Review of current status of cardiovascular and thoracic surgery in Nepal: An analysis from collection of institutional database

OBJECTIVE

Data collected from various institutions around the country was analyzed to assess the current status of cardiovascular and thoracic surgery in the country.

METHODS

We collected data from institutions performing cardiovascular and thoracic surgery from all over the country through direct correspondence for the year 2019. Individual institution data on the number of surgeries performed for cardiac, vascular, and thoracic surgery and its outcome in terms of mortality were compiled. The data were further evaluated depending on the type of procedures performed.

RESULTS

Overall, a total of 2264 cardiac surgeries were performed in the country in the year 2019. The majority of the surgeries were for valvular heart surgery accounting for 34.3%, followed by congenital surgeries (32.8%) and surgeries for coronary artery disease (25.9%). A total of 649 thoracic surgeries were documented, which is probably marginally less than the actual numbers because we were unable to include an additional few institutions performing low-volume or isolated thoracic procedures in this report. A total of 852 vascular procedures were performed in the country, which is probably underreported. The mortality rates for complex congenital procedures were higher than those reported in the literature and that of adult procedures such as valvular heart disease and coronary artery disease similar to literature.

CONCLUSION

We evaluated the recent status of cardiovascular and thoracic surgery in the country with respect to the type of procedures and the postoperative outcomes.

Towards reducing chemical usage for weed control in agriculture using UAS imagery analysis and computer vision techniques

Currently, applying uniform distribution of chemical herbicide through a sprayer without considering the spatial distribution information of crops and weeds is the most common method of controlling weeds in commercial agricultural production system. This kind of weed management practice lead to excessive amounts of chemical herbicides being applied in a given field. The objective of this study was to perform site-specific weed control (SSWC) in a corn field by: (1) using a unmanned aerial system (UAS) to map the spatial distribution information of weeds in the field; (2) creating a prescription map based on the weed distribution map, and (3) spraying the field using the prescription map and a commercial size sprayer. In this study, we assumed that plants growing outside the corn rows are weeds and they need to be controlled. The first step in implementing such an approach is identifying the corn rows. For that, we are proposing a Crop Row Identification algorithm, a computer vision algorithm that identifies corn rows on UAS imagery. After being identified, the corn rows were then removed from the imagery and remaining vegetation fraction was classified as weeds. Based on that information, a grid-based weed prescription map was created and the weed control application was implemented through a commercial-size sprayer. The decision of spraying herbicides on a particular grid was based on the presence of weeds in that grid cell. All the grids that contained at least one weed were sprayed, while the grids free of weeds were not. Using our SSWC approach, we were able to save 26.2% of the acreage from being sprayed with herbicide compared to the current method. This study presents a full workflow from UAS image collection to field weed control implementation using a commercial size sprayer, and it shows that some level of savings can potentially be obtained even in a situation with high weed infestation, which might provide an opportunity to reduce chemical usage in corn production systems.

Minimally Invasive Thoracic Surgery for Low- and Middle-Income Countries

The burden of respiratory and upper-gastrointestinal diseases especially affects low- and middle-income countries. Five billion people lack access to safe, timely, and affordable surgical care, including thoracic surgical care. Minimally invasive thoracic surgery (MITS) has been shown to reduce complications, shorten hospital lengths of stay, and minimize health care costs, thereby enabling patients to pay less out-of-pocket and/or limit time away from work and families. Experiences with MITS exist but are limited in low- and middle-income countries; professional societies, academic institutions, policymakers, and industry can facilitate scale-up of MITS by increasing financing, expanding surgical training, and optimizing surgical supply chains.

An unusual tracheal foreign body residing for 15 years: A case report and review of literature

Airway foreign bodies are common in children, and usually present as emergencies. However, they may sometimes present late, due to a number of reasons. Chronic lodgement of foreign bodies in trachea is rarer than that in bronchial tree. Flexible and rigid bronchoscopies have revolutionized the management of foreign bodies at large. Here, we report a successful bronchoscopic management of an unusual foreign body residing in the trachea of a patient for 15 years.

