoue K, Fuchigami A, Higashide S, et al. Gallbladder sludge and stone formation in relation to contractile function after gastrectomy. A prospective study. Ann Surg 1992;215:19–26PubMedCrossRefGoogle Scholar
  18. 18.
    Manning BJ, Winter DC, McGreal G, et al. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy. Surgery 2001;130:788–791PubMedCrossRefGoogle Scholar
  19. 19.
    Basse L, Hjort Jakobsen D, Billesbolle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000;232:51–57PubMedCrossRefGoogle Scholar
  20. 20.
    Kehlet H, Buchler MW, Beart RW, Jr, et al. Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 2006;202:45–54PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Nicolas Carrère
    • 1
    Email author
  • Patrick Seulin
    • 1
  • Charles Henri Julio
    • 1
  • Eric Bloom
    • 1
  • Jean-Luc Gouzi
    • 1
  • Bernard Pradère
    • 1
  1. 1.Department of Gastrointestinal Surgery (Pr Pradère)Purpan University HospitalToulouseFrance

Personalised recommendations