Yonsei Medical Journal Vol. 46, No. 5, pp. 648 - 651, 2005 Percutaneous Needle Decompression during Laparoscopic Gastric Surgery: A Simple Alternative to Nasogastric Decompression Woo Jin Hyung,1,2 Changsoo Song,1 Jae Ho Cheong,1,2 Seung Ho Choi,1 and Sung Hoon Noh1,2,3 1Department of Surgery, 2Cancer Metastasis and Research Center, and 3Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. Laparoscopic gastric surgeries are routinely performed with use of a nasogastric tube to decompress the upper gastroin- testinal tract. A distended upper gastrointestinal tract can com- plicate successful laparoscopic gastric surgery as the distention compromises not only the visual field but also the laparoscopic manipulation of the stomach. Since nasogastric intubation is not without risks, we have attempted laparoscopic-assisted gastric cancer surgeries without nasogastric tubes. In this article we describe a simple method of aspirating gastric con- tents using a 9 cm long 19-gauge needle inserted percutane- ously during laparoscopic-assisted gastrectomy. First, a 9 cm long 19-gauge disposable needle was introduced through the abdominal wall. This needle was then introduced to the stomach through the anterior wall and the stomach gases and fluids were aspirated by connecting the needle to suction. Thus, a collapsed upper gastrointestinal tract was easily ob- tained. We performed this procedure instead of nasogastric decompression on twenty-two patients with gastric cancer who underwent laparoscopic-assisted distal subtotal gastrectomy with lymph node dissection. The results were good with only one patient experiencing wound infection (4.5%) and one patient with postoperative acalculus cholecystitis (4.5%). There were no patients with either intraabdominal infection or anasto- motic leakage and none of the patients needed postoperative nasogastric decompression, except the patient who experienced acaculus cholecystitis. Percutaneous needle aspiration is a very simple and efficient technique with little risk of postoperative complications. It can be used as an alternative to nasogastric tube decompression of the gastrointestinal tract for laparo- scopic-assisted gastrectomy. Key Words: Laparoscopy, nasogastric intubations, gastric surgery, percutaneous aspiration Received January 7, 2005 Accepted April 18, 2005 Reprint address: requests to Dr. Sung Hoon Noh, Department of Surgery, Yonsei University College of Medicine, 134 Shinchon- dong, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-2114, Fax: 82-2-2228-2100, E-mail: sunghoonn@yumc.yonsei.ac.kr Yonsei Med J Vol. 46, No. 5, 2005 INTRODUCTION Although gastric surgery without nasogastric intubation has been advocated recently, most sur- geons continue to use nasogastric decompression for gastrointestinal surgeries.1-3 Even in the ma- jority of clinical trials comparing selective versus routine nasogastric decompression, nasogastric tube was used for decompression during the operative procedure. Without nasogastric decom- pression, it is difficult to get an uncluttered sur- gical field due to air and fluid in the stomach and duodenum during the operation.4 Similarly, the laparoscopic gastric surgeries have been per- formed with routine use of nasogastric tube. It is important to collapse the upper gastrointestinal tract during laparoscopic gastric surgery since upper gastrointestinal distention compromises not only the visual field, but also the laparoscopic manipulation of the stomach. We have previously reported that intraoperative needle decompression technique can be used without complications as an alternative to naso- gastric intubation for intraoperative decompres- sion of gastrointestinal tract for open gastric can- cer surgery.5 However, during laparoscopic sur- gery, needle decompression is more complicated than during open surgery. We have attempted laparoscopic-assisted gastric cancer surgeries without nasogastric intubations. In this article we describe a simple method, the aspiration of gastric contents using a 9 cm long 19-gauge needle percutaneously, as a simple alter- native to nasogastric intubation for gastrointes-