Early removal of nasogastric tube after cystectomy with urinary diversion: does postoperative ileus risk increase?

OBJECTIVES

To examine the risk factors of postoperative ileus and investigate whether the duration of postoperative nasogastric tube (NGT) use affects the rate of postoperative ileus in patients undergoing radical cystectomy with urinary diversion.

METHODS

A total of 101 patients underwent radical cystectomy with urinary diversion from 1999 to 2003. We examined the demographic and perioperative variables of the patients who did and did not develop postoperative ileus. We divided the patients into two groups--those who had the NGT removed within 24 hours and those who had the NGT removed at first flatus. We compared the two groups for the incidence of ileus and clinical variables.

RESULTS

Postoperative ileus was observed in 23 patients (23%). The demographic data of both groups were not different in terms of age or American Society of Anesthesiologists score. Also, the operative time, estimated blood loss, type of diversion, and postoperative complication rate were not significantly different between the two groups (P >0.05). However, the risk of postoperative ileus was significantly greater in those who took polyethylene glycol for bowel preparation than in those who took sodium phosphate (40% versus 18%, respectively, P = 0.02). No significant difference in the prevalence of ileus was found between the patients whose NGT was removed within 1 day and those in whom it was removed after 2 days (25% versus 22%, respectively, P >0.05).

CONCLUSIONS

The results of our study suggest that the use of sodium phosphate for bowel preparation may reduce the incidence of postoperative ileus and that early NGT removal after cystectomy is not correlated with ileus.