Intercolony Comparisons of Gut Microbiome Composition From Lab Reared Eastern Subterranean Termites (Blattodea: Rhinotermitidae)

Termites are social insects living in colonies composed of worker, soldier, and reproductive castes. Termite hindguts are inhabited by all three domains of life- Eukarya (protists), Bacteria, and Archaea. These gut microorganisms are horizontally and vertically transferred by nestmates and reproductives, respectively. Prior evidence suggests that every colony potentially has a different gut microbiome that was transferred vertically and horizontally over time. However, we do not know if different colonies reared in the laboratory on the same diet will ultimately demonstrate similar microbial composition and structure. Therefore, we looked at gut bacteria in Eastern subterranean termite (Reticulitermes flavipes) colonies that were reared in the laboratory with identical diets and rearing conditions. Based on16S rRNA gene sequencing, the observed features, and Shannon's diversity were significantly different between the colonies while differences in Pielou evenness and Faith phylogenetic diversity were not statistically significant. In addition, the microbial community structures were significantly different between colonies. Based on ANCOM (Analysis of Composition of Microbiomes), the taxa Elizabethkingia (Bacteroidetes: Flavobacteriales) and Chryseobacterium (Bacteroidetes: Flavobacteriales) were differentially abundant between the colonies. These results suggest that providing the exact same diet and rearing environment for >2 yr cannot result in identical gut microbiomes between termite colonies.

An Audit of the Outcomes of Thymic Surgery

Most pathology of the thymus gland warrant its surgical removal; and this requires significant expertise and adequate medical set-up. This study aimed to audit the results of thymectomies performed in a specialised tertiary level centre in a resource-poor country. The outcomes of open and minimally invasive video-assisted thoracoscopic surgery (VATS) thymectomies were also compared. Out of 58 patients operated at Department of Thoracic Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Kathmandu, Nepal between October 2012 and January 2019, 33 patients underwent open thymectomy and 25 had VATS thymectomy. We conducted a retrospective search to look at operative time, blood loss and length of postoperative hospitalisation. The open surgery group was followed for an average of 32 months, and the VATS cohort for 38 months. No significant differences were found in mean operative times and overall survival between groups. In selected cases, thymectomy via VATS is safer and comparable to open thymectomy in terms of operative safety and oncological completeness. Key Words: Thymus, VATS, Thymectomy, Outcome.

Socio-demographic and Healthcare-seeking Predictors of Undernutrition among Children Under-five Years of Age in a Western District of Nepal

BACKGROUND

Undernutrition is highly prevalent in Nepal, which interferes with physical and mental development among children. It is one of the severe health problems contributing to the significant portion of the disease burden. This study aimed to explore socio-demographic and healthcare-seeking related predictors of undernutrition among children under five years old in Dang, Nepal.

METHODS

This was a descriptive cross-sectional study. A sample of 426 children was participated through stratified proportionate random sampling to identify socio-demographics and healthcare-seeking predictors of undernutrition. Multivariable regression was applied to identify the independent predictors of undernutrition.

RESULTS

This study found that children below 24 months of age were more likely to be undernourished than children aged 24-36 months. Female children (OR=2.32, 95% CI: 1.19-4.54), illiterate or non-formally educated women (OR=4.09, 95% CI: 1.84-9.08), mother's occupation other than a housewife (OR=13.05, 95% CI: 4.19-40.68), labor work of father (OR=2.40, 95% CI: 1.04-5.57) had increased risk of undernutrition among children. Similarly, food insufficiency from their land, antenatal care visit, postnatal care visit, and delivery place were significantly associated with childhood undernutrition among children.  Conclusions: The study showed that undernutrition among children is associated with age and gender of children, educational attainment of the mother, food sufficiency, health-seeking practices of the mother during pregnancy, delivery, and postnatal. Socio-demographics and health-seeking practices related predictors must be explicitly considered to address undernutrition among children under the age of five years.

