Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?
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Since the spread of enhanced recovery programs, early withdrawal of the nasogastric tube (NGT) is recommended after pancreaticoduodenectomy (PD), although few data on the safety of this practice are available. The aim of the present study was to evaluate the absence of nasogastric decompression after PD on postoperative outcome.
All consecutive patients undergoing PD between January 2014 and December 2015 at a single center were retrospectively analyzed. Since May 2015, all operated patients had the NGT removed immediately after the procedure (NGT− group) and were compared to patients operated before this practice (NGT+ group), who had the NGT maintained until at least postoperative day 3.
During the study period, 139 patients underwent PD, of whom 40 (29%) were in the NGT− group and 99 (71%) were in the NGT+ group. The length of hospital stay (LOS) and rate of postoperative complications of grade 2 or higher according to the Clavien-Dindo grading system were significantly higher in the NGT+ group [14 (11–25) vs. 10 (8–14.2), P = 0.005 and 82.8 vs. 40%, P < 0.001, respectively]. Incidence and severity of delayed gastric emptying (DGE) grade B–C were also higher in the NGT+ group (45.5 vs. 7.5%, P < 0.001). There was no difference between the two groups concerning the 90-day postoperative mortality (P = 0.18).
The absence of systematic nasogastric decompression after PD might reduce postoperative complications, DGE, and LOS. These encouraging results deserve to be confirmed by a prospective randomized study (NCT: 02594956).
KeywordsPancreaticoduodenectomy Nasogastric tube Enhanced recovery Delayed gastric emptying
Length of hospital stay
Delayed gastric emptying
Enhanced recovery after surgery
Nasojejunal early enteral nutrition
Postoperative pancreatic fistula
Study concept and design: EG and LS; acquisition of data: EG; analysis and interpretation of data: EG, DB, and LS; drafting of the manuscript: EG, FR, DB, and LS; critical revision of the manuscript for important intellectual content: LT, AM, HB, BM, KB, LS, and MR; statistical analysis: DB; final revision and final approval for publication: LS
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
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