Primary Surgery for Malignant Large Bowel Obstruction: Postoperative Nasogastric Tube Reinsertion is Not Mandatory.

Abstract

Malignant large bowel obstructions frequently require emergency surgery. Compliance with enhanced recovery after surgery programmes is significantly reduced due to non-removal of the nasogastric tube in the postoperative period. The first aim of the present study was to research factors associated with the failure of immediate nasogastric tube removal in patients who had undergone emergency surgery for malignant large bowel obstruction. The second aim was to assess the morbidity linked to nasogastric tube reinsertion. This retrospective and monocentric study included all consecutive patients admitted for acute malignant large bowel obstruction who underwent emergency surgery. Patients who were not primarily operated on were excluded (n=178; 69.3%). The group of patients requiring nasogastric tube (NGT) reinsertion was compared with the group that did not require NGT reinsertion. Seventy-nine patients underwent emergency surgery, of which 18 (22.8%) required nasogastric tube reinsertion. There was no difference between the two groups with regard to (a) immediate nasogastric tube removal (p=0.87) and (b) inclusion in an enhanced recovery programme (p=0.75). However, preoperative small bowel dilatation was associated with a reduction in the need for NGT reinsertion (p=0.04). A left-sided tumour was also associated with the need for NGT reinsertion in uni- (p=0.034) and multivariate analysis (OR=8; p<0.05). Surgical access and procedure were not significantly associated with NGT reinsertion. The postoperative course influenced NGT reinsertion, which was significantly associated with postoperative ileus (OR=4; p<0.05) and postoperative morbidity (OR=4; p<0.05). Morbidity was not linked to nasogastric tube removal. Nasogastric tube reinsertion was not affected by immediate removal of the tube. Left-sided tumours and patients at risk of postoperative ileus should be managed with caution. Immediate nasogastric tube removal is not contraindicated in the case of large bowel obstruction because it is not associated with a higher risk of NGT reinsertion.