Current literature suggests that the routine use of nasogastric tubes for uncomplicated surgery does not decrease anastomotic leak, wound complications, pulmonary complications, or length of hospital stay and should be abandoned. Avoiding a nasogastric tube encourages early feeding which has been shown to decrease recovery time without worsening ileus or vomiting. Without routine use only 10 % of patients will need postoperative placement of nasogastric tubes—essentially the same number that need to be reinserted if they are used routinely and removed several days after surgery. Risk factors predicting the need for postoperative NG tubes include age greater than 60, preoperative use of narcotics, previous abdominal surgery (requiring lysis of adhesion), low albumin, low hemoglobin, low potassium, low calcium, and deep vein thrombosis.

Routine placement of nasogastric tubes has no value in liver surgery and may increase the risk of pulmonary complications. Risk factors for need of postoperative placement in one randomized trial are female patients, current smokers, and left hepatectomy with 30 % risk with all three factors present.

One randomized controlled trial has shown that avoiding a nasogastric at the time of surgery decreased time to flatus, time to oral intake, and length of hospital stay. In this trial 12 % of patients required placement of a nasogastric tube postoperatively. A meta-analysis of studies of the need for routine nasogastric or nasojejunal decompression after gastrectomy for gastric cancer found no difference in leaks, respiratory complications, length of stay, or complications with their use while time to oral diet was significantly longer when routine decompression was used. The role for nasogastric decompression after esophagectomy requires more study, with contradictory findings related to pulmonary complications.

Good evidence suggests that routine use of a nasogastric tube is not necessary.