Safe without Suction: RCT Challenges Routine Gastric Decompression in Laparoscopy

Abstract

Study Objective

The study aims to evaluate the necessity of intraoperative gastric decompression during gynecologic laparoscopy. The primary outcomes include (1) where the lower edge of the stomach resides with or without an orogastric tube and (2) whether experienced surgeons accurately detect group assignment.

Design

Double-blind, randomized control trial. Participants undergoing gynecologic laparoscopy with umbilical entry were block-randomized (1:1) to orogastric decompression or none. Upon abdominal entry, the surgeon assessed adequacy of decompression, risk of gastric injury, and measured the distance between entry site and the stomach.

Setting

Operating room.

Patients or Participants

Low-risk participants undergoing gynecologic laparoscopy with umbilical entry were included. Participants were excluded for a variety of reasons including risk of delayed gastric emptying (e.g., GLP-1 receptor agonist) or suspected gastric insufflation during intubation.

Interventions

Intraoperative assessment.

Measurements and Primary Results

Of 150 participants enrolled, 139 were included in the study. Participants in the study and control groups did not significantly vary based on age (37.8 vs, 36.8), BMI (27.3 vs 27.9), or procedure type. A total of four complex gynecologic surgeons performed the intraoperative assessment, blinded to the assignment. Stomach decompression was rated “excellent” or “good” in 69% of cases without orogastric tube placement. The stomach was adequately decompressed in 100% of participants who had an orogastric tube and 97% of participants who did not. There were no cases of gastric injury. The surgeon thought an orogastric tube was present in 31.9% (n=23) of participants without gastric intubation. There was a significant difference between groups in percentage of cases with accurate assessment of gastric intubation (p=0.0001). The distance between the umbilicus and inferior aspect of the stomach correlated well with BMI.

Conclusion

Routine gastric decompression during gynecologic laparoscopy with umbilical entry is not necessary for low-risk patients. Regardless of placement of an orogastric tube, the stomach was adequately decompressed, without risk of injury, and without immediate postoperative negative experience.