CLINICAL RESEARCH
The effect of active gas aspiration to reduce pain after laparoscopic sleeve gastrectomy for morbid obesity: a randomized controlled study
 
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1
Istanbul Obesity Surgery (IOC), Kurtköy Ersoy Hospital, Istanbul, Turkey
 
2
Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey
 
3
Department of General Surgery, University of Health Sciences, Ümraniye Education and Research Hospital, Istanbul, Turkey
 
4
Sözen Surgery Clinic, Istanbul, Turkey
 
 
Submission date: 2021-05-12
 
 
Acceptance date: 2021-07-21
 
 
Publication date: 2021-09-20
 
 
Arch Med Sci Civil Dis 2021;6(1):109-116
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Residual, intra-abdominal CO2 contributes to abdominal distension and pain after laparoscopic surgery. Our aim was to investigate the effects of active gas aspiration on postoperative outcomes and pain following laparoscopic sleeve gastrectomy.

Material and methods:
Patients were randomly assigned to either the active gas reduction group (Group 1, n = 69) or the control group (Group 2, n = 74). After completion of the operative procedures, residual gas was aspirated with a flexible cannula in Group 1. In Group 2, gas release from the abdomen was performed using the port site by opening the gas tap only. The demographic data, body mass index, educational status, operation time, insufflated CO2 volume during the operation, and intraabdominal pressure were recorded. Postoperative pain assessment was performed using a numerical pain intensity scale (NPIS) at the 1st h, the 24th h, and the 3rd day.

Results:
NPIS scores at the 24th h were significantly lower in Group 1 (p < 0.001). However, there were no significant differences in the NPIS scores following the 1st h and the 3rd day. No differences were found in the operation time (p > 0.05). According to the correlation analysis between the operation time and NPIS scores between the groups, in Group 1 the duration of surgery was significantly proportional to NPIS24. All patients were discharged from the hospital on the 4th postoperative day.

Conclusions:
Active aspiration of the remaining gas just before the removal of the trocars is a simple procedure that reduces pain, leading to a more comfortable hospital stay.

 
REFERENCES (36)
1.
Lazzati A, Guy-Lachuer R, Delaunay V, Szwarcensztein K, Azoulay D. Bariatric surgery trends in France: 2005-2011. Surg Obes Relat Dis 2014; 10: 328-34.
 
2.
Reames BN, Finks JF, Bacal D, Carlin AM, Dimick JB. Changes in bariatric surgery procedure use in Michigan, 2006-2013. JAMA 2014; 312: 959-61.
 
3.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg 2017; 27: 2279-89.
 
4.
Kalaycı G, Çakıl D, Ekici F. Laparoskopik cerrahi ve kardiyorespiratuar fonksiyonlara Etkileri. AİBÜ İzzet Baysal Tıp Fakültesi Dergisi 2011; 6: 1-7.
 
5.
Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991; 146: 278-82.
 
6.
Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum. J Gastrointest Surg 2009; 13: 1009-16.
 
7.
Aktan B, Akbayrak T. Physiotherapy and rehabilitation in shoulder pain after gynecological laparoscopic surgery: a case report. Konuralp Tıp Dergisi 2020; 12: 334-7.
 
8.
Memedov C, Menteş Ö, Şimşek A, et al. Laparoskopik kolesistektomi sonrası postoperatif ağrının önlenmesinde çoklu bölgeye lokal anestezik infiltrasyonu: ropivakain ve prilokainin plasebo kontrollü karşılaştırılması. GülhaneTıp Dergisi 2008; 50: 84-90.
 
9.
Radosa JC, Radosa MP, Mavrova R, et al. Five minutes of extended assisted ventilation with an open umbilical trocar valve significantly reduces postoperative abdominal and shoulder pain in patients undergoing laparoscopic hysterectomy. Eur J Obstet Gynecol Reprod Biol 2013; 171: 122-27.
 
10.
Tuvayanon W, Toskulkao T, Asdornwised U. Factors impacting readiness to discharge time from recovery room after laparoscopic cholecystectomy. Thai Surg 2011; 32: 53-9.
 
11.
Mazahreh TS, Alfaqih M, Saadeh R, et al. The effects of laparoscopic sleeve gastrectomy on the parameters of leptin resistance in obesity. Biomolecules 2019; 9: 533.
 
12.
Jackson SA, Laurence AS, Hill JC. Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia 1996; 51: 485-7.
 
13.
Dixon JB, Reuben Y, Halket C, O’Brien PE. Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg 2005; 15: 1111-7.
 
14.
Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J. Effect of CO(2) gas warming on pain after laparoscopic surgery: a randomized double-blind controlled trial. Surg Endosc 1999; 13: 1110-4.
 