Alive leech in the airway: a case report

Airway foreign bodies are common problems in children. However, they can also occur in adults, albeit less commonly. These are usually inanimate objects but sometimes, animate objects may also be ‘inhaled’, and these can rarely include live creatures! In this report, we discuss an interesting case of a live leech in the airway that we managed in our center.

Esophageal 'pyocele': thoracoscopic management

Mucocele of the native esophagus is a rare complication after esophageal bypass surgery for various indications. Esophageal mucoceles rarely get infected, forming a ‘pyocele’ which becomes symptomatic. Various approaches have been utilized in the management of such pyoceles. We report a similar patient managed successfully in our center utilizing a thoracoscopic deroofing and partial excision of the pyocele.

Thoracoscopic Surgery for Posterior Mediastinal Mass: Our Initial Experience

Background: Thoracoscopic surgery has been increasingly used for a variety of indications. Posterior mediastinal tumors form an important component of a thoracic surgeon’s workload. This report represents a summary of our initial experience in thoracoscopic management of such tumors. Methods: We retrospectively reviewed the clinical and operative data from records over the study period. We also describe our usual perioperative management and surgical techniques. Results: A total of 11 patients, 8 being females, were operated during the period of 30 months. Seven were incidental findings, and chest pain was the commonest presentation in symptomatic patients. The mean age of the patients was 38.7 years; mean tumor diameter was 4.4 cm; eight had benign schwannoma, and no patient had a malignant tumor. Mean operative duration was 175.5 min; there were no conversions and no transfusion was required. Mean length of stay in the hospital was 5.6 days. There were no perioperative deaths or major complications. Three minor complications were recorded. Follow-up (4 to 18 months) was uneventful. Conclusions: Thoracoscopic management of posterior mediastinal tumors is feasible and safe.

Surgery for parasitic lung infestations: roles in diagnosis and treatment

Pulmonary parasitic infestations are a worldwide problem associated with significant morbidity and socioeconomic impact. They are known to have varied clinical presentations and radiological appearances. Prevention of parasite transmission and medical treatment of cases form the two pillars of control of these diseases. The role of surgery is limited to the diagnosis and definitive treatment of the minority of pulmonary parasitic afflictions, most notably hydatidosis. Despite surgery being established as the treatment of choice in pulmonary hydatid cysts (PHCs) for over half a century, variations and unresolved controversies persist regarding the best surgical technique. Complications brought on by cyst rupture, multiplicity and multi-organ involvement add complexity to treatment decisions. The development of video-assisted thoracoscopic surgery (VATS) brings the promise of reduced peri-operative morbidity but is yet to be universally accepted as a safe technique. In this review, we endeavor to discuss the common pulmonary infestations focusing on the current trends and controversies surrounding surgery for PHC.

Operative management of pediatric empyema: a single center review

Introduction: Empyema thoracis is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. Its management is still controversial, with a range of treatment options available and evolving gradually towards adoption of video-assisted thoracoscopic surgery (VATS) as the most commonly practiced one. Aim: The aim of this study was to review our experience in pediatric empyema thoracis. Methods: It was a retrospective review of the prospectively recorded data, spanning a period of 18 months in the Department of Cardio-Thoracic and Vascular Surgery in Manmohan Cardio-Thoracic Vascular and Transplant Center. Results: A total of 40 consecutive patients, 29 males and 11 females, aged 15 years or less were operated upon for a diagnosis of empyema thoracis made based on clinical, radiological and laboratory evidence. All of them were referred patients, mostly from pediatricians. VATS was undertaken in 36 of them, the remaining four treated by open approach. Deloculation sufficed in majority (26/40; 65%) of the patients which mostly (23/26; 90%) had either acute or subacute presentation. Decortication was required in 35% (14/40) of the patients. However, all of the patients but one had a successful outcome in terms of lung expansion, sterilization of the pleural cavity and absence of recurrence. There was no operative mortality. Conclusion: Surgical management of pediatric thoracic empyema is feasible and safe with favorable outcome. VATS is gradually becoming the more favored modality of operative management.  

