Post-operative course after conventional or laparoscopic gastroplasty in morbidly obese patients

Abstract

The post-operative period is particularly dangerous for obese patients. The aim of this study was to compare the immediate post-operative course after either laparoscopic or open gastroplasty. We studied retrospectively 20 and 14 consecutive patients who underwent laparoscopic or open adjustable silicone gastric banding, respectively. After the laparoscopic procedure, patients had a significantly shorter stay in the post-anaesthesia care unit (0.3 +/- 0.4 and 1.1 +/- 1 days), reduced analgesic requirements, a shorter period of intravenous catheter use (2.3 +/- 1.9 and 4.8 +/- 1.4 days), were able to walk sooner (1 +/- 0.4 and 2.1 +/- 1.6 days) and had a significantly shorter duration of in-hospital stay (5.4 +/- 2.3 and 15.8 +/- 4.5 days) than after an open procedure. This report suggests that the use of laparoscopy for gastroplasty in morbidity obese patients may significantly improve the immediate post-operative course.

Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva?

“…(2) The opposite is also true, fewer complications reduce hospital stay and therefore lessen hospital costs. (14) Some studies reported a range of 5 to 24% of patients submitted to bariatric surgery who required ICU for more than 24 hours. (2,9,13,15,16) Bariatric surgery by videolaparoscopy showed better results when compared to open surgery, with shorter length of stay in PARR and hospital in addition to less time with venous catheter, with a statistical significance.…”

“…(2,9,13,15,16) Bariatric surgery by videolaparoscopy showed better results when compared to open surgery, with shorter length