Yonsei Med J.  2005 Oct;46(5):648-651. 10.3349/ymj.2005.46.5.648.

Percutaneous Needle Decompression during Laparoscopic Gastric Surgery: A Simple Alternative to Nasogastric Decompression

• Hyung WJ
• Song C
• Cheong JH
• Choi SH
• Noh SH

• KMID: 2158144
• DOI: http://doi.org/10.3349/ymj.2005.46.5.648

Abstract

Laparoscopic gastric surgeries are routinely performed with use of a nasogastric tube to decompress the upper gastrointestinal tract. A distended upper gastrointestinal tract can complicate successful laparoscopic gastric surgery as the distention compromises not only the visual field but also the laparoscopic manipulation of the stomach. Since nasogastric intubation is not without risks, we have attempted laparoscopic-assisted gastric cancer surgeries without nasogastric tubes. In this article we describe a simple method of aspirating gastric contents using a 9 cm long 19-gauge needle inserted percutaneously during laparoscopic-assisted gastrectomy. First, a 9 cm long 19-gauge disposable needle was introduced through the abdominal wall. This needle was then introduced to the stomach through the anterior wall and the stomach gases and fluids were aspirated by connecting the needle to suction. Thus, a collapsed upper gastrointestinal tract was easily obtained. We performed this procedure instead of nasogastric decompression on twenty-two patients with gastric cancer who underwent laparoscopic-assisted distal subtotal gastrectomy with lymph node dissection. The results were good with only one patient experiencing wound infection (4.5%) and one patient with postoperative acalculus cholecystitis (4.5%). There were no patients with either intraabdominal infection or anastomotic leakage and none of the patients needed postoperative nasogastric decompression, except the patient who experienced acaculus cholecystitis. Percutaneous needle aspiration is a very simple and efficient technique with little risk of postoperative complications. It can be used as an alternative to nasogastric tube decompression of the gastrointestinal tract for laparoscopic-assisted gastrectomy.

Keyword

Laparoscopy; nasogastric intubations; gastric surgery; percutaneous aspiration

MeSH Terms

Stomach Neoplasms/*surgery
Middle Aged
Male
Laparoscopy/*methods
Intubation, Gastrointestinal/*methods
Intraoperative Period
Humans
Gastrectomy/*methods
Female
Decompression, Surgical/*methods
Aged
Adult

Figure

• 

  Fig. 1 Percutaneous needle decompression of distended stomach during laparoscopic gastric surgery. A 9 cm long 19-gauge disposable needle is introduced through the abdominal wall.

Reference

1. Lee JH, Hyung WJ, Noh SH. Comparison of gastric cancer surgery with versus without nasogastric decompression. Yonsei Med J. 2002. 43:451–456.

2. Yoo CH, Son BH, Han WK, Pae WK. Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg. 2002. 168:379–383.

3. Wu CC, Hwang CR, Liu TJ. There is no need for nasogastric decompression after partial gastrectomy with extensive lymphadenectomy. Eur J Surg. 1994. 160:369–373.

4. Wolff BG, Pembeton JH, van Heerden JA, Beart RW Jr, Nivatvongs S, Devine RM, et al. Elective colon and rectal surgery without nasogastric decompression. A prospective, randomized trial. Ann Surg. 1989. 209:670–673. discussion 673-5.

5. Hyung WJ, Lee JH, Lah KH, Noh SH. Intraoperative needle decompression: a simple alternative to nasogastric decompression. J Surg Oncol. 2001. 77:277–279.

6. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002. 5:1–5.

7. Soyel DI. Nasogastric decompression following laparotomy (selected summaries). Gastroenterology. 1996. 110:645–646.

8. Cheatham ML, Chapman WC, Key SP, Sawyers JL. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg. 1995. 221:469–478.

9. Chung HY, Yu W. Reevaluation of routine gastrointestinal decompression after gastrectomy for gastric cancer. Hepatogastroenterology. 2003. 50:1190–1192.

10. Hafner CD, Wylie JH, Brush BE. Complications of gastrointestinal intubation. Arch Surg. 1961. 83:147–160.