Prophylactic nasogastric decompression after abdominal surgery

“The prophylactic use of nasogastric tubes after abdominal operations, flexible tubes inserted through the nose, pharynx, oesophagus and into the stomach, has happened only in the last century, becoming so prevalent that it has been variously described as “the standard of care” (Montgomery 1996), “traditionally used by most surgeons” (Lee 2002), “common practice” (Cunningham 1992, Sakadamis 1999, Manning 2001), “unquestioned” (Savassi-Rocha 1992), and “routine” (Wolff 1989). What is to be achieved by this prophylaxis is gastric decompression, decreased likelihood of nausea and vomiting, decreased distention, less chance of pulmonary aspiration and pneumonia, less chance of wound separation and infection, less chance of fascial dehiscence and hernia, earlier return of bowel function, and earlier hospital discharge.”

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Article of interest: Comparison of open gastrostomy tube to percutaneous endoscopic gastrostomy tube in lung transplant patients.

Taghavi S, et al. Comparison of open gastrostomy tube to percutaneous endoscopic gastrostomy tube in lung transplant patients. Ann Med Surg (Lond). 2015 Dec 23;5 :76-80.

Introduction: Lung transplant patients require a high degree of immunosuppression, which can impair wound healing when surgical procedures are required. We hypothesized that because of impaired healing, lung transplant patients requiring gastrostomy tubes would have better outcomes with open gastrostomy tube (OGT) as compared to percutaneous endoscopic gastrostomy tube (PEG).

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Janeway Gastrostomy

Gastrostomy. Ellison E, & Zollinger R.M., Jr.(Eds.), (2016). Zollinger’s Atlas of Surgical Operations, 10e. McGraw-Hill. Emory login required.

“As a temporary gastrostomy, the Witzel or the Stamm procedure is used frequently and is easily performed. A permanent type of gastrostomy, such as the Janeway and its variations, is best adapted to patients in whom it is essential to have an opening into the stomach for a prolonged period of time. Under these circumstances, the gastric mucosa must be anchored to the skin to ensure long-term patency of the opening. Furthermore, the construction of a mucosa-lined tube with valve-like control at the gastric end tends to prevent the regurgitation of the irritating gastric contents. This allows periodic intubation and frees the patient from the irritation of a constant indwelling tube.”

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