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. 2007 Jul 18;2007(3):CD004929.
doi: 10.1002/14651858.CD004929.pub3.

Prophylactic nasogastric decompression after abdominal surgery

R Nelson  1 , S Edwards, B Tse
Affiliations

Prophylactic nasogastric decompression after abdominal surgery

R Nelson et al. Cochrane Database Syst Rev. .

Abstract

Background: Routine use of nasogastric tubes after abdominal operations is intended to hasten the return of bowel function, prevent pulmonary complications, diminish the risk of anastomotic leakage, increase patient comfort and shorten hospital stay.

Objectives: To investigate the efficacy of routine nasogastric decompression after abdominal surgery in achieving each of the above goals.

Search strategy: Search terms were nasogastric, tubes, randomised, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (Central), and references of included studies, from 1966 through 2006.

Selection criteria: Patients having abdominal operations of any type, emergency or elective, who were randomised prior tot he completion of the operation to receive a nasogastric tube and keep it in place until intestinal function had returned, versus those receiving either no tube or early tube removal, in surgery, in recovery or within 24 hours of surgery. Excluded will be randomised studies involving laparoscopic abdominal surgery and patient groups having gastric decompression through gastrostomy.

Data collection and analysis: Data were abstracted onto a form that assessed study eligibility, as defined above, quality related to randomizations, allocation concealment, study size and dropouts, interventions, including timing and duration of intubation, outcomes that included time to flatus, pulmonary complications, wound infection, anastomotic leak, length of stay, death, nausea, vomiting, tube reinsertion, subsequent ventral hernia.

Main results: 33 studies fulfilled eligibility criteria, encompassing 5240 patients, 2628 randomised to routine tube use, and 2612 randomised to selective or No Tube use. Patients not having routine tube use had an earlier return of bowel function (p<0.00001), a decrease in pulmonary complications (p=0.01) and an insignificant trend toward increase in risk of wound infection (p=0.22) and ventral hernia (0.09). Anastomotic leak was no different between groups (p=0.70). Vomiting seemed to favour routine tube use, but with increased patient discomfort. Length of stay was shorter when no tube was used but the heterogeneity encountered in these analyses make rigorous conclusion difficult to draw for this outcome. No adverse events specifically related to tube insertion (direct tube trauma) were reported. Other outcomes were reported with insufficient frequency to be informative.

Authors' conclusions: Routine nasogastric decompression does not accomplish any of its intended goals and so should be abandoned in favour of selective use of the nasogastric tube.

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Conflict of interest statement

None known

Figures

1
1
Funnel plot of comparison: 1 Time to Flatus, outcome: 1.1 Does Postoperative nasogastric decompression hasten recovery of gastrointestinal function?.
1.1
1.1. Analysis
Comparison 1 Time to Flatus, Outcome 1 Does Postoperative nasogastric decompression hasten recovery of gastrointestinal function?.
2.1
2.1. Analysis
Comparison 2 Pulmonary Complications, Outcome 1 Does post‐operative nasogastric decompression diminish the risk of pulmonary complications?.
3.1
3.1. Analysis
Comparison 3 Wound Infection, Outcome 1 Does post‐operative nasogastric decompression diminish the risk if wound infection?.
4.1
4.1. Analysis
Comparison 4 Length of Post‐operative Stay, Outcome 1 Does post‐operative nasogastric decompression shorten the lenght of stay?.
5.1
5.1. Analysis
Comparison 5 Gastric upset, Outcome 1 How many patients have gastric upset (vomiting)?.
6.1
6.1. Analysis
Comparison 6 Anastomotic Leak, Outcome 1 Does the nasogastric tube prevent anastomotic leak?.
7.1
7.1. Analysis
Comparison 7 Incisional Hernia, Outcome 1 Does NG Tube use lessen the Risk of Incisional Hernia?.
8.1
8.1. Analysis
Comparison 8 Sensitivity Analysis: Time to Flatus, Outcome 1 Time To Flatus: Only Studies providing precise Standard Deviations.
9.1
9.1. Analysis
Comparison 9 Colon Surgery, Outcome 1 Time To Flatus.
9.2
9.2. Analysis
Comparison 9 Colon Surgery, Outcome 2 Pulmonary Complications.
9.3
9.3. Analysis
Comparison 9 Colon Surgery, Outcome 3 Anastomotic Leak.
10.1
10.1. Analysis
Comparison 10 Gastroduodenal Surgery, Outcome 1 Time to flatus.
10.2
10.2. Analysis
Comparison 10 Gastroduodenal Surgery, Outcome 2 Pulmonary Complications.
10.3
10.3. Analysis
Comparison 10 Gastroduodenal Surgery, Outcome 3 Wound Infection.
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References

