• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Introduction
  • Preoperative
  • Intraoperative
  • Postoperative
  • Resources
    • Frequently Asked Questions (FAQ)
    • SMART Course Videos
    • Pathways
    • Implementation Timeline

Avoid tubes, drains, lines

Nasogastric tubes: Prophylactic NG tubes are not inserted routinely after bowel surgery. Meta-analyses of trials in mainly lower GI surgery found that bowel function was accelerated and pulmonary complications reduced when NGs were not used (1). NG tube insertion postoperatively may be required in up to 15% of patients. After gastrectomy, a meta-analysis comparing routine NG versus no NG found shorter time to oral diet in the no NG group with no difference in other complications (2).

Urinary catheter: For routine laparoscopic right colectomy, the urinary catheter is removed in the operating room. Even in the presence of a thoracic epidural, urinary catheters can be removed on POD1 in patients at low risk for urinary retention. A bladder scan based protocol is used to monitor for urinary retention in patients who do not void, and in-and-out catheterization performed. This approach reduces UTI rates and does not result in increased rates of reinsertion of the foley catheter compared to later removal (3).

Drains: These are not used routinely for colon, gallbladder, thyroid or uncomplicated liver surgery. In pancreatic surgery, removal is guided by amylase screening and protocolized. For rectal surgery, they are used selectively.


For more information, see Chapter 15: Management of Tubes, Drains and Catheters in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery


References
1. Nelson R1, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD00492

2. Yang Z, Zheng Q, Wang Z. Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Br J Surg. 2008 Jul;95(7):809-16

3. Zaouter C, Kaneva P, Carli F. Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):542-8.


1,827

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Surgery Type
Bowel
Building Blocks
Intraoperative

SAGES Enhanced Recovery

SAGES improves quality patient care through education, research, innovation and leadership, principally in gastrointestinal and endoscopic surgery.

Representing a worldwide community of more than 6,000 surgeons, SAGES sets the clinical and educational guidelines on standards of practice in various procedures, critical to enhancing patient safety and health.

SAGES Support

SAGES gratefully acknowledges Medtronic for its generous educational grant in support of the SMART Enhanced Recovery Program.

Preoperative
Intraoperative
Postoperative

SAGES Smart Task Force

  • Liane Feldman, Chair
  • Thomas Aloia, Co-Chair
  • Gina Adrales
  • Rajesh Aggarwal
  • Joselin Anandam
  • Conor Delaney
  • Diana Diesen
  • Justin Dimick
  • Julio Fiore Jr.
  • Gerald Fried
  • Pascal Fuchshuber
  • I. Gorgun
  • Alexis Grucela
  • Matthew Hutter
  • Edmundo Inga-Zapata
  • Rohan Joseph
  • Deborah Keller
  • Anne Lidor
  • David Liska
  • Sumeet Mittal
  • Charles Paget III
  • Michele Riordon
  • Vadim Sherman
  • Andrew Wright
  • Tonia Young-Fadok
  • Yulia Zak

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons