title: Minimally invasive esophagectomy without the use of postoperative nasogastric tube decompression.
abstract: A nasogastric tube (NGT) is commonly used in the postoperative period after esophagectomy for decompression of the gastric conduit. The aim of this study was to evaluate the safety of a minimally invasive esophagectomy without the use of NGT decompression. We performed a retrospective review of 124 patients who underwent minimally invasive esophagectomy. Ninety-eight patients had an NGT placed for postoperative decompression and 26 patients did not. The main outcome measure was postoperative complications in regard to the gastric conduit and esophageal anastomosis. There were 96 males with a mean age of 65 +/- 11 years. Three (3%) of 98 patients with operative NGT placement developed postoperative complications directly related to the NGT, which included perforation of the gastric conduit (n = 1) and perforation of the anastomosis (n = 2). In the 26 patients without operative NGT decompression, one patient (3.8%) had distention of the gastric conduit requiring placement of a NGT under fluoroscopic guidance on postoperative Day 1. There was no significant difference in the leak rate between the groups with NGT decompression compared with the group without NGT decompression (9.2 vs 7.7%, respectively). In conclusion, the use of NGT decompression during minimally invasive esophagectomy can be safely omitted. In cases with postoperative gastric conduit distention, an NGT can be safely placed under fluoroscopic guidance.
authors.affiliation: Department of Surgery, University of California Irvine Medical Center, Orange, California, USA. ninhn@uci.edu
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Johnathan
authors.initials: J
authors.lastname: Slone
authors.forename: James
authors.initials: J
authors.lastname: Wooldridge
authors.forename: Brian R
authors.initials: BR
authors.lastname: Smith
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: David
authors.initials: D
authors.lastname: Hoyt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019299:Decompression, Surgical; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome