A randomized controlled trial for evaluation of routine use of postoperative nasogastric tube decompression after pancreaticoduodenectomy

Abstract

Introduction: Nasogastric decompression (NGD) has been routinely used after major gastrointestinal surgery. The purpose of this randomized controlled trial (RCT) is to evaluate the benefit of NGD in the early postoperative period as compared to routine intra-operative oro-gastric tube (OGT) decompression, in patient undergoing pancreaticoduodenectomy (PD). Methods: Over 4-year period, a total of 120 patients undergoing PD were enrolled in this prospective RCT. There were 57 patients in group 1 (OGT) and 63 patient in group II (NGT). Postoperative variables evaluated, were time to starting oral diet, Incidence of postoperative nausea and vomiting, Postoperative ileus, delayed gastric emptying (DGE), NGT re-insertion rate, anastomotic leak, pulmonary complication, length of hospital stay (LOS), and mortality. Results: There were no significant difference between both groups in regard to the preoperative and intra-operative variables. However, time to oral diet was significantly shorter in group I compared to group II (1.5 ± 0.5 vs 3.0 ± 2.4; P < 0.05, respectively). On average, NGT was maintained for 1.4 ± 1 days after surgery in group II. The re-insertion rate of NGT was similar in both group I and II (11.3 % vs 10.2%, respectively, P value = 0.3). Nasogastric decompression did not significantly reduce the incidence of nausea in group II compared to group I (12% vs 17%, P value = 0.5). The incidence of anastomotic leakage, DGE, postoperative ileus, and morbidity and mortality were similar in both groups. Similarly, there was no difference in the LOS in either group. Conclusion: Routine postoperative NGT decompression is not necessary after pancreaticoduodenectomy.