15.
Corsale I, Fantini C, Gentili C, Sapere P, Garruto O, Conte R. Peritoneal innervation and post-laparoscopic course. Role of CO2. Minerva Chir 2000; 55: 205-10.
 
16.
Sammour T, Kahokehr A, Hayes J, Hulme-Moir M, Hill AG. Warming and humidification of insufflation carbon dioxide in laparoscopic colonic surgery: a double-blinded randomized controlled trial. Ann Surg 2010; 251: 1024-33.
 
17.
Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A 2010; 20: 677-82.
 
18.
Hsiao-Wen T, Yi-Jen C, Chiu-Ming H, et al. Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study. Arch Surg 2011; 146: 1360-6.
 
19.
Alexander JI, Hull MG. Abdominal pain after laparoscopy: the value of a gas drain. Br J Obstet Gynaecol 1987; 94: 267-9.
 
20.
Hwan KD, Young PJ, Myong-Hwan K, et al. Smoking may increase postoperative opioid consumption in patients who underwent distal gastrectomy with gastroduodenostomy for early stomach cancer: a retrospective analysis. Clin J Pain 2017; 33: 905-11.
 
21.
Weingarten TN, Erie EA, Shi Y, Schroeder DR, Abel M, Warner DO. Influence of tobacco use on postoperative opiate analgesia requirements in patients undergoing coronary artery bypass graft surgery. Signa Vitae 2011; 6: 72-7.
 
22.
Tirault M, Derrode N, Clevenot D, Rolland D, Fletcher D, Debaene B. The effect of nefopam on morphine overconsumption induced by large-dose remifentanil during propofol anesthesia for major abdominal surgery. Anesth Analg 2006; 102: 110-7.
 
23.
Delvaux B, Ryckwaert Y, Van Boven M, De Kock M, Capdevila X. Remifentanil in the intensive care unit: tolerance and acute withdrawal syndrome after prolonged sedation. Anesthesiology 2005; 102: 1281-2.
 
24.
Gupta PK, Franck C, Miller WJ, Gupta H, Forse RA. Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset. J Am Coll Surg 2011; 212: 301-9.
 
25.
Hartwig M, Allvin R, Bäckström R, Stenberg E. factors associated with increased experience of postoperative pain after laparoscopic gastric bypass surgery. Obes Surg 2017; 27: 1854-8.
 
26.
Chia YY, Chow LH, Hung CC, Liu K, Ger LP, Wang PN. Gender and pain upon movement are associated with the requirements for postoperative patient-controlled iv analgesia: a prospective survey of 2,298 Chinese patients. Can J Anaesth 2002; 49: 249-55.
 
27.
Lau H, Patil NG. Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc 2004; 18: 92-6.
 
28.
Leclerc A, Gourmelen J, Chastang JF, Plouvier S, Niedhammer I, Lanoë JL. Level of education and back pain in France: the role of demographic, lifestyle and physical work factors. Int Arch Occup Environ Health 2009; 82: 643-52.
 
29.
Atak I, Ozbagriacik M, Akinci OF, et al. Active gas aspiration to reduce pain after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2011; 21: 98-100.
 
30.
Das K, Karateke F, Menekse E, et al. Minimizing shoulder pain following laparoscopic cholecystectomy: a prospective, randomized, controlled trial. J Laparoendosc Adv Surg Tech A 2013; 23: 179-82.
 
31.
Nursal TZ, Yildirim S, Tarim A, et al. Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Arch Surg 2003; 388: 95-100.
 
32.
Arı DE, Ar AY, Karip CS, et al. Ultrasound-guided subcostal-posterior transversus abdominis plane block for pain control following laparoscopic sleeve gastrectomy. Saudi Med J 2017; 38: 1224-9.
 
33.
Saber AA, Lee YC, Chandrasekaran A, et al. Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG): a double-blind randomized controlled trial. Am J Surg 2019; 217: 126-32.
 
34.
Ekmekçi P, Kazak Bengisun Z, Kazbek BK, Han S, Tüzüner F. Ultrasound guided TAP block for the treatment of postoperative prolonged pain – an alternative approach. Agri 2012; 24: 191-3.
 
35.
Gravante G, Castrì F, Araco F, Araco A. A comparative study of the transversus abdominis plane (TAP) block efficacy on post-bariatric vs aesthetic abdominoplasty with flank liposuction. Obes Surg 2011; 21: 278-82.
 
36.
Alabassi A. Ultrasound-guided subcostal-posterior transversus abdominis plane block for pain control following laparoscopic sleeve gastrectomy. Saudi Med J 2018; 39: 532-3.
 
ISSN:2451-0637
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