# Comparative Outcomes of Early Versus Delayed Ryle’s Tube Removal Following Laparoscopic Cholecystectomy: Less Tube, Less Trouble?

## TL;DR

Removing a nasogastric tube during surgery improves recovery after gallbladder removal, with faster eating and fewer side effects.

## Contribution

Demonstrates that early Ryle’s tube removal improves postoperative recovery outcomes in laparoscopic cholecystectomy.

## Key findings

- Early tube removal led to faster oral intake and shorter hospital stays.
- Reduced postoperative nausea and vomiting with early removal.
- Lower incidence of sore throat and pulmonary complications in the early removal group.

## Abstract

Background: Nasogastric (Ryle’s) tube decompression is commonly used during laparoscopic cholecystectomy to reduce the risk of aspiration and improve visualization. However, the optimal timing of tube removal, whether intraoperative or postoperative, remains uncertain. This study evaluated early (on-table) versus delayed (≥4 hours postoperative) Ryle’s tube removal in elective laparoscopic cholecystectomy, focusing on recovery-related outcomes.

Materials and methods: A retrospective observational study was conducted at R.L. Jalappa Hospital, Kolar, involving 144 patients who underwent elective laparoscopic cholecystectomies from October 2023 to July 2025. Patients were divided into Group A (on-table removal, n = 72) and Group B (postoperative removal, n = 72). Primary and secondary outcomes included time to oral intake, postoperative nausea and vomiting (PONV), pulmonary complications, sore throat/discomfort, and hospital stay. Statistical analyses used independent t-tests and chi-square tests, with significance set at p < 0.05.

Results: Baseline characteristics were comparable between groups (p > 0.05). Group A achieved earlier oral intake (5.2 ± 1.1 hours) compared to Group B (8.4 ± 1.6 hours; p < 0.01). PONV occurred in 13 patients (18.1%) in Group A versus 27 patients (37.5%) in Group B (p = 0.02). Pulmonary complications were seen in three patients (4.2%) in Group A and seven patients (9.7%) in Group B (p = 0.18). Sore throat/discomfort was reported in 9 patients (12.5%) in Group A versus 20 patients (27.8%) in Group B (p = 0.04). The mean length of hospital stay was significantly shorter in Group A (1.8 ± 0.5 days) than in Group B (2.4 ± 0.7 days; p < 0.001).

Conclusions: Early on-table removal of the Ryle’s tube is associated with improved postoperative recovery, including earlier oral intake and reduced PONV and throat discomfort. These findings support incorporating early removal into enhanced recovery protocols for elective laparoscopic cholecystectomy.