Top

World Journal of Surgery

Published in:

01-07-2017 | Original Scientific Report

Primary Surgery for Malignant Large Bowel Obstruction: Postoperative Nasogastric Tube Reinsertion is Not Mandatory

Authors: A. Venara, J. Barbieux, P. A. Colas, A. Le Fouler, E. Lermite, A. Hamy

Published in: World Journal of Surgery | Issue 7/2017

Abstract

Background

Malignant large bowel obstructions frequently require emergency surgery. Compliance with enhanced recovery after surgery programmes is significantly reduced due to non-removal of the nasogastric tube in the postoperative period. The first aim of the present study was to research factors associated with the failure of immediate nasogastric tube removal in patients who had undergone emergency surgery for malignant large bowel obstruction. The second aim was to assess the morbidity linked to nasogastric tube reinsertion.

Methods

This retrospective and monocentric study included all consecutive patients admitted for acute malignant large bowel obstruction who underwent emergency surgery. Patients who were not primarily operated on were excluded (n = 178; 69.3%). The group of patients requiring nasogastric tube (NGT) reinsertion was compared with the group that did not require NGT reinsertion.

Results

Seventy-nine patients underwent emergency surgery, of which 18 (22.8%) required nasogastric tube reinsertion. There was no difference between the two groups with regard to (a) immediate nasogastric tube removal (p = 0.87) and (b) inclusion in an enhanced recovery programme (p = 0.75). However, preoperative small bowel dilatation was associated with a reduction in the need for NGT reinsertion (p = 0.04). A left-sided tumour was also associated with the need for NGT reinsertion in uni- (p = 0.034) and multivariate analysis (OR = 8; p < 0.05). Surgical access and procedure were not significantly associated with NGT reinsertion. The postoperative course influenced NGT reinsertion, which was significantly associated with postoperative ileus (OR = 4; p < 0.05) and postoperative morbidity (OR = 4; p < 0.05). Morbidity was not linked to nasogastric tube removal.

Conclusion

Nasogastric tube reinsertion was not affected by immediate removal of the tube. Left-sided tumours and patients at risk of postoperative ileus should be managed with caution. Immediate nasogastric tube removal is not contraindicated in the case of large bowel obstruction because it is not associated with a higher risk of NGT reinsertion.

Ménégoz F, Black RJ, Arveux P, Magne V, Ferlay J, Buémi A et al (1997) Cancer incidence and mortality in France in 1975–95. Eur J Cancer Prev 6:442–466CrossRefPubMed

Jooste V, Remontet L, Colonna M, Belot A, Launoy G, Binder F et al (2011) (2010) Trends in the incidence of digestive cancers in France between 1980 and 2005 and projections for the year. Eur J Cancer Prev 20:375–380CrossRefPubMed

Kye BH, Lee YS, Cho HM, Kim JG, Oh ST, Lee IK, et al. (2016) Comparison of long-term outcomes between emergency surgery and bridge to surgery for malignant obstruction in right-sided colon cancer: a multicenter retrospective study. Ann Surg Oncol 23:1866–1874CrossRef

Otsuka S, Kaneoka Y, Maeda A, Takayama Y, Fukami Y, Isogai M (2015) One-stage colectomy with intraoperative colonic irrigation for acute left-sided malignant colonic obstruction. World J Surg 39:2336–2342. doi:10.1007/s00268-015-3078-5 CrossRefPubMed

Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678CrossRefPubMed

Lohsiriwat V (2014) Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol 14(20):13950–13955CrossRef

Roulin D, Blanc C, Muradbegovic M, Hahnloser D, Demartines N, Hübner M (2014) Enhanced recovery pathway for urgent colectomy. World J Surg 38:2153–2159. doi:10.1007/s00268-014-2518-y CrossRefPubMed

Nelson R, Edwards S, Tse B (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 28(3):CD004929

Rao W, Zhang X, Zhang J, Yan R, Hu Z, Wang Q (2011) The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis 26:423–429CrossRefPubMed

10.

Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17:962–972CrossRefPubMed

11.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

12.

Moolla Z, Madiba TE (2014) Trends in demographics and management of obstructing colorectal cancer. World J Surg 38:2466–2470. doi:10.1007/s00268-014-2595-y CrossRefPubMed

13.

Branger F, Thibaudeau E, Mucci-Hennekinne S, Métivier-Cesbron E, Vychnevskaia K, Hamy A et al (2010) Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis 25:1481–1485CrossRefPubMed

14.

Maruthachalam K, Lash GE, Shenton BK, Horgan AF (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94:1151–1154CrossRefPubMed

15.

Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G et al (2015) Comparison of long-term outcomes of colonic stent as “bridge to surgery” and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol 22:497–504CrossRefPubMed

16.

Chapuis PH, Bokey L, Keshava A, Rickard MJFX, Stewart P, Young CJ et al (2013) Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Ann Surg 257:909–915CrossRefPubMed

17.

Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E (2012) Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World J Surg 36:179–185. doi:10.1007/s00268-011-1339-5 CrossRefPubMed

18.

Vather R, Josephson R, Jaung R, Robertson J, Bissett I (2015) Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 157:764–773CrossRefPubMed

19.

van Bree SHW, Bemelman WA, Hollmann MW, Zwinderman AH, Matteoli G, El Temna S et al (2014) Identification of clinical outcome measures for recovery of gastrointestinal motility in postoperative ileus. Ann Surg 259:708–714CrossRefPubMed

20.

Moghadamyeghaneh Z, Hwang GS, Hanna MH, Phelan M, Carmichael JC, Mills S, et al. (2016) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30:603–609CrossRefPubMed

21.

Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN (2015) Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr 34:367–376CrossRefPubMed

22.

Tevis SE, Carchman EH, Foley EF, Harms BA, Heise CP, Kennedy GD (2015) Postoperative ileus-more than just prolonged length of Stay? J Gastrointest Surg 19:1684–1690CrossRefPubMed

Title: Primary Surgery for Malignant Large Bowel Obstruction: Postoperative Nasogastric Tube Reinsertion is Not Mandatory
Authors: A. Venara
J. Barbieux
P. A. Colas
A. Le Fouler
E. Lermite
A. Hamy
Publication date: 01-07-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3949-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Primary Surgery for Malignant Large Bowel Obstruction: Postoperative Nasogastric Tube Reinsertion is Not Mandatory

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2017

Erratum to: Glasgow Prognostic Score and Prognosis After Hepatectomy for Hepatocellular Carcinoma

Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis

Endoscopic Treatment of High-Grade Dysplasia and Early Esophageal Cancer

From Heartburn to Barrett’s Esophagus, and Beyond

Population-Based Autopsy Study of Traumatic Fatalities

Indeterminate Pulmonary Nodules in Resected Liver Metastases from Colorectal Cancer: A Comparison of Patient Outcomes