title: Nasogastric drainage may be unnecessary after pancreaticoduodenectomy: a comparison of routine vs selective decompression.
abstract: BACKGROUND
  Limited data exist for the use of nasogastric decompression after pancreaticoduodenectomy (PD), when postoperative nasogastric tube (NGT) use remains the standard of care. This study seeks to evaluate the effects on patient outcomes of routine vs selective NGT use after PD.
  
  
  METHODS
  Two hundred and fifty patients undergoing PD between July 2003 and February 2012 by a single surgeon at an academic center were evaluated as 2 consecutive cohorts of 125 patients. The first patient cohort had NGTs placed intraoperatively and maintained until clinically indicated. In the second cohort, NGTs were selectively maintained only in rare circumstances, such as inability to extubate the patient postoperatively. The primary outcomes evaluated were postoperative NGT insertion and reinsertion, delayed gastric emptying incidence, time to dietary tolerance, and length of stay. Secondary analysis examined overall surgical morbidity and additional specific complications of interest.
  
  
  RESULTS
  Mean patient age was 63.4 years and the most common indication was pancreatic neoplasm. Patients in both the routine and selective placement groups were evaluated in an intent-to-treat manner. In the selective group, NGTs were maintained in 9 patients postoperatively (7.2%). Need for NGT insertion and reinsertion and duration of NGT replacement did not differ significantly between selective and routine groups. Overall complication rates were similar, however, patients in the selective group had decreased incidence of delayed gastric emptying (p = 0.015), length of stay (p < 0.001), and time to dietary tolerance (p < 0.001).
  
  
  CONCLUSIONS
  Routine postoperative nasogastric decompression in patients undergoing PD appears unnecessary in many cases, and can adversely impact postoperative course. Selective NGT usage seems an appropriate treatment strategy.
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT 06520-8062, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Kunstman
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Klemen
authors.forename: Annabelle L
authors.initials: AL
authors.lastname: Fonseca
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Araya
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Salem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003237:Connecticut / Q000453:epidemiology; D019299:Decompression, Surgical; D004322:Drainage / Q000379:methods; D005260:Female; D018589:Gastroparesis / Q000453:epidemiology; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: DGE; NGT; PD; PPPD; delayed gastric emptying; nasogastric tube; pancreaticoduodenectomy; pylorus-preserving pancreaticoduodenectomy