Background The practice of nasogastric decompression post laparotomies is routine among surgeons. The aim being to prevent abdominal distension due to ileus, aid faster return of bowel function and early hospital discharge. This belief has been challenged by many studies. Aims and objectives The aim of the study was to determine if routine postoperative nasogastric decompression can be safely avoided in both elective and emergency laparotomies. Also to compare the morbidity of all laparotomies with or without postoperative nasogastric decompression and to identify conditions if any that make postoperative nasogastric decompression mandatory. Methods The study was a prospective randomised study. Patients who were booked for elective and emergency laparotomies were recruited into the study based on defined inclusion and exclusion criteria. They were randomised to receive postoperative nasogastric decompression or no postoperative nasogastric decompression and the outcome measures were compared. Statistical analysis was done using SPSS version 20 and level of statistical significance was set at p value of <0.05. Results A total of 136 patients recruited into the study were equally divided into no postoperative nasogastric decompression group and postoperative nasogastric decompression group. Male: female ratio was 2.7:1 and 1.1:1 in the no nasogastric tube group and nasogastric tube group respectively. The commonest indication for surgery was peritonitis secondary to perforated gut. In the no nasogastric tube group 40(58.8%) patients had emergency surgery while 28(41.2%) had elective surgery. In the nasogastric tube group 60 patients (88.2%) had emergency surgery while 8 patients (11.8%) had elective surgery. The no nasogastric tube group had shorter duration of hospital stay (p-0.025) (<0.05) compared to the nasogastric tube group. Wound infection rate and electrolyte derangements were also higher in the nasogastric tube group (p-0.010) and (p-0.027) respectively. Mortalities recorded in the study were five patients and all occurred in the nasogastric tube group. Conclusion Avoiding routine postoperative nasogastric decompression may be safe in both elective and emergency laparotomies in adults.