Systematic review of prophylactic nasogastric decompression after abdominal operations

Abstract

Routine use of nasogastric tubes after abdominal operations is intended to hasten the return of bowel function, prevent pulmonary complications, diminish the risk of anastomotic leakage, increase patient comfort and shorten hospital stay. This meta-analysis of published studies examines the efficacy of this practice after abdominal surgery in achieving each of these goals. Search terms were 'nasogastric, tubes, randomized', using Medline, Embase, the Cochrane Controlled Trials Register and references from included studies. Eligible studies included patients having abdominal operations of any type, emergency or elective, who were randomized before completion of the operation to receive a nasogastric tube and keep it in place until intestinal function had returned or to selective use of a tube with early removal. Twenty-eight studies fulfilled the eligibility criteria. These included 4194 patients, 2108 randomized to routine tube and 2087 randomized to selective or no tube. Those not having a nasogastric tube routinely inserted experienced an earlier return of bowel function (P < 0.001), a marginal decrease in pulmonary complications (P = 0.07), and a marginal increase in wound infection (P = 0.08) and ventral hernia (P = 0.09). Anastomotic leakage was similar in the two groups (P = 0.70). Routine nasogastric decompression does not accomplish any of its intended goals and so should be abandoned in favour of selective use of the nasogastric tube.