References to studies included in this review

Adekunle 1979 {published data only}
    1. Adekunle OO, Solanke TF, Itayemi SO, Banigo OG. Tubeless Post‐operative Care of Elective Cases of Duodenal Ulcer: A Controlled Study of 170 Cases. Afr. J. Med. 1979;8:85‐88. - PubMed
Bashey 1985 {published data only}
    1. Bashey AA, Cuschieri A. Patient comfort after upper abdominal surgery. Journal of the Royal College of Surgeons of Edinburgh 1984;30(2):97‐100. - PubMed
Carrere2006 {published data only}
    1. Carrere N, Seulin P, Julio CH, Blom E, Gouzi JL, Pradere B. Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg 2007;31(1):122‐7. - PubMed
Cheadle 1985 {published data only}
    1. Cheadle WG, Vitale GC, Mackie CR, Cuschieri A. Prophylacitic Postoperative Nasogastric Decompression. Ann Surg 1985;202:361‐365. - PMC - PubMed
Colvin 1986 {published data only}
    1. Colvin DB, Lee W, Eisenstat TE, Rubin RJ, Salvati EP. The Role of Nasointestinal Intubation in Elective Colonic Surgery. Diseases of the Colon & Rectum 1986;5:295‐299. - PubMed
Cunningham 1992 {published data only}
    1. Cunningham J, Temple WJ, Langevin JM, Kortbeek J. A prospective randomized trial of routine postoperative nasogastric decompression in patients with bowel anastomosis. Can J Surg 1992;35(6):629‐31. - PubMed
Cutillo 1999 {published data only}
    1. Cutillo G, Maneschi F, Franchi M, Giannice R, Scambia G, Benedetti‐Panici P. Early Feeding Compared with Nasogastric Decompression After Major Oncologic Gynecology Surgery: A Randomized Study. Obstetrics & Gynecology 1999;93(1):41‐45. - PubMed
Daryaei 2009 {published data only}
    1. Daryaei P, Davari FV, Mir M, Harirchi I, Salmasian H. Omission of Nasogastric Tube Application in Postoperative Care of Oesophagectomy. World J Surg 2009;33:773‐777. - PubMed
Doglietto 2004 {published data only}
    1. Doglietto GB, Papa V, Tortorelli AP, Bassola M, Covino M, Pacelli F. Nasojejunal tube placement after total gastrectomy. Arch Surg. 2004;139:1309‐13. - PubMed
Edlund 1979 {published data only}
    1. Edlund G, Gedda S, Linden WVD. Intraperitoneal Drains and Nasogastric Tubes In Elective Cholecystectomy. The American Journal of Surgery 1979;137:775‐779. - PubMed
Friedman 1996 {published data only}
    1. Friedman SG, Sowerby SA, Pin CAD, Scher LA, Tortolani AJ. A prospective randomized study of abdominal aortic surgery without postoperative nasogastric decompression. Cardiovascular Surgery 1996;4(4):492‐494. - PubMed
Goueffic 2005 {published data only}
    1. Goueffic Y, Rozec B, Sonnard A, Patra P, Blanoeil Y. Evidence for early nasogastric tube removal after infrarenal aortic surgery: a randomized trial. J Vasc. Surg. 2005;42:654‐9. - PubMed
Hsu 2007 {published data only}
    1. Hsu S, Yu J C, Chen T W, Chou S J, Hsieh H F, Chan D C. Role of nasogastric tube insertion after gastrectomy. Chirurgische Gastroenterologie Interdisziplinar 2007;23(3):303‐6.
Hyland 1980 {published data only}
    1. Hyland JMP, Taylor I. Is Nasogastric Aspiration Really Necessary Following Cholecystectomy?. The British Journal of Clinical Practice 1980;34(10):293‐294. - PubMed
Jiang 2007 {published data only}
    1. Jiang ZW, Wang ZM, Li N, Liu XX, Li XY, Zhu SH, Diao YQ, Nai YJ, Huang XJ. The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy [Chinese: Chung‐Hua Wai Ko Tsa Chih]. Chinese Journal of Surgery 2007 Oct 1;45(19):1314‐7. - PubMed
Knoepp 1999 {published data only}
    1. Knoepp LF, Thomae KR. Prospective, Randomized Evaluation of Early Removal of Nasogastric Tubes in Postceliotomy Trauma Patients. The American Surgeon 1999;65:52‐55. - PubMed
Koukouras 2001 {published data only}
    1. Koukouras D, Mastronikolis NS, Tzoracoleftherakis E, Angelopoulou E, Kalfarentzos F, Androulakis J. The role of nasogastric tube after elective abdominal surgery. Clin Ter 2001;152:241‐244. - PubMed
Lee 2002 {published data only}
    1. Lee JH, Hyung WJ, Noh SH. Comparison of gastric cancer surgery th versus without nasogastric decompression. Yonsei Med J 2002;43(4):451‐6. - PubMed
Lei 2004 {published data only}
    1. Lei WZ, Zhao GP, Cheng Z, Li K, Zhou ZG. Gastrointestinal decompression after excision and anastomosis of lower digestive tract. World J Gastroenterol 2004;10(13):1998‐2001. - PMC - PubMed
