The rationale for routinely inserting a flexible tube through the nose and into the stomach has been that keeping the digestive tract empty would help it restart more quickly. Surgeons also commonly believe that the practice reduces the likelihood of vomiting and related aspiration pneumonia.
To conduct a rigorous analysis including numerous recent studies, Dr. Richard Nelson, colorectal surgeon at the University of Illinois College of Medicine, and co-authors identified 28 randomised controlled trials of emergency or elective abdominal surgeries. They did not include studies of laparoscopic surgeries or those involving gastrostomy.
In the eligible trials, a total of 4,194 patients had been randomly assigned to one of two groups: those with a nasogastric tube in place until intestinal function returned or those with either no tube or tube removal within 24 hours of surgery.
The review revealed that the "selective tube use" approach results in earlier return of bowel function with no significant increase in pulmonary complications. Although the evidence suggests that routine tube use may lead to a very slight decrease in wound infection and related hernia, Nelson contends that other measures could also achieve this benefit.
"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," the authors conclude.
What does all this mean for someone facing abdominal surgery? "If the doctor says you're going to wake up with a tube in your nose, the informed patient has a right to ask why" says Nelson. Unless there is a specific need to use a tube, such as a history of previous abdominal surgeries or a bowel obstruction, the surgeon shouldn't, he says.
MEDICA.de; Source: University of Illinois