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

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.

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