Miller 1972 {published data only}
    1. Miller DF, Mason JR, McArthur J, Gordon I. A Randomized Prospective Trial Comparing Three Established Methods of Gastric Decompression After Vagotomy. Brit. J. Surg. 1972;59(8):605‐607. - PubMed
Montgomery 1996 {published data only}
    1. Montgomery RC, Bar‐natan MF, Thomas SE, Cheadle WG. Postoperative nasogastric decompression; a prospective randomized trial.. Southern Medical J. 1996;89(11):1063‐1066. - PubMed
Nathan 1991 {published data only}
    1. Nathan BM, Pain JA. Nasogastric suction after elective abdominal surgery: a randomized study. Annals of the Royal College of Surgeons of England 1991;73:291‐294. - PMC - PubMed
Olesen 1983 {published data only}
    1. Olesen KL, Birch M, Bardram L, Burcharth F. Value of Nasogastric Tube after Colorectal Surgery. Acta Chir Scand 1983;150:251‐253. - PubMed
Ortiz 1996 {published data only}
    1. Ortiz H, Armendariz P, Yarnoz C. Is early postoperative feeding feasible in elective colon and rectal surgery?. International Journal of Colorectal Disease 1996;11:119‐121. - PubMed
Otchy 1995 {published data only}
    1. Otchy DP, Wolff BG, Heerden JA, Ilstrup DM, Weaver AL, Winter LD. Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia. Dis. Colon & Rectum 1995;38:604‐608. - PubMed
Pearl 1996 {published data only}
    1. Pearl ML, Valea FA, Fischer M, Chalas E. A Randomized Controlled Trial of Postoperative Nasogastric Tube Decompression in Gynecology Oncology Patients Undergoing Intra‐Abdominal Surgery. Obstetrics & Gynecology 1996;88:399‐402. - PubMed
Pessaux 2007 {published data only}
    1. Pessaux P, Regimbeau M, Dondero F, Plasse M, Mantz J, Belghiti J. Randomized clinical trial evaluating the need for routine nasogastric decompression after elective hepatic resection. British Journal of Surgery 2007;94:297‐303. - PubMed
Petrelli 1993 {published data only}
    1. Petrelli NJ, Stulc JP, Rodriguez‐Bigas M, Blumenson L. Nasogastric Decompression following Elective Colorectal Surgery: A Prospective Randomized Study. The American Surgeon 1993;55(10):632‐635. - PubMed
Racette 1987 {published data only}
    1. Racette DL, Chang FC, Trekell ME, Farha GJ. Is Nasogastric Intubation Necessary in Colon Operations?. The American Journal of Surgery 1987;154:640‐641. - PubMed
Reasbeck 1984 {published data only}
    1. Reasbeck PG, Rice ML, Herbison GP. Nasogastric Intubation After Intestinal Resection. Surgery, Gynecology & Obstetrics 1984;158:354‐358. - PubMed
Sakadamis 1999 {published data only}
    1. Sakamandis AK, Ballas KD, Kabaroudis AG. Role of nasogastric intubation in major operations: a prospective study. Med. Sci Res. 1999;27:789‐91.
Savassi‐Rocha 1992 {published data only}
    1. Savassi‐Rocha PR, Conceicao SA, Ferreira JT, Diniz MTC, Campos IC, Fernandes VA, Garavini D, Castro LP. Evaluation of the routine use of the nasogastric tube in digestive operation by a prospective controlled study. Surgery, Gynecology & Obstetrics 1992;174:317‐320. - PubMed
Sitges‐Serra 1984 {published data only}
    1. Sitges‐Serra A, Cabrol J, Gubern JMA, Simo J. Randomized Trial of Gastric Decompression After Truncal Vagotomy and Anterior Pylorectomy. Surgery, Gynecology & Obstetrics 1984;158:557‐560. - PubMed
Wolff 1989 {published data only}
    1. Wolff BG, Pemberton JH, Heerden JA, Beart RW, Nivatvongs S, Devine RM, Dozois RR, Ilstrup DM. Elective colon and rectal surgery without nasogastric decompression. Ann. Surg. 1989;209(6):670‐3. - PMC - PubMed
Wu 1994 {published data only}
    1. Wu CC, Hwang CR, Liu TJ. There Is No Need For Nasogastric Decompression After Partial Gastrectomy with Extensive Lymphadenectomy. Eur J Surg 1994;160:369‐373. - PubMed
Yoo 2002 {published data only}
    1. Yoo CH, Son BH, Han WK, Pae WK. Nasogastric Decompression is not Necessary in Operations for Gastric Cancer: Prospective Randomised Trial. Eur J Surg 2002;168:379‐383. - PubMed
Zhou 2006 {published data only}
    1. Zhou T, Wu XT, Zhou YJ, Huang X, Fan W, Li Yc. Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy. Wrold J Gastroenterol 2006;12(15):2459‐63. - PMC - PubMed

