Is it necessary to insert nasogastric tube routinely after radical cystectomy with urinary diversion? A meta-analysis

To evaluate the necessity of using nasogastric tube (NGT) for patients undergoing radical cystectomy with urinary diversion.

Literature was searched from PubMed, EMBASE, and Cochrane Library. We identified randomized controlled trials, Cohort study, and Case-control analysis that compared the individuals with or without nasogastric tube after radical cystectomy with urinary diversion. We performed the meta-analysis to evaluate the role of nasogastric tube in decompression after radical cystectomy with urinary diversion.

Two randomized controlled trial and four Cohort studies (780 patients) fulfilled the inclusion criteria. There was significant difference between the time (days) commencement of a liquid diet and the development of bowel sounds in patients without nasogastric tube than those with NGT (nasogastric tube) [P < 0.0001, standard mean difference (SMD) = -0.35, 95% CI -0.52 to -0.18; P < 0.00001, SMD = -0.43, 95% CI -0.60 to 0.26, respectively]. Additionally, there was no significant differences in pulmonary complications and wound complication [P = 0.25, odds ratio (OR) = 0.60 95% CI 0.25 to 1.43; P = 0.66 OR = 1.16 95% CI 0.60 to 2.25, respectively]. But the differences were significant in the paralytic ileus or bowel obstruction (P = 0.010, OR = 0.60, 95% CI 0.41 to 0.88) after surgery. Furthermore, the difference of the duration of hospital stay (days) between the NGT group and Without NGT group (P = 0.0005, SMD = -0.30, 95% CI -0.47 to -0.13).

It cannot shorten the time of gastrointestinal function recovery or reduce the incidence of complications after radical cystectomy by using the nasogastric tube routinely. Routinely use of nasogastric tube after radical cystectomy with urinary diversion was not recommended.