Bench-to-bedside review: Routine postoperative use of the nasogastric tube – utility or futility?

Michèle Tanguy,Philippe Seguin,Yannick Mallédant

doi:10.1186/cc5118

Abstract

This article provides a summary of current information on rational postoperative use of the nasogastric tube, based on a review of literature related to postoperative gastrointestinal discomfort and management with the nasogastric tube. Routine gastric decompression after major surgery neither hastens the return of bowel function nor diminishes the incidence of postoperative nausea and vomiting. The multimodal postoperative rehabilitation programme is a modern and more efficient approach. Omission of nasogastric tube decompression does not increase the incidence of anastomotic leakage or wound dehiscence. Conversely, early enteral feeding is feasible and safe, favours local immunity and gut integrity, and improves nutritional status. With the objective to feeding, nasogastric tube could be used in selected patients. To conclude, use of the nasogastric tube to prevent or limit postoperative gastrointestinal discomfort must be challenged. In contrast to gastric decompression, early gastric feeding must be considered within the new concept of fast track surgery.

Highlights

Since the 1930s routine use of the nasogastric tube to achieve postoperative gastric decompression has enjoyed widespread acceptance, and for decades patients’ complaints were not taken into consideration by anaesthesiologists and surgeons
Anaesthesiologists were mainly concerned with postoperative nausea and vomiting (PONV), whereas surgeons were concerned with preventing wound dehiscence, incisional hernia and anastomotic leakage
In a recent study conducted in patients undergoing cardiac surgery with a high PONV score [39], perioperative use of the nasogastric tube did not influence the incidence of nausea, vomiting, or retching

Summary

Introduction

Since the 1930s routine use of the nasogastric tube to achieve postoperative gastric decompression has enjoyed widespread acceptance, and for decades patients’ complaints were not taken into consideration by anaesthesiologists and surgeons. Postoperative nausea and vomiting are consequences of individual factors PONV and POI are distinct components of the pathophysiological response to surgery These entities have been combined in studies conducted during recent decades. A recent systematic review of prophylactic nasogastric decompression after abdominal operations [38] did not support a beneficial effect of the tube on various aspects of gastric upset during the postoperative period, but it identified more discomfort with routine use of the tube. In a recent study conducted in patients undergoing cardiac surgery with a high PONV score [39], perioperative use of the nasogastric tube did not influence the incidence of nausea, vomiting, or retching. When a gastric tube is used as a route for feeding or administration of medications, silicone rubber is appropriate to reduce patient discomfort

Conclusion

French WE

Findings

15. Steinbrook RA