Unnecessary Gastric Decompression in Distal Elective Bowel Anastomoses in Children. A Randomized Study

Hospital Infantil de Mexico Federico Gomez

Status: Completed

Conditions: Unnecessary Nasogastric Tube; Bowel Anastomosis

Treatments: Other: Non application of nasogastric tube in the experimental group

Study type: Interventional

Funder types: Other

Identifiers

NCT01011023

robdape1

Details and patient eligibility

About

Objective. To study the role of nasogastric drainage to prevent postoperative complications in children with <b>distal</b> elective bowel anastomosis. Summary Background Data. Nasogastric drainage has been used as a routine measure after gastrointestinal surgery in children and adults, to hasten bowel function, prevent post operative complications and shorten hospital stay. However, there is no former study that states in a scientific manner its benefit in children. Methods. The investigators performed a clinical controlled, randomized trial, comprising 60 children that underwent distal elective bowel anastomoses comparing post operative complications between a group with nasogastric tube in place (n=29) and one without it (n=31). <b>As an equivalence study the investigators expected that the two techniques were equivalent.</b> Statistics: Descriptive statistics for global description. Student's t test for quantitative variables and chi square test for qualitative variables. Considering statistically significant a p-value less than 0.05. <b>Being an equivalence study, the default delta generated by the Stata command "equim" was used to demonstrate the equivalence between both groups.</b> Results: Demographic data and diagnosis were comparable in both groups (p=NS). No anastomotic leakage or entero-cutaneous fistulae was found in any patient. The investigators demonstrated equivalency since each confidence interval is entirely contained within delta, except for one variable (beginning deambulation), in which equivalency is suggested. There were no significant differences between groups in abdominal distention, infection, or hospital stay variables. Only one patient in the experimental group required placement of the nasogastric tube due to persistent abdominal distension (3.2%). Conclusions. The routine use of nasogastric drainage can be eliminated after distal elective intestinal surgery in children. It's use should be individualized.

Enrollment: 60 patients

Sex: All

Ages: 1 month to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All patients between the ages of 1 month to 18 years old that required elective laparotomy with an intestinal anastomosis (jejunum, ileum and colon).

Exclusion criteria

• Non elective anastomosis and high risk groups:

  • newborns
  • upper gastrointestinal tract anastomoses (esophagus, gastric, duodenal or jejunal)
  • bilious-digestive or rectal anastomoses
  • immunosuppressed patients
  • gastrostomy or any pre anastomotic derivation
  • multiple anastomoses
  • chronic intestinal obstruction
  • intraoperative fluids-electrolyte disorders
  • reductive enteroplasty (tapering)
  • emergency operations and patients who did not complete the minimum POP follow up of one month.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

60 participants in 2 patient groups

WITHOUT NASOGASTRIC TUBE

Experimental group

Description:

1. Experimental group (EG): without NGT, by removing the NGT at the end of the surgery, once the stomach had been aspirated,

Treatment:

Other: Non application of nasogastric tube in the experimental group

WITH NASOGASTRIC TUBE

Active Comparator group

Description:

2. Control group (CG): with NGT, with radiographic corroboration of correct placement after the surgery. Both groups were given: 5-day fasting because it was the therapeutic gold standard at our hospital and our country, intravenous solutions and antibiotics for 5 days, ranitidine, and analgesics, without use of any antiemetic drug. Once the fasting period ended, in the CG the NGT was clamped and withdrawn, and in both groups oral fluids and diet were started. Once the regular diet was tolerated, the patients were discharged and followed up at clinic 30 days afterwards.

Treatment:

Other: Non application of nasogastric tube in the experimental group