To evaluate the need for routine prophylactic nasogastric tube decompression following gastrointestinal surgery, we retrospectively reviewed the cases of 177 patients. The patients were classified as those not receiving nasogastric tubes, those whose tubes were removed within 48 hours postoperatively, and those whose tubes remained for more than 48 hours. No significant differences were noted in duration of hospital stay, time for return of adequate bowel function, or time before beginning an oral diet. Further, there were no differences in the frequency of wound complications, anastomotic leakage, or mortality. Patients without tubes had no greater incidence of vomiting, and despite a more frequent occurrence of abdominal distention and nausea, only 8% required insertion of a tube for persistent symptoms. Intubated patients had a greater frequency of respiratory complications. The results indicate that routine prophylactic use of nasogastric decompression is unnecessary and may be safely eliminated in patients having gastrointestinal surgery.