Abstract
Background. The routine use of nasogastric tubes in patients undergoing elective abdominal operation
is associated with an increased incidence of postoperative fever, atelectasis, and
pneumonia. Previous studies have shown that nasogastric tubes have no significant
effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter
pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients
undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal
reflux in the perioperative period. Methods. A prospective randomized case-control study was undertaken in which 15 consenting
patients, admitted electively for bowel surgery, were randomized into 2 groups. Group
1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did
not. All patients had manometry and pH probes placed with the aid of endoscopic vision
at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric
tubes, where present, were left on free drainage, and sphincter pressures and pH were
recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis
of variance. Results. The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group
was 137 compared with a median of 8 episodes in the group managed without nasogastric
tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group
1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1,
with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where
a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. Conclusions. These findings demonstrate that patients undergoing elective laparotomy with routine
nasogastric tube placement have significant gastroesophageal reflux in the perioperative
period and a reduced ability to clear refluxed acid from the distal esophagus. Due
to the associated risk of postoperative pulmonary complications, we recommend that
nasogastric intubation be performed on a selective rather than routine basis. (Surgery
2001;130:788-91.)
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Article info
Publication history
Accepted:
March 24,
2001
Footnotes
*Reprint requests: Professor H. P. Redmond, Professor of Surgery, Cork University Hospital, Wilton, Cork, Ireland.
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