Autologous blood patching in the management of broncho-pleural fistula in spontaneous pneumothorax

Introduction: Autologous blood patching (ABP) has been described as a modality of treatment of bronchopleural fistulas (BPF). The success rates have varied chiefly because the numbers studied have been small and the populations inhomogeneous. We conducted this study to determine the success rate in patients with BPF of spontaneous onset.Methods: All patients with spontaneous pneumothorax with no evidence of pleural infection and in whom the air leak did not subside despite 48 hours of conservative management were included These  patients underwent one to three episodes of blood patching in 50ml aliquots. Demographic profile, smoking status, success rate and complications were recorded and compared.Results: Between July 2011 and January 2014, seventy-six patients underwent ABP. The overall success rate of ABP was 58%. Twenty one were successful in first attempt (27.6%), a further 12/55 (22%) in the second and 11/43 (25%) in third attempt. The success rates did not differ significantly with etiology of spontaneous pneumothorax (P = 0.706); smoking status (P value = 0.958); duration of air leak prior to ABP (P= 0.149) and presence of residual pneumothorax after chest tube insertion (P= 0.176). Seven complications (3 pleural infections, 1 surgical emphysema, 1 expansion of pneumothorax and 2 recurrence) occurred. Infectious complications occurred in patients who received two or more instillations of blood.Conclusion: ABP achieved a modest success rates in our experience. Two or more attempts may be necessary to attain a successful result but one has to be mindful of the possibility of infection.Journal of Society of Surgeons of Nepal, 2015; 18 (2)

Outcome of diaphragmatic herniation and eventration repair in adults

Introduction: Diaphragmatic hernia and eventration are amongst the less commonly encountered thoracic surgical problems in Nepal. Unlike, the cases of traumatic herniation, adults with congenital hermination  and eventration seek medical attention very late.Methods: It is a retrospective observational study of patients presenting with diaphragmatic hermiation  and eventration at Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal. Medical records of five years (May, 2010 to April, 2015) were reviewed. Analysis of the demographic profile, clinical features, management and outcome was done.Results: There were a total of 15 patients who were diagnosed to have diaphragmatic hermiation  and eventration. There were eight cases of hermiation and seven cases of eventration. There were three cases of acute diaphragmatic hermiation. Thoracic trauma was found to be associated in three cases of herniation only. The mean age at presentation was 46.5 years. Thoracic trauma was seen in Younger age (mean age being 34 yrs). There were two cases of morgagni hernia and one of these was diagnosed incidentally. Mean duration of symptoms was two months. The most common presenting symptoms were shortness of breath and cough. Twelve cases were repaired via thoracotomy. Mean size of diaphragmatic defect was six centimeters. The most commonly herniated organ was stomach followed by momentum. Placation was the most commonly performed procedure in eventration and primary repair was done in six cases of hermiation and mesh repair in two cases. Only two patients had superficial surgical site infection. Mean duration of hospital stay was eight days. The patients were doing good up to mean follow up period of four months.Conclusion: Diaphragmatic hermiation and eventration in symptomatic patients should be managed surgically. Surgical approaches can be thoracotomy, laparotomy and Video Assisted Thoracoscopic Surgery. Outcome following surgery is good with minimal postoperative complications. JSSN 2015; 18 (1), Page : 1-4

Successful surgical management of a rare esophageal inflammatory myofibroblastic tumour: a case report

Inflammatory myofibroblastic tumour (IMT) is an uncommon mesenchymal tumour, which can occur anywhere in the body, rarely in esophagus. Mostly, the diagnosis is postoperative, after the hispathological evaluation of the specimen. There are no definite guidelines regarding the diagnosis and management. Here, we report a 60 year old lady presenting with dysphagia, diagnosed to have a submucosal esophageal tumor with Barium esophagogram and contrast enhanced computed tomography. She was managed successfully with surgical enucleation with the final histopathological diagnosis of IMT. Surgical excision is not only therapeutic but also diagnostic in such cases.

