A METAANALYSIS OF SELECTIVE VERSUS ROUTINE NASOGASTRIC DECOMPRESSION AFTER ELECTIVE LAPAROTOMY

Objective A meta-analysis of all published clinical trials comparing s elective versus routine nasogastric decompression was performed in an attempt to evaluate the need for nasogastric decompression after elect ive laparotomy. Background Many studies have suggested that routine na sogastric decompression is unnecessary after elective laparotomy and m ay be associated with an increased incidence of complications. Despite these reports, many surgeons continue to practice routine nasogastric decompression, believing that its use significantly decreases the ris k of postoperative nausea, vomiting, aspiration, wound dehiscence, and anastomotic leak. Methods A comprehensive search of the English langu age medical literature was performed to identify all published clinica l trials evaluating nasogastric decompression. Twenty-six trials (3964 patients) met inclusion criteria. The outcome data extracted from eac h trial were subsequently ''pooled'' and analyzed for significant diff erences using the Mantel-Haenszel estimation of combined relative risk . Results Fever, atelectasis, and pneumonia were significantly less co mmon and days to first oral intake were significantly fewer in patient s managed without nasogastric tubes. Meta-analysis based on study qual ity revealed significantly fewer pulmonary complications, but signific antly greater abdominal distension and vomiting in patients managed wi thout nasogastric tubes. Routine nasogastric decompression did not dec rease the incidence of any other complication. Conclusions Although pa tients may develop abdominal distension or vomiting without a nasogast ric tube, this is not associated with an increase in complications or length of stay. For every patient requiring insertion of a nasogastric tube in the postoperative period, at least 20 patients will not requi re nasogastric decompression. Routine nasogastric decompression is not supported by metaanalysis of the literature.