When to remove Nasogastric (NG) tube after small bowel resection?

From the Guidelines

The nasogastric (NG) tube should be removed as early as possible after small bowel resection, ideally once bowel function returns, as evidenced by passing gas, having a bowel movement, decreased abdominal distention, and active bowel sounds on examination 1. The decision to remove the NG tube is based on individual patient assessment, taking into account the risk of gastric stasis and aspiration related to gut dysfunction. Daily revaluation of the need for NG tube placement is recommended, and it should be removed as soon as possible to minimize postoperative ileus and promote early recovery 1. Some key points to consider when deciding to remove the NG tube include:

• The extent of surgery, with more extensive resections potentially requiring longer NG tube placement
• The patient's overall recovery progress and tolerance to oral intake
• The presence of signs of returning bowel function, such as passing gas or having a bowel movement
• The risk of complications, such as nausea, vomiting, or abdominal distention, which may require replacement of the NG tube According to recent guidelines, a multifaceted approach to minimizing postoperative ileus, including early removal of nasogastric intubation, should be used to promote early recovery and reduce complications 1. Additionally, studies have shown that routine prophylactic nasogastric intubation may not be necessary and can even be associated with greater length of stay and delay to starting diet 1.

From the Research

Timing of Nasogastric Tube Removal after Small Bowel Resection

• The optimal timing for removing a nasogastric tube (NGT) after small bowel resection is not explicitly stated in the provided studies, but we can infer some guidelines based on the recovery of gastrointestinal motility and the feasibility of early NGT removal.
• A study published in 2025 2 found that solid foods are tolerated after a median of about 3 hours after small bowel resection, and the first flatus appears approximately 16 hours after resection.
• Another study from 2022 3 suggested that early removal of NGT after small bowel obstruction surgery is feasible, safe, and efficient, at least in selected patients.
• The studies 4, 5 also indicate that the use of NGT may not be necessary in all cases of small bowel obstruction and that early removal of NGT can be beneficial in reducing morbidity and shortening hospital stay.

Factors Influencing NGT Removal

• The decision to remove the NGT should be based on the patient's individual recovery progress, including the return of gastrointestinal motility and the ability to tolerate solid food.
• The studies suggest that patients who undergo small bowel resection may be able to tolerate solid food and have their NGT removed earlier compared to those who undergo right or left colon resection 2.
• However, the timing of NGT removal may also depend on other factors, such as the presence of nausea, vomiting, or abdominal distension, which may require a more cautious approach.

Clinical Implications

• The provided studies suggest that early removal of NGT after small bowel resection or obstruction surgery can be beneficial in reducing morbidity and shortening hospital stay 3, 4, 5.
• A randomized controlled trial from 2020 6 compared the use of long tube placement and administration of Gastrografin through a nasogastric tube for non-strangulated acute small bowel obstruction, and found that the latter approach was non-inferior to the former in terms of non-surgery rate.
• Overall, the timing of NGT removal after small bowel resection should be individualized based on the patient's clinical progress and the presence of any complications or contraindications to early removal.