Role of Nasogastric tube insertion after gastrectomy

Background: Nasogastric decompression has been routinely used in most abdominal operations to prevent the consequences of postoperative ileus. Most surgeons traditionally continue to use nasogastric decompression, believing that its use facilitates better surgical field and reduces complications such as nausea, vomiting, aspiration, and anastomotic leakage caused by postoperative ileus. The aim of the study was to evaluate whether gastric cancer surgery could be performed safely without nasogastric decompression. Patients and Methods: We enrolled 151 patients who had been surgically treated for gastric adenocarcinoma at the Tri-Service General Hospital from January 2005 to December 2005. The mean age was 55.4 years ( range 25-72 years). 76 patients ( Group A) were randomized into the intubated group and the other 75 patients ( Group B) were randomized into the tubeless group. All patients received epidural pain control. Postoperative complications, preoperative serum albumin levels, mean time to first orally feeding, passage of stools, hospital stay and cost of hospitalization were recorded. Results: Between the two groups, there were no significant differences in preoperative clinical characteristics, age, stage and operative parameters. The complication rate, length of hospital stay, and time to pass flatus were not different in the two groups. Only the postoperative complication rate in those patients of Group A with low serum albumin level was significantly lower than that of patients without nasogastric tube. Conclusion: There were no significant differences with respect to improvement of postoperative complications when comparing gastric cancer patients who underwent gastrectomy with or without nasogastric tube insertion.