Prevent gastric distention and vomiting after surgery

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2 Remove toxic and unwanted substances from the stomach Administration of enteral nutrition, drugs and so on It favors lung expansion in mechanically unconscious and ventilated subjects Aspiration gastric contents in case of intestinal occlusion Prevent gastric distention and vomiting after surgery

3 NGT removal only after intestinal peristalsis in the absence of nausea, vomiting and abdominal distension Start water diet if there is no nausea and vomiting Progressive implementation of the food in the following days RISK: Pneumonia ab ingestis RISK: Laparocele Anastomosis dehiscence Intestinal perforation

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5 80% 70% 60% 50% 40% 30% 20% 10% 0% Cytomorphic surgery for Lymphadenectomy Radical histerectomy Abdominal histerectomy ovarian cancer Brewer MA et al. Postoperative nasogastric intubation in gynecologic oncology patients: a survey. Gynecol Oncol 1998

6 Neurogenic component Inflammatory compenent Pharmacological component

7 1,2 3, 4, 5 1. LaRosa J et al. The incidence of adynamic ileus in poscesarean patients; patient controlled analgesa versus intramuscular analgesia. J Reprod Med Wolff BG et al. Patterns of gastrointestinal recovery after bowel resection and total abdominal hysterectomy: pooled results from the placebo arms of alvimopan phase III North American clinical trials. Am Coll Surg Woods JH, Erickson LW, Condon RE, Schulte WJ, Sillin LF. Postoperative ileus: a colonic problem? Surgery 1978; 4. Wilson et al. Postoperative ileus: a colonic problem? Surgery Fagotti A1, et al. Postoperative ileus after para-aortic lymphadenectomy: a prospective study. Gynecol Oncol

8 NGT NO NGT Vomit 10% 8% Pneumonia ab ingestis 6% 3% Laparocele 2% 0,6% Intestinal perforation 1% 1% Cheatham ML, Chapman WC, Key SP, Sawyers JL. A metaanalysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995

9 GROUP A GROUP B + Rapid postoperative ileum resolution (P <0.01) + Rapid Power Recovery (P<0.01) Shorter hospital stay (P<0.5) In 6 pts (10%) NGT was needed, of which 3 for postoperative complications Difficulty in swallowing Nasal indolence Discomfort was observed in 88% of pts Rate of nausea and vomiting similar in both groups

10 : : Prevention of gastric atrophy Increase in endogenous bacterial charge Reduce the rate of infection

11 GROUP A (EOF) GROUP B (TOF) P Hospital stay 5dd 6dd Post-operative complications 17% 39% Postop Infections 3% 14% 0.02 PSS

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13 Results Delay resumes intestinal function Increases the risk of respiratory complications No protective effects on intestinal anastomosis Extension hospital stay length Conclusion NGT's routine prophylactic use does not imply achievement of the objectives and is proposed and must be abandoned in favor of selective use

14 Wensheng Rao et al. International Journal of Colorectal Disease. April 2011

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19 Nasogastric decompression increases the incidence of ab ingestis pneumonia and does not reduce other postoperative complications with increased Pts discomfort. The use of nasogastric tube for major gynecological surgery is not recommended. NGT (to be removed in any case in perioperative surgery) may be beneficial in laparoscopic surgery to reduce the risk of gastric perforation during access to abdominal cavity.

20 Early post-operative feeding is not associated with increased complications and reduces hospital stay Early post-operative feeding after early intestinal resection reduces the rate of post-operative infections and dehiscence of anastomosis The incidence of postoperative ileum can be reduced by gum chewing, intestinal stimulation, alvimopan and ketorolac

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