Outcome of Patients Undergoing Gastrointestinal Anastomosis without Nasogastric Tube Insertion during Elective Surgery

Background: Routine nasogastric decompression after gastrointestinal surgery has been standard practice since its introduction by Levin in 1921. While traditionally believed to hasten bowel function recovery and prevent complications, recent evidence questions its necessity and suggests potential adverse effects. This study evalu-ates outcomes in patients undergoing gastrointestinal anastomosis without nasogastric tube insertion during elective surgery. Methods: A hospital-based prospective study was conducted on 100 patients undergoing elective gastrointesti-nal anastomosis at Kalpana Chawla Government Medical College and Hospital, Karnal, between June 2022 and November 2023. Primary outcomes included time to return of bowel sounds, passage of flatus, and resumption of oral intake. Secondary outcomes included postoperative respiratory tract infections and wound infections. Results: Of 100 patients, 93% were male with majority (40%) aged 18-30 years. Mean time for return of bowel sounds was 1.503±0.85 days, with 90% returning within first three postoperative days. Passage of flatus oc-curred at mean 2.51±1.03 days, with 88% passing flatus between days 1-3. Oral intake resumed at mean 4.80±1.42 days. Gastrointestinal symptoms included nausea (49%), vomiting (18%), and abdominal distention (11%). Respiratory complications occurred in 4% patients (pleural effusion). Wound infection was observed in 32% patients (23% minor, 9% major). Anastomotic dehiscence occurred in 6% patients, necessitating nasogas-tric tube insertion. Most procedures were small bowel anastomoses (87%), with ileoileal being most common (78%). Conclusion: Selective rather than routine nasogastric tube insertion appears appropriate for patients undergoing elective gastrointestinal anastomosis. This approach offers advantages of patient comfort and earlier return of bowel function while maintaining acceptable complication rates.