Prophylactic nasogastric decompression after emergency laparotomy

INTRODUCTION

Post-operative nasogastric intubation after emergency laparotomy is a common practice in many centers, with the intent of hastening the return of bowel function, relieving gastrointestinal discomfort, reducing various post-operative complications and reducing hospital stay. However, bowel rest and gastric decompression have been re-examined in the light of more recent data. Many studies and meta-analyses over the last 50 years have challenged the routine use of nasogastric tubes after laparotomy. The objective of this study is to evaluate the need for routine nasogastric decompression after emergency laparotomy.

METHODS

A prospective, randomized controlled trial was conducted for 12 months (May 1, 2007 to Apr 30, 2008) in the Department of Surgery, Tribhuvan University Teaching Hospital, after ethical approval. Patients were enrolled as per criteria (Box 1), and subsequently allocated by simple randomization into two groups: Group 1 and Group 2. Patients undergoing emergency laparotomy for perforation peritonitis, intestinal obstruction and abdominal trauma were randomized to two groups - with or without nasogastric tube after surgery. Gastric upset, return of bowel function and postoperative complications were compared.

RESULTS

Total of 115 patients met the inclusion criteria. There was no statistically significant difference in the occurrence of gastric upset (P: 0.38), wound complications (P: 0.30), respiratory complications (P: 0.30) and anastomotic leak (P: 0.64) between two groups. Bowel function returned in comparable times in both groups (correlation coefficient: 0.14; P: 0.54). Nasogastric tube had to be reinserted in three patients in the group with nasogastric decompression postoperatively, and four in the group without (P: 0.43). Thus, routine nasogastric decompression neither prevented the development of gastrointestinal discomfort nor precluded the need for tube replacement once it was discontinued. For every patient who required post-operative nasogastric decompression, at least 14 patients were spared one. Mean hospital stay was significantly more in the decompressed group (7.52 days; correlation coefficient: 0.22; P<0.05).

CONCLUSION

This study has shown that the prophylactic nasogastric decompression following emergency laparotomy is ineffective in achieving any of the intended goals.

KEYWORDS

complications; decompression; emergency laparotomy; flatus; nasogastric tube; prophylactic.

An unusual case of pulmonary embolism

Pulmonary embolism carries a significant morbidity and mortality. Metastatic choriocarcinoma presenting as pulmonary embolism is a rare event. Here, we report a case of a 25-year-lady with a history of worsening shortness of breath for 4 months who was treated as a case of pneumonia and tuberculosis. Owing to the worsening condition, she had a contrast enhanced computed tomography (CECT) chest done and was diagnosed to have pulmonary embolism. She underwent pulmonary embolectomy. The histopathological examination of the embolus revealed it to be metastatic choriocarcinoma. She showed a good response to chemotherapy. Metastatic choriocarcinoma should be considered as a differential diagnosis in females presenting with pulmonary embolism.

Breast cancer in young women from a low risk population in Nepal

BACKGROUND

The overall incidence of breast cancer in South Asian countries, including Nepal, is low compared to Western countries. However, the incidence of breast cancer among young women is relatively high. Breast cancer in such cases is characterized by a relatively unfavorable prognosis and unusual pathological features. The aim of this study was to investigate clinico-pathological and biological characteristics in younger breast cancer patients (<40 years) and compare these with their older counterparts.

MATERIALS AND METHODS

Nine hundred and forty four consecutive female breast cancer patients, admitted to the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal between November 1997 and October 2012, were retrospectively analyzed.

