DOES THE AVOIDANCE OF NASOGASTRIC DECOMPRESSION FOLLOWING ELECTIVE ABDOMINAL COLORECTAL SURGERY AFFECT THE INCIDENCE OF INCISIONAL HERNIA -RESULTS OF A PROSPECTIVE, RANDOMIZED TRIAL

PURPOSE: In a previous, prospective, randomized study of the use of na sogastric tubes in patients undergoing elective abdominal colorectal s urgery, we found that patients who did not have nasogastric (NG) decom pression postoperatively had a significantly higher rate of abdominal distention, nausea, and vomiting. Patients from that study have now be en followed for a median duration of 5.3 years to evaluate whether thi s elevation in perioperative intra-abdominal pressure would subsequent ly lead to an increased incidence of incisional hernia. RESULTS: Of th e 251 patients who received NG decompression, 8 (3.2 percent) develope d incisional hernias compared with 15 (6.6 percent) of 229 patients wh o were not decompressed (P = 0.085). CONCLUSIONS: The increase in post operative abdominal distention and vomiting that occurs in patients wh o do not receive NG decompression does not lead to a significantly inc reased incidence of incisional hernia. Furthermore, we continue to sup port avoidance of routine prophylactic postoperative nasogastric decom pression in uncomplicated, elective abdominal colorectal surgery.