Efficacy and necessity of nasojejunal tube after gastrectomy.

BACKGROUND: Nasojejunal tube (NJT) decompression is routinely used for intestinal drainage after total gastrectomy. It is supposed that it would protect anastomosis, but since the stomach should be completely removed, today its efficacy is under question. On the other hand, the tube leads to the discomfort of patients and aspiration disorders or nasopharyngial ulceration. The aim of this study was to evaluate the efficacy and necessity of the nasojejunal tube decompression after gastrectomy. METHODS: In this interventional study, 50 gastric cancer patients who underwent gastrectomy in Ghaem and Omid hospitals, which are affiliated with the Mashhad University of Medical Sciences, from 2001 to 2008 were enrolled. The patients were randomly divided into two groups of with NJT (25 cases) and without NJT (25 cases). The rate of complications, hospital stay duration and the time of beginning their diet were evaluated. RESULTS: The two groups were similar in age, sex, state of the disease, bleeding volume and length of removed esophagus. There was no significant difference between these two groups considering the initial passing of gas, the beginning of their diet, and hospital stay duration. But the incidence of sore throat, nasal discomfort, speech disorders, and patients' dissatisfation were higher in the group with NJT. CONCLUSION: It seems that patients without NJT were more comfortable and satisfied after total gastrectomy. Thus, there is no need for the insertion of the NJT after gastrectomy.

To peritonealise or not to peritonealise? A randomised trial at abdominal hysterectomy in Iran.

We conducted a trial to determine whether non-closure of the visceral and parietal peritoneum alters the intraoperative or post-operative course at abdominal hysterectomy. This was a parallel-group double-blind randomised controlled trial was performed on 66 women who underwent abdominal hysterectomy with or without salpingo-oophorectomy. Twenty-seven were allocated to the control 'closed' group and 39 women to the study 'open' group. The main outcome measures were operative time, estimated blood loss, postoperative pain assessed by visual analogue scale and amount of postoperative analgesia. The study was conducted in the Department of Gynecological Oncology in a university teaching hospital. The operative time was shorter (P < 0.05) and the time to ambulation without assistance was significantly shorter in study group. There were no difference in postoperative pain, blood loss, amount of postoperative analgesia and antibiotics in the two groups. Peritoneal closure at abdominal hysterectomy provides no immediate postoperative benefits while unnecessarily lengthening surgical time and anaesthesia exposure. We suggest that the traditional practice of visceral and parietal closure be abolished at abdominal hysterectomy.