Elective colon and rectal surgery without nasogastric decompression. A prospective, randomized trial.
Bruce G. Wolff,John H. Pemberton,J A van Heerden,Robert W. Beart,Santhat Nivatvongs,Richard M. Devine,Roger R. Dozois,Duane M. Ilstrup +7 more
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TL;DR: Routine nasgastric decompression is not warranted after elective colon and rectal surgery, even though there is an increase in the rate of minor symptoms of nausea, vomiting, and abdominal distention.
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Abstract: Nasogastric (NG) decompression after colorectal surgery is practiced commonly. Our aim was to determine whether routine NG decompression benefitted patients undergoing this type of surgery. Five hundred thirty-five patients were randomized prospectively to either NG decompression or no decompression. Stratification was by type of operation and patient age. Excluded were patients who had emergency surgery with peritonitis, extensive fibrous adhesions, enterotomies, previous pelvic irradiation, intra-abdominal infection, pancreatitis, chronic obstruction. prolonged operating times, or difficult endotracheal intubation. Two hundred seventy-four patients received NG decompression (Salem sump, Argyle Co., Division of Sherwood Medical, St. Louis, MO) and two hundred sixty-one did not. There were 33 protocol violations included in the 535 patients. Patients who were not decompressed experienced significantly more abdominal distention, nausea, and vomiting than did those patients who were. Moreover, 13% required subsequent NG decompression as opposed to a reinsertion rate of 5% for patients routinely decompressed. The mean length of hospitalization for both groups was 11 days. There were no significant differences in nasopharyngeal or gastric bleeding, inability to cough effectively, respiratory infections, wound disruptions, reoperation, and wound infection rates (5%) between the two groups. We conclude that even though there is an increase in the rate of minor symptoms of nausea, vomiting, and abdominal distention, routine nasgastric decompression is not warranted after elective colon and rectal surgery.
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Citations
Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia?: Results of a prospective, randomized trial
Daniel Otchy,Bruce G. Wolff,Jonathan A. van Heerden,Duane M. Ilstrup,Amy L. Weaver,Lorraine D. Winter +5 more
TL;DR: The increase in postoperative abdominal distention and vomiting that occurs in patients who do not receive NG decompression does not lead to a significantly increased incidence of incisional hernia and continues to support avoidance of routine prophylactic post-operative nasogastric decompression in uncomplicated, elective abdominal colorectal surgery.
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Systematic review of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer.
TL;DR: Routine nasogastric or nasojejunal decompression does not facilitate the recovery of bowel function or reduce the risk of postoperative complications, therefore, routine decompression is unnecessary after gastrectomy for gastric cancer.
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Lessons learned from the evolution of the laparoscopic revolution.
TL;DR: After 100 years of practice, the face of general surgery changed forever when laparoscopic cholecystectomy was introduced and minimally invasive surgery challenged dogma of traditional perioperative care, allowing streamlining of postoperative recovery.
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•Journal Article
Enhanced recovery pathways in colorectal surgery: a consensus paper by the Associazione Chirurghi Ospedalieri Italiani (ACOI) and the PeriOperative Italian Society (POIS).
F Ficari,Felice Borghi,Marco Catarci,Marco Scatizzi,V Alagna,I. Bachini,Gianandrea Baldazzi,U Bardi,M Benedetti,Luigi Beretta,E Bertocchi,D Caliendo,R Campagnacci,A Cardinali,M. Carlini,Marco Cascella,Diletta Cassini,S Ciotti,A Cirio,P Coata,D Conti,Paolo Delrio,C Di Marco,Lara Ferla,C Fiorindi,Gianluca Garulli,C Genzano,Gianluca Guercioni,B Marra,A Maurizi,R Monzani,U Pace,L Pandolfini,A Parisi,M Pavanello,N Pecorelli,Luigi Pellegrino,Roberto Persiani,Felice Pirozzi,B Pirrera,Antonio Rizzo,M Rolfo,Stefano Romagnoli,Giacomo Ruffo,Antonio Sciuto,Pierluigi Marini +45 more
TL;DR: This paper presents the results of a critical review of the existing evidence by members of the two national societies dealing with ERAS pathways in Italy, the PeriOperative Italian Society (POIS) and the Associazione Italiana Chirurghi Ospedalieri (ACOI), showing theresults of a consensus development conference held at Matera, Italy, during the national ACOI Congress on June 10, 2019.
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To tube or not to tube: do infants and children need post-laparotomy gastric decompression?
TL;DR: NG decompression need not be routinely used in the pediatric patient undergoing abdominal surgery, as there is no difference in postoperative complications and the hospital stay is shortened.
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