Is routine nasogastric decompression necessary following emergency surgery for perforated peptic ulcer?

Nasogastric (NG) tube decompression has traditionally been used after abdominal surgery to prevent postoperative ileus and gastric distension. The aim of this study was to evaluate the necessity of NG tube decompression following emergency repair of perforated peptic ulcer (PUP).

This retrospective study included 189 patients who underwent emergency surgery for PUP between 1999 and 2017. Patients were divided into two groups: those managed with an NG tube (Group 1, n=154) and those managed without an NG tube (Group 2, n=35). Demographic data, clinical characteristics (American Society of Anesthesiologists [ASA] scores and comorbidities), intraoperative findings, and postoperative outcomes, including length of hospital stay, time to oral intake, and complications, were analyzed.

The study cohort included 189 patients, of whom 84.1% were male, with a mean age of 54.1±19.9 years. Baseline demographic and clinical characteristics, including age, comorbidities, ASA scores, and operative details, were comparable between the two groups. There were no statistically significant differences in postoperative complications or 30-day mortality. However, patients in Group 2 demonstrated a significantly earlier transition to oral feeding (3.7±0.9 vs. 4.3±1.4 days; p=0.03) and a shorter duration of hospital stay (6.6±3.1 vs. 8.1±3.8 days; p=0.04) compared to Group 1.

Routine NG decompression is not necessary following surgery for PUP. Avoiding routine NG tube use does not increase morbidity or mortality and is associated with earlier oral intake and a shorter hospital stay. We recommend the use of NG decompression in selected patients when clinically indicated.