METHODS OF POSTOPERATIVE GASTRIC DECOMPRESSION INCLUDING AN EXPERIENCE WITH THE OMISSION OF ITS ROUTINE USE

Stamm gastrostomy for postoperative gastric decompression in gynecologic oncology patients

OBJECTIVE

The aim of this study was to report our experience with Stamm gastrostomy for postoperative gastric decompression on a gynecologic oncology service.

METHODS

This was an observational study over the 9-year period ending in October 2000. A 24 French MIC gastrostomy with the Stamm technique was used. Criteria for a gastrostomy are outlined in the text and tubes placed for palliation were excluded. Patients were followed to determine length of open drainage, time to removal, related complications, and those who may have benefited.

RESULTS

A total of 167 patients had 174 nonpalliative gastrostomy tubes placed. Nine percent of the patients had related complications with a major complication rate of 2%. Overall, approximately one-third of the patients appeared to benefit from the gastrostomy tube.

CONCLUSION

The results support the safety and efficacy of the MIC gastric tube in patients undergoing extensive gynecologic cancer surgery which is likely to impact the function of the gastrointestinal tract.

A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy

OBJECTIVE

A meta-analysis of all published clinical trials comparing selective versus routine nasogastric decompression was performed in an attempt to evaluate the need for nasogastric decompression after elective laparotomy.

BACKGROUND

Many studies have suggested that routine nasogastric decompression is unnecessary after elective laparotomy and may 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 risk of postoperative nausea, vomiting, aspiration, wound dehiscence, and anastomotic leak.

METHODS

A comprehensive search of the English language medical literature was performed to identify all published clinical trials evaluating nasogastric decompression. Twenty-six trials (3964 patients) met inclusion criteria. The outcome data extracted from each trial were subsequently "pooled" and analyzed for significant differences using the Mantel-Haenszel estimation of combined relative risk.

RESULTS

Fever, atelectasis, and pneumonia were significantly less common and days to first oral intake were significantly fewer in patients managed without nasogastric tubes. Meta-analysis based on study quality revealed significantly fewer pulmonary complications, but significantly greater abdominal distension and vomiting in patients managed without nasogastric tubes. Routine nasogastric decompression did not decrease the incidence of any other complication.

CONCLUSIONS

Although patients may develop abdominal distension or vomiting without a nasogastric 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 require nasogastric decompression. Routine nasogastric decompression is not supported by meta-analysis of the literature.

Gastrointestinal motility studies as a guide to postoperative management

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