Nasogastric decompression versus non- decompression after elective laparotomy at kenyatta national hospital: a camparison of post -operative outcomes

Abstract

Prophylactic nasogastric decompression after elective laparotomy is being practiced at Kenyatta National Hospital. Available evidence suggests that complications like vomiting and anastomotic leakage cannot be prevented by using nasogastric tubes after elective open laparotomy. The use of nasogastric tubes is associated with increase duration of return of normal bowel function and pulmonary complications hence prolonging hospital stay. Furthermore it increases patient discomfort. Following the above findings, the use of prophylactic nasogastric tubes might not be necessary. Most studies done elsewhere in abdominal surgical centers with a high volume of patients as opposed to our general surgical units do not support its use. In a Study carried out in the neighbouring region among patients undergoing laparotomy, nasogastric decompression was not found to prevent occurrence of complications. There is need for a study to assess the local situation. This study is aimed, at evaluating the differences in outcomes in decompressed versus non-decompressed groups after elective open laparotomy. Objective This prospective randomized clinical study sought to evaluate the difference in outcomes in non- decompressed versus decompressed groups after elective laparotomy. Study design A prospective randomized clinical study. Setting The general surgical, gynecological wards and theatres at Kenyatta National Hospital. Patients and method Eighty eight consecutive patients scheduled for elective laparotomy between 15th July and 15th October, 2011 who met the inclusion criteria (in section 3.3) were recruited. Patients enrolled in this study were randomly assigned to one group in whom decompression was used and another in whom decompression was not used. Randomization was done using a computer generated table of random numbers. The randomization was provided by an independent computer consultant. The surgeon was informed of the group designation just before closure of the abdomen. Results Eighty eight consecutive patients who underwent elective laparotomy randomized into nondecompression and decompression groups were studied with 43(48.9%) and 45(51.1%) being males and females respectively. The age range was 14 to 86 years with a mean of 44.25 years. The commonest reason for laparotomy was closure of gut stomas (43.2%). The occurrence of complications (vomiting, pulmonary and anastomotic leakage) was slightly higher in the decompression group though it did not reach statistical significance. The decompression group stayed longer in the hospital as compared to the non-decompression group 8.67 and 5.19 days respectively with a p-value of 0.0004. Conclusion The use of nasogastric decompression after elective laparotomy did not reduce the occurrence of complications. Decompressed patients spent longer in the hospital postoperatively.