Routine Gastric Decompression after Pancreatoduodenectomy: Treating the Surgeon?

• DOI: 10.1007/s11605-021-04971-w
• Publication Date: 2021-03-26T21:02:36Z
• Authors: K.F. Flick; M. Soufi; M.T. Yip-Schneider; R.E. Simpson; C.L. Colgate; T.K. Nguyen; E.P. Ceppa; M.G. House; N.J. Zyromski; A. Nakeeb; C.M. Schmidt
• Keywords: Decompression; Surgeons; Pancreatoduodenectomy; Pancreaticoduodenectomy; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Gastric Emptying; Humans; Prospective Studies; Delayed gastric emptying; Intubation, Gastrointestinal; Nasogastric decompression; Retrospective Studies

The decision to routinely leave a nasogastric tube after pancreatoduodenectomy remains controversial. We sought to determine the impact of immediate nasogastric tube removal versus early nasogastric tube removal (<24 h) on postoperative outcomes.A retrospective review of our institution's prospective ACS-NSQIP database identified patients that underwent pancreatoduodenectomy from 2015 to 2018. Outcomes were compared among patients with immediate nasogastric tube removal versus early nasogastric tube removal.A total of 365 patients were included in primary analysis (no nasogastric tube, n = 99; nasogastric tube removed <24 h, n = 266). Thirty-day mortality and infectious, renal, cardiovascular, and pulmonary morbidity were similar in comparing those with no nasogastric tube versus early nasogastric tube removal on univariable and multivariable analyses (P > 0.05). Incidence of delayed gastric emptying (11.1 versus 13.2%) was similar between groups. Patients with no nasogastric tube less frequently required nasogastric tube reinsertion (n = 4, 4%) compared to patients with NGT <24 h (n = 39, 15%) (OR = 3.83, 95% CI [1.39-10.58]; P = 0.009).Routine gastric decompression can be safely avoided after uneventful pancreaticoduodenectomy.