Major Elective Abdominal Surgery without Nasogastric Decompression and with Early Opening of the Oral Route

Abstract

Introduction: Nasogastric tube decompression, together with the oral route closed for several days, has been a common practice after elective surgical procedures of the digestive tract. Programs to improve postoperative recovery (Enhanced Recovery After Surgery) advise changing this practice.

Objective: To assess compliance and impact on postoperative evolution of two program actions for nasogastric tube removal and opening of the oral route on the intervention day.

Methods: A prospective study was carried out, from September 2017 to August 2020, in the general surgery service of Hermanos Ameijeiras Hospital. The sample consisted of 270 patients who underwent major elective surgery of the colon, liver, bile duct or pancreas and were applied the program to improve postoperative recovery.

Results: In 79.6% of patients, the nasogastric tube was removed in the operating room after the intervention, a fact associated with faster recovery of intestinal function, shorter stay, as well as fewer complications, readmissions and reinterventions. In 60% of the patients, the oral route was started at six hours after surgery, while 79.6% of them tolerated a soft diet at 48 hours. These patients presented fewer complications and mortality.

Conclusions: In the context of a program to improve postoperative recovery after elective abdominal surgery, nasogastric tube removal on the intervention day, with early opening of the oral route and rapid progression to a soft diet, are well-tolerated actions that have a positive effect on postoperative evolution.

Keywords: ERAS programs; fats-track surgery; postoperative recovery.