Nasogastric Tube Decompression in Stomach and Small Bowel Surgery

Pokharel N*, Adhikari S**

Abstract


INTRODUCTION: The use of nasogastric tube(NGT) after abdominal operations is intended for early return of bowel function and to avoid pulmonary complications by preventing vomiting which can cause aspiration pneumonia. Many studies in the past few decades have suggested that the routine use of nasogastric tube decompression has no benefit in preventing the postoperative morbidity. In our country, the routine use of nasogastric decompression is still in practice in most of the institutions by the surgeons. This study aims to see the outcome of NGT decompression in postoperative period in all surgeries involving stomach and small bowel.

METHOD: Between July2015 and May 2017, all the 120 patients undergoing elective resectional stomach and small bowel surgery were included for the study of which 65(54.2) were randomized to nasogastric decompression group (NGT) and 55(45.8) were randomized to no nasogastric decompression (NNGT) group. The postoperative courses of both groups were recorded. The postoperative results were analyzed and conclusion was made.

RESULT: The mean age distribution in NGT insertion and NNGT insertion group was 50.88± 15.89 and 48.93±15.54 respectively, there was no significant difference across the age distribution. The sex distribution between the groups didn’t show any statistical difference (p value-0.088).The rate of abdominal distension
was more in NGT group 8(12.30%) as compared to NNGT group 2(3.6%) but the difference was not statistically significant. Vomiting was seen in 1(1.5%) case in NGT group but none of the patient in NNGT group had vomiting. Anastomotic leak was seen in 7(10.8%) in NGT groupand 3(5.5%) in NNGT group which on statistical analysis didn’t show any significance (p value-0.296).The day of first bowel sound was similar in
groups,2.68+/-0.752 days in NGT group and 2.67+/- 0.747 days in NNGT group (p value-0.96), without any significant difference between the groups. However the time of passage of flatus was3.25+/-0.613 days in NGT group but was earlier 3.05+/-0.731 days in NNGT group even though it was statistically not significant(p value - 0.159). The start of oral feed on postoperative days which was tolerated by the patient was similar between the groups, 2.69+/-0.748 days in NGT and 2.78+/-0.658 days in NNGT group, (p value-0.343).The rate of pulmonary complications was higher in the NGT group 9(13.8%) than4(7.3%) in NNGT group but it was not statistically significant, (P = 0.250). The overall complications rate was 29(44.60%)in NGT group whereas it was 24(43.60%) in NNGT group which was not statistically significant, (p value- 0.914). However, with regard to number of days of stay postoperatively, the NGT group had 17.899+/-6.67 days which was longer than NNGT group, 14.4+/-7.23 days, this was statistically significant in the favor of NNGT group.

CONCLUSION: Routine use of NGT seems to serve no beneficial purpose and may even be harmful in patients after abdominal surgery and it is uncomfortable for the patients as well. Therefore, NGT use may be only recommended as a therapeutic approach for abdominal distension and vomiting not as routine use in postoperative patients.

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