Prophylactic Nasogastric Decompression after Emergency Laparotomy

Abstract

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