Prophylactic nasogastric decompression after emergency laparotomy.

Introduction: Post-operative nasogastric intubation after emergency laparotomy is a common practice in many centers, with the intent of hastening the return of bowel function, relieving gastrointestinal discomfort, reducing various post-operative complications and reducing hospital stay. However, bowel rest and gastric decompression have been re-examined in the light of more recent data. Many studies and meta-analyses over the last 50 years have challenged the routine use of nasogastric tubes after laparotomy. The objective of this study is to evaluate the need for routine nasogastric decompression after emergency laparotomy.

Methods: A prospective, randomized controlled trial was conducted for 12 months (May 1, 2007 to Apr 30, 2008) in the Department of Surgery, Tribhuvan University Teaching Hospital, after ethical approval. Patients were enrolled as per criteria (Box 1), and subsequently allocated by simple randomization into two groups: Group 1 and Group 2. Patients undergoing emergency laparotomy for perforation peritonitis, intestinal obstruction and abdominal trauma were randomized to two groups - with or without nasogastric tube after surgery. Gastric upset, return of bowel function and postoperative complications were compared.

Results: Total of 115 patients met the inclusion criteria. There was no statistically significant difference in the occurrence of gastric upset (P: 0.38), wound complications (P: 0.30), respiratory complications (P: 0.30) and anastomotic leak (P: 0.64) between two groups. Bowel function returned in comparable times in both groups (correlation coefficient: 0.14; P: 0.54). Nasogastric tube had to be reinserted in three patients in the group with nasogastric decompression postoperatively, and four in the group without (P: 0.43). Thus, routine nasogastric decompression neither prevented the development of gastrointestinal discomfort nor precluded the need for tube replacement once it was discontinued. For every patient who required post-operative nasogastric decompression, at least 14 patients were spared one. Mean hospital stay was significantly more in the decompressed group (7.52 days; correlation coefficient: 0.22; P<0.05).

Conclusion: This study has shown that the prophylactic nasogastric decompression following emergency laparotomy is ineffective in achieving any of the intended goals.

Keywords: complications; decompression; emergency laparotomy; flatus; nasogastric tube; prophylactic.