Outcomes of avoidance of routine nasogastric decompression following elective major gastrointestinal and hepatopancreatobiliary surgery: a single-center prospective observational cohort study.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) guidelines discourage routine nasogastric decompression (NGD); however, evidence from resource-limited settings remains limited. METHODS: This prospective observational cohort study was conducted at Birat Medical College Teaching Hospital, Nepal, between January 2024 and February 2025. Ninety-seven patients were assessed; after excluding protocol breaches (n = 5), non-surgical early mortality (n = 2), and referral (n = 1), 89 adults undergoing elective major gastrointestinal (GI) or hepatopancreatobiliary (HPB) surgery were managed without routine NGD. Patients were categorized according to their postoperative requirement for nasogastric tube reinsertion (NG-R). The outcomes included reinsertion rate, postoperative hospital stay, morbidity (Clavien-Dindo classification), reoperation rate, and 30-day mortality. RESULTS: Routine NGD avoidance was successful in 80 of 89 patients [89.9%; 95% confidence interval (CI): 81.9%-94.6%]. Nine patients (10.1%; 95% CI: 5.4%-18.1%) required therapeutic nasogastric tube (NGT) reinsertion. All reinsertion events occurred in the setting of established postoperative complications and were classified as complication-related therapeutic reinsertions rather than as primary failures of NGD avoidance. Patients in the NG-R group had a descriptively longer median hospital stay (24 vs. 7.5 days, P < 0.001), higher major morbidity (100% vs. 2.5%, P < 0.001), increased reoperation (66.7% vs. 0%, P < 0.001), and higher 30-day mortality (44.4% vs. 0%, P < 0.001). CONCLUSION: Routine NGD omission appears feasible in elective major GI and HPB surgeries in this resource-limited cohort. Rather than representing a primary failure of NGD avoidance, therapeutic NGT reinsertion occurred in the setting of established postoperative complications and was associated with an adverse postoperative outcome. These findings support a selective, indication-based approach to postoperative nasogastric tube use, consistent with ERAS principles.