Nasogastric tube after small bowel obstruction surgery could be avoided: a retrospective cohort study
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ORIGINAL ARTICLE
Nasogastric tube after small bowel obstruction surgery could be avoided: a retrospective cohort study Maxime Delestre1,2 · Pierre Berge2,3 · Christophe Aubé2,3,4 · Antoine Hamy1,2,3 · Jean‑François Hamel5 · Anita Paisant2,3,4 · Aurélien Venara1,2,4,6 Received: 25 July 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The safety and feasibility of early removal of nasogastric tube (NGT) after small bowel obstruction (SBO) surgery have not yet been assessed. Such a practice could allow to implement enhanced recovery after surgery (ERAS) protocols after acute SBO surgery. The aims of this study were to assess the safety of early NGT removal by comparing the short-term outcomes of patients with postoperative NGTs and those with no postoperative NGT. Methods All patients undergoing surgery for strangulation or adhesive SBO between January the 1st of 2014 and December the 31st of 2017 were retrospectively included. Results Among the 123 included, NGT was removed immediately after the end of the procedure in 26 cases (21.1%) and 19 patients required NGT replacement (15.4%). In univariate analysis, early removal of NGT was significantly associated with a reduction of overall morbidity, severe morbidity and postoperative ileus occurrence. Multivariate analysis confirmed that NGT left in place was a risk factor for postoperative ileus [Odd Ratio (OR) 4.9, Confidence Interval (CI) 95% 1.3–19.2; p = 0.02], while it has no incidence on severe morbidity. Conclusions Early NGT removal after ASBO surgery seemed to be feasible, safe and efficient, at least in selected patients. This primary study represents the initial foundations for building the implementation of ERAS protocols after ASBO surgery. Keywords Nasogastric tube · Small bowel obstruction · Adhesions · Surgery
Introduction Maxime Delestre and Pierre Berge have made equal contributions to the drafting of the manuscript. * Aurélien Venara auvenara@chu‑angers.fr 1
Department of Digestive and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933 Angers Cedex 9, France
2
University of Medicine of Angers, Angers, France
3
Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933 Angers Cedex 9, France
4
HIFIH, UPRES EA 3859, University of Angers, Angers, France
5
Department of Biostatistics, Maison de la Recherche, University Hospital of Angers, 4 rue Larrey, 49933 Angers Cedex 9, France
6
UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders Institut Des Maladies de l’Appareil Digestif, 1, rue Gaston Veil, 44035 Nantes, France
Enhanced recovery after emergency abdominal surgery is feasible and safe [1]. Its implementation is associated, as it is in elective surgery, with reduced postoperative complication, accelerated recovery of bowel function and shorter postoperative hospital stay [1]. A recent meta-analysis of enhanced recovery after surgery (ERAS) protocols concludes that there should be an effort to inc
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