References to studies excluded from this review

Akbaba 2004 {published data only}
    1. Akbaba S, Kayaalp C, Savkilioglu M. Nasogastric decompression after total gastrectomy. Hepatogastroenterol. 2004;51(60):1881‐5. - PubMed
Chung 2003 {published data only}
    1. Chung HY, Yu W. Reevaluation of Routine Gastrointestinal Decompression after Gastrectomy for Gastric Cancer. Hepato‐Gastroenterology 2003;50:1190‐1192. - PubMed
Di Saverio 1988 {published data only}
    1. Saviero G, Bergamaschi R, Manunta A, Cecchini A, Giuliano P. [Is it necessary to use a naso‐gastric tube in cholecystectomy operations?] [E necessario l'uso del sondino naso‐gastrico negli interventi di colecistectomia?]. G. Chir. 1988;9(1):47‐48. - PubMed
Hoffmann 2001 {published data only}
    1. Hoffmann S, Koller M, Plaul U, Stinner B, Gerdes B, Lorenz W, Roghmund M. Nasogastric tube versus gastrostomy tube for gastric decompression in abdominal surgery: a prospective, randomized trial comparing patients' tube‐related inconvenience. Langenbeck's Arch Surg 2001;386:402‐209. - PubMed
Kerger 2009 {published data only}
    1. Kerger KH, Mascha E, Steinbrecher B, Frietsch T, Radke OC, Stoecklein K, Frenkel C, Fritz G, Danner K, Turan A, Apfel CC. Routine Use of Nasogastric Tubes Does Not Reduce Postoperative Nausea and Vomiting. Ambulatory Anesthesiology Sep2009;109(3):768‐773. - PubMed
Manning 2001 {published data only}
    1. Manning BJ, Winter DC, McGreal G, Kirwan WO, Redmond HP. Nasogastric intrubation causes gastroesophagel reflux in patients undergoing elective laparotomy. Surgery 2001;130(5):788‐91. - PubMed
Michowitz 1988 {published data only}
    1. Michowitz M, Chen J, Waizbard E, Bawnik JB. Abdominal Operations Without Nasogastric Tube Decompression of the Gastrointestinal Tract. The American Surgeon 1988;54:672‐675. - PubMed

References to studies awaiting assessment

Additional references

Ahmed 1998
    1. Ahmed A, Aggarwal M, Watson E. Esophageal perforation: a complication of nasogastric tube insertion. Am J Emerg. Med 1998;16(1):64‐66. [9451317] - PubMed
Bucknall 1983
    1. Bucknall TE, Cox PJ, Ellis H. Brust Abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Brit. Med. J 27 March, 1982;284(6320):931‐933. [MEDLINE: ] - PMC - PubMed
Cheatham 1995
    1. Cheatham ML, Chapman WC, Key SP, Sawyers JL. A meta‐analysis of selective versus routine nasogastric decompression after elective laparotomy. Annals of Surgery 1995;221(5):469‐478. - PMC - PubMed
Gianelli 1998
    1. Gianelli Castiglioni A, Bruzzone E, Burrello C, Pisani R, Ventura F, Canale M. Intracranial insertioon of a nasogastric tube in a case of homicidal head trauma. Am J Forensic Med Pathol. 1998;19(4):329‐334. [MEDLINE: ] - PubMed
Lawrence 2006
    1. Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery. Annals of Internal Medicine Apr 2006;144(8):596‐608. - PubMed
Yahchouchy 2003
    1. Yahchouchy‐Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A. Incisional Hernias. Digestive Surgery 2003;20:3‐9. [MEDLINE: ] - PubMed
Yang 2008
    1. Yang Z, Zheng Q, Wang Z. Meta‐analysis of the need for nasogastric or naso jejunal decompression after gastrectomy for gastric cancer. British Journal of Surgery 2008;95:809‐816. - PubMed

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