Nasogastric decompression after intestinal surgery in children: a systematic review and meta-analysis

Abstract

Purpose

Postoperative nasogastric decompression has been routinely used after intestinal surgery. However, the role of nasogastric decompression in preventing postoperative complications and promoting the recovery of bowel function in children remains controversial. This systematic review aimed to assess whether routine nasogastric decompression is necessary after intestinal surgery in children.

Methods

A systematic review was conducted following the PRISMA guideline. Literature search was performed in electronic databases including PubMed, Embase, CENTRAL, and Web of science. Studies comparing outcomes between children who underwent intestinal surgery with postoperative nasogastric tube (NGT) placement (NGT group) and without postoperative NGT placement (no NGT group) were included.

Results

Six studies were eligible for inclusion criteria including two randomized controlled trials (RCT) and four comparative observational studies. The overall rate of postoperative anastomotic leak was 0.6% (1/179) in NGT group and 0.9% (2/223) in no NGT group. The overall rate of wound dehiscence was 2.4% (4/169) in NGT group and 1.6% (4/245) in no NGT group. Meta-analysis of two RCTs in children undergoing elective intestinal surgery showed significant increase of mild vomiting in no NGT group compared with NGT group (OR 3.54 95% CI 1.04, 11.99) but no significant difference in persistent vomiting requiring NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), abdominal distension (OR 2.36 95% CI 0.34, 16.59), NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), wound infection (OR 1.63 95% CI 0.49, 5.48) and time to return of bowel movement (MD − 0.14 95% CI − 0.45, 0.17). There was no incidence of anastomotic leak in these 2 RCTs. However, there was an incidence of NGT-related discomfort in NGT group, which ranged from 30 to 100% of children studied.

Conclusion

Routine postoperative nasogastric decompression can be omitted in children undergoing intestinal surgery due to no benefit in preventing postoperative complications while increasing patient discomfort.

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Funding

This study was funded by the Naccarato Foundation.

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Authors

Contributions

SC, MY, and AP contributed to the study conception and design. Literature search and data analysis were performed by SC and MY. The first draft of the manuscript was written by SC, MY, NG, PV and AP. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Agostino Pierro.

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Cite this article

Chusilp, S., Yamoto, M., Vejchapipat, P. et al. Nasogastric decompression after intestinal surgery in children: a systematic review and meta-analysis. Pediatr Surg Int 37, 377–388 (2021). https://doi.org/10.1007/s00383-020-04818-6

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Keywords

  • Nasogastric decompression
  • Intestinal surgery
  • Child
  • Systematic review