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Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?

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Abstract

Background

Since the spread of enhanced recovery programs, early withdrawal of the nasogastric tube (NGT) is recommended after pancreaticoduodenectomy (PD), although few data on the safety of this practice are available. The aim of the present study was to evaluate the absence of nasogastric decompression after PD on postoperative outcome.

Study design

All consecutive patients undergoing PD between January 2014 and December 2015 at a single center were retrospectively analyzed. Since May 2015, all operated patients had the NGT removed immediately after the procedure (NGT− group) and were compared to patients operated before this practice (NGT+ group), who had the NGT maintained until at least postoperative day 3.

Results

During the study period, 139 patients underwent PD, of whom 40 (29%) were in the NGT− group and 99 (71%) were in the NGT+ group. The length of hospital stay (LOS) and rate of postoperative complications of grade 2 or higher according to the Clavien-Dindo grading system were significantly higher in the NGT+ group [14 (11–25) vs. 10 (8–14.2), P = 0.005 and 82.8 vs. 40%, P < 0.001, respectively]. Incidence and severity of delayed gastric emptying (DGE) grade B–C were also higher in the NGT+ group (45.5 vs. 7.5%, P < 0.001). There was no difference between the two groups concerning the 90-day postoperative mortality (P = 0.18).

Conclusion

The absence of systematic nasogastric decompression after PD might reduce postoperative complications, DGE, and LOS. These encouraging results deserve to be confirmed by a prospective randomized study (NCT: 02594956).

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Abbreviations

NGT:

Nasogastric tube

PD:

Pancreaticoduodenectomy

LOS:

Length of hospital stay

DGE:

Delayed gastric emptying

ERAS:

Enhanced recovery after surgery

FT:

Fast track

POD:

Postoperative day

NJEEN:

Nasojejunal early enteral nutrition

POPF:

Postoperative pancreatic fistula

OFA:

Opioid-free anesthesia

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Author information

Authors and Affiliations

  1. Université de Rennes 1, F-35000, Rennes, France

    Elodie Gaignard, Damien Bergeat, Laetitia Courtin-Tanguy, Michel Rayar, Aude Merdrignac, Fabien Robin, Karim Boudjema, Helene Beloeil, Bernard Meunier & Laurent Sulpice

  2. Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France

    Elodie Gaignard, Damien Bergeat, Laetitia Courtin-Tanguy, Michel Rayar, Aude Merdrignac, Fabien Robin, Karim Boudjema, Helene Beloeil, Bernard Meunier & Laurent Sulpice

  3. CIC INSERM 1414, Rennes, France

    Michel Rayar, Karim Boudjema, Helene Beloeil & Laurent Sulpice

  4. INSERM 1241, NUMECAN (Nutrition Metabolism and Cancer), Rennes, France

    Helene Beloeil & Laurent Sulpice

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  1. Elodie Gaignard
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Contributions

Study concept and design: EG and LS; acquisition of data: EG; analysis and interpretation of data: EG, DB, and LS; drafting of the manuscript: EG, FR, DB, and LS; critical revision of the manuscript for important intellectual content: LT, AM, HB, BM, KB, LS, and MR; statistical analysis: DB; final revision and final approval for publication: LS

Corresponding author

Correspondence to Laurent Sulpice.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

The present work was presented as an oral communication at the 12th Annual Joint Congress of the French Society of Digestive Surgery (SFCD) and the Association of Hepato-Biliary Surgery and Transplantation (ACBHT) in December 2016, Paris, France.

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Gaignard, E., Bergeat, D., Courtin-Tanguy, L. et al. Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?. Langenbecks Arch Surg 403, 573–580 (2018). https://doi.org/10.1007/s00423-018-1688-8

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