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Nasogastric decompression after intestinal surgery in children: a systematic review and meta-analysis
Sinobol Chusilp1,2, Masaya Yamoto1,3, Paisarn Vejchapipat4
1Division of General and Thoracic Surgery, Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
Insights
Routine nasogastric decompression after pediatric intestinal surgery is unnecessary. This systematic review found no significant benefit in preventing complications, and it increased patient discomfort, suggesting it can be omitted.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Clinical Outcomes Research
Background:
- Postoperative nasogastric decompression is a common practice following intestinal surgery in children.
- The necessity and impact of routine nasogastric decompression on preventing complications and enhancing bowel function recovery in pediatric patients remain debated.
Purpose of the Study:
- To systematically evaluate the efficacy and necessity of routine nasogastric decompression after intestinal surgery in children.
- To compare outcomes between pediatric patients with and without postoperative nasogastric tube (NGT) placement.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Literature search encompassed PubMed, Embase, CENTRAL, and Web of Science databases.
- Included studies compared outcomes in children undergoing intestinal surgery with (NGT group) versus without (no NGT group) postoperative nasogastric tube placement.
Main Results:
- Six studies (2 RCTs, 4 observational) were included. Overall anastomotic leak rates were 0.6% (NGT group) vs. 0.9% (no NGT group); wound dehiscence rates were 2.4% (NGT group) vs. 1.6% (no NGT group).
- Meta-analysis of RCTs indicated a significant increase in mild vomiting in the no NGT group (OR 3.54) but no significant differences in persistent vomiting, abdominal distension, NGT reinsertion, wound infection, or time to bowel movement return.
- A significant incidence of NGT-related discomfort (30-100%) was reported in the NGT group, with no anastomotic leaks observed in the included RCTs.
Conclusions:
- Routine postoperative nasogastric decompression is not necessary for children undergoing intestinal surgery.
- Omitting routine nasogastric decompression does not increase postoperative complications and reduces patient discomfort.
- Clinical practice guidelines may consider de-emphasizing routine nasogastric decompression in pediatric intestinal surgery.
Purpose:
Postoperative nasogastric decompression has been routinely used after intestinal surgery. However, the role of nasogastric decompression in preventing postoperative complications and promoting the recovery of bowel function in children remains controversial. This systematic review aimed to assess whether routine nasogastric decompression is necessary after intestinal surgery in children.
Methods:
A systematic review was conducted following the PRISMA guideline. Literature search was performed in electronic databases including PubMed, Embase, CENTRAL, and Web of science. Studies comparing outcomes between children who underwent intestinal surgery with postoperative nasogastric tube (NGT) placement (NGT group) and without postoperative NGT placement (no NGT group) were included.
Results:
Six studies were eligible for inclusion criteria including two randomized controlled trials (RCT) and four comparative observational studies. The overall rate of postoperative anastomotic leak was 0.6% (1/179) in NGT group and 0.9% (2/223) in no NGT group. The overall rate of wound dehiscence was 2.4% (4/169) in NGT group and 1.6% (4/245) in no NGT group. Meta-analysis of two RCTs in children undergoing elective intestinal surgery showed significant increase of mild vomiting in no NGT group compared with NGT group (OR 3.54 95% CI 1.04, 11.99) but no significant difference in persistent vomiting requiring NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), abdominal distension (OR 2.36 95% CI 0.34, 16.59), NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), wound infection (OR 1.63 95% CI 0.49, 5.48) and time to return of bowel movement (MD - 0.14 95% CI - 0.45, 0.17). There was no incidence of anastomotic leak in these 2 RCTs. However, there was an incidence of NGT-related discomfort in NGT group, which ranged from 30 to 100% of children studied.
Conclusion:
Routine postoperative nasogastric decompression can be omitted in children undergoing intestinal surgery due to no benefit in preventing postoperative complications while increasing patient discomfort.
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