الفهرس 
ContentsOnly 14 pages are availabe for public view
 |  | from | 112 |  |  |
| | | from | 112 | | |
Abstract
Postoperative gastric decompressi on,by the nasogastric tube (NGT) after elective abdominal surgery, is a routine procedure in most surgical units. The rationale for this measure is to prevent gaseous distension and fluid retention in the early postoperative period.
To evaluate the role of the NGT, 120 patients were randomly allocated to one of two groups A or B (60 patients each). The ir age ranged from 15 — 70 years with the highest incidence among patients of the 5 decade. They were all submitted to major elective abdominal surgery.
In group (A):— There were 40 males and 20 f ema 1 es. Biliary surgery was performed in 18 patients, gastric surgery in 14, splenectomy in another 14, colonic and sma11 intestinal operations in 10. Four patients had undergone dual procedures. They were managed postoperatively with a NGT insitu until the passage of f1atus.
In group B:— There were 38 males and 22 females. Twenty— two patients were subjected to biliary surgery, 15 performed gastric surgery, splenectomy in 15 and 9 had
*
procedures had were managed
colonic and small intestinal surgery. Dual been performed in 2 patients. They postoperatively without a NGT.
Every patient was subjected to detailed history taking, clinical examination, routine investigations, serum electrolyte estimation and special investigations pertinent to the type of the operation proposed.
Operatively : group A, received a NGT from the start
of the operation until the passage of flatus. In the group
B, if the stomach was found distended, it was decompressed
by the (NGT) and at the end of the operation it was
removed. ,....-..„.,...
<■ ■ • •- .- i K .
I’! I : ””” -•’.’■/(:’■
The postoperative follow up stressed upon the possible hazards related to the tube as regard the respiratory tract, gastrointestinal tract, the drain, the wound, electrolyte disturbance and fluid balance. Also the patients impression about the tube was taken into cons iderat ion.
In the intubated group, peristalsis returned after 12.64 ±5.21 hours and flatus passed after 66.13 ±13.64 hours while this duration was shorter in the nonintubated group as peristalsis returned after 9.65 ± 1.9 h. and
flatus passed after 57.55 ±10.95 hours. The rapid return of intestinal movements in the nonintubated group led to a shorter duration of I.V. fluids and consequently an early start of oral feeding.
The tube may be considered as a potential source of chest infection as it was noticed that the nonintubated group suffered less from respiratory complications. Bronchitis occured in 14 of the intubated patients and in 6 of the nonintubated group.
Thi rteen percent of the intubated group compla i ned
from dysphagia while 10% suffered from eructation. These
complaints were not met with in the non—intubated group.
There was no statistical significance in the incidence of
occurence of the other gastrointestinal complications
j (e.g. Hiccough, vomi ting, constipation, diarrhea) between
I both groups. In our study .abdominal distension occured in
j 8.3% of the intubated group and in 10% of the tubeless
j group. The incidence of abdominal distension which is
usually colonic in nature was not influenced by the
presence or absence of the tube. Also wound dehiscence was
not reported in both groups.
There was no significant disturbance of electrolytes levels (Na, K, HC03) in both groups. The fluids were daily
adjusted to maintain a positive balance of 700—1000 cc and to correct any electrolyte disturbance. The chloride level was the only one which showed significant variation. It was lower in the intubated group than in the nonintubated group.
The ma in objection to the NGT, is the discomfort caused by the tube to the patient. The most obvious difference between both groups was the increased comfort and mobility in the tubeless group. In this study 45 of 60 intubated patients were distressed from the tube and considered it as the most unpleasant experience they had ever met.