RESULTS

Out of the 944 female breast cancer patients, 263 (27.9%) were <40 years. The mean age was 34.6 ± 5.0 years among younger patients compared to 54.1 ± 9.9 for those ≥ 40 years. The mean age at menarche was also significantly lower (13.5 ± 1.5 vs 14.2 ± 1.5 years p=0.001) while the mean duration of symptoms was significantly longer (7.6 vs 6.5 months p=0.004). Family history of breast cancer was evident in 3.0% of the young women versus 0.3% in the older one. Mammography was performed less frequently in younger patients (59.7%), compared to older (74.4%), and was of diagnostic benefit in only 20% of younger patients compared to 85% of older ones. At diagnosis, the mean tumor diameter was significantly larger in young women (5.0 ± 2.5 vs 4.5 ± 2.4 cm, p=0.005). Axillary lymph nodes were positive in 73% of younger patients and 59% of older patients. In the younger group, the proportion of stage III or IV disease was higher (55.1% vs 47.1%, p ≤ 0.05). The proportion of breast conserving surgery was higher in young patients (25.1% vs 8.7%) and a higher proportion of younger patients receive neoadjuvant chemotherapy (9.9% vs 2.8%). The most common histological type was ductal carcinoma (93.1% vs 86%). The proportion of histological grade II or III was higher in younger patients (55.9% vs 24.5%). Similarly, in the younger group, lymphatic and vascular invasion was more common (63.2% vs 34.3% and 39.8% vs 25.4%, respectively). Patients in the younger age group exhibited lower estrogen and/ or progesterone receptor positivity (34.7% vs 49.8%). Although statistically not significant, the proportion of triple negative tumors in younger age group was higher (22.4% vs 13.6%).

CONCLUSIONS

Breast cancer in young Nepalese women represents over one quarter of all female breast cancers, many being diagnosed at an advanced stage. Tumors in young women exhibit more aggressive biological features. Hence, breast cancer in young women is worth special attention for earlier detection.

Transbronchial needle aspiration cytology of endobronchial abnormalities: does it increase the positivity rates of bronchoscopy

Background: Negative results in bronchoscopic sampling techniques increase costs and delay treatment. We analyzed if addition of transbronchial needle aspiration (TBNA) increases the diagnostic yield of bronchoscopy. Materials and Methods: Patients with endobronchial abnormalities in whom a full set of sampling techniques (lavage, TBNA, biopsy and brushing) were done and had a confirmed diagnosis of lung cancer by one or more methods were included. The positivity rates of each of the sampling techniques and their various combinations were studied. We compared the positivity rates of bronchoscopy with and without TBNA. We also studied if TBNA was more valuable in any specific type, histology or position of endobronchial abnormalities. Results: The overall positivity rate of TBNA was 56%. It was higher than lavage and brushing but lower than biopsy. The addition of TBNA to the routine combination of sampling tachniques (lavage, biopsy and brushing) increased diagnostic yield from 76% to 86.6%. Contrary to previous reports, the increase in diagnostic yields did not differ significantly between types (exophytic vs submucosal), side or location of the endobronchial lesions. TBNA was found to have a significantly better positivity rates in small cell carcinoma than in non-small cell carcinoma cases. Conclusion: TBNA is a safe sampling technique for endobronchial abnormalities during bronchoscopy. It increases the diagnostic yields of bronchoscopy and this increase seems to be uniform amongst different types, histologies and locations of endobronchial abnormalities. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10324 Journal of Pathology of Nepal (2014) Vol. 4, 565-569

Traumatic pseudoaneurysm of the heart

Missile injuries to heart are one of the most severe penetrating chest injuries, and mostly fatal. The presentation in those who survive may be unusual and insidious. Pseudoaneurysms of the heart, usually sequel to myocardial infarction, may rarely present after penetrating cardiac wounds. Their management is a challenging one, and requires the provision of cardiopulmonary bypass. We report a case of ventricular pseudoaneurysm as a consequence of bullet injury, successfully managed in our center.

Intercostal muscle flap and intracostal suture to reduce post-thoracotomy pain

BACKGROUND

Thoracotomy is considered to be the most painful surgical access, the main culprit being intercostal nerve injury. Despite the use of many techniques, this remains a major problem, pointing towards prevention as a better strategy. The effect of protecting both the upper and lower intercostal nerves during surgery has attracted many researchers.

METHOD

A prospective study spanning 15 months was undertaken in 48 patients randomized to a conventional group (n = 25) and a study group (n = 23). Pericostal sutures in the former and intracostal sutures in the latter were used for closure. An intercostal muscle flap was harvested at the start of the operation in the study group only. The groups were comparable in terms of baseline characteristics. With a similar pain protocol, pain scores and analgesic consumption were recorded and analyzed.

RESULTS

Times for pedicle harvest, intracostal suture, and pericostal suture were 5.2 ± 1.56, 3.65 ± 0.71, and 6.4 ± 1.20 min, respectively, in the study group. Total operative time was similar in both groups. Postoperative pain scores and the overall frequency of pain were consistently lower in the study group.

CONCLUSION

these techniques lead to a reduction in the acute and chronic post-thoracotomy pain, without increasing complications.

Impalement injury to the heart

Cardiac impalement injury is rare and one of the most severe penetrating chest injuries, often fatal. The management of penetrating cardiac injuries is a challenging one. The success in management of impaling cardiac trauma requires stabilization of the impaling object, expeditious transfer to a facility for open heart surgery, rapid imaging, access to blood and blood products and a ready surgical team. We report a case of impalement injury to the heart by a stick, transfixing the right ventricle and its successful treatment.

Prophylactic Nasogastric Decompression after Emergency Laparotomy

Introduction: Post-operative nasogastric intubation after emergency laparotomy is a commonpractice in many centers, with the intent of hastening the return of bowel function, relievinggastrointestinal discomfort, reducing various post-operative complications and reducing hospitalstay. However, bowel rest and gastric decompression have been re-examined in the light of morerecent data. Many studies and meta-analyses over the last 50 years have challenged the routine useof nasogastric tubes after laparotomy. The objective of this study is to evaluate the need for routinenasogastric decompression after emergency laparotomy.Methods: A prospective, randomized controlled trial was conducted for 12 months (May 1, 2007 toApr 30, 2008) in the Department of Surgery, Tribhuvan University Teaching Hospital, after ethicalapproval. Patients were enrolled as per criteria (Box 1), and subsequently allocated by simplerandomization into two groups: Group 1 and Group 2. Patients undergoing emergency laparotomyfor perforation peritonitis, intestinal obstruction and abdominal trauma were randomized to twogroups – with or without nasogastric tube after surgery. Gastric upset, return of bowel function andpostoperative complications were compared.Results: Total of 115 patients met the inclusion criteria. There was no statistically significantdifference in the occurrence of gastric upset (P: 0.38), wound complications (P: 0.30), respiratorycomplications (P: 0.30) and anastomotic leak (P: 0.64) between two groups. Bowel function returnedin comparable times in both groups (correlation coefficient: 0.14; P: 0.54). Nasogastric tube had tobe reinserted in three patients in the group with nasogastric decompression postoperatively, andfour in the group without (P: 0.43). Thus, routine nasogastric decompression neither prevented thedevelopment of gastrointestinal discomfort nor precluded the need for tube replacement once it wasdiscontinued. For every patient who required post-operative nasogastric decompression, at least 14patients were spared one. Mean hospital stay was significantly more in the decompressed group(7.52 days; correlation coefficient: 0.22; P<0.05).Conclusion: This study has shown that the prophylactic nasogastric decompression followingemergency laparotomy is ineffective in achieving any of the intended goals._______________________________________________________________________________________Keywords: complications; decompression; emergency laparotomy; flatus; nasogastric tube; prophylactic._______________________________________________________________________________________