National survey on management practices for adhesional small bowel obstruction and nasogastric tube use among general surgeons in Australia

Background: The nasogastric tube (NGT) is recommended routinely by current guidelines in the non-operative management of adhesional small bowel obstruction (ASBO). However, several retrospective studies have reported poorer outcomes in ASBO patients managed with an NGT. We sought to examine current practices among Australian General Surgeons in managing ASBO and using NGTs, assess the presence of surgical equipoise for a potential randomised controlled trial (RCT), and evaluate interest in multi-centre collaboration. Methods: In October 2021, we conducted an online survey of all active members of General Surgeons Australia using a REDCap® questionnaire distributed via email. The survey included clinical scenarios of small bowel obstruction and questions on demographics, management practices, and clinical reasoning. Descriptive statistics were used to summarise all relevant variables. Results: Of the 893 emails sent, 181 responses were received (20%). Most respondents were from New South Wales (47%) and had subspecialty training (71%). An NGT was used in over 90% of ASBO cases by 42% of respondents. Sixty-four percent believed NGT use could prevent surgery, and 93% viewed it as having a therapeutic role. Vomiting was the most common indication for insertion, and 69% believed it reduces aspiration risk. Gastrografin® was used by 96% of surgeons. Forty-two percent expressed willingness to participate in an RCT evaluating NGT use. Conclusions: Current practice among Australian surgeons reflects a selective approach to NGT use in the management of ASBO. Given the variability in beliefs regarding its utility, a randomised controlled trial is needed to establish best practice in non-operative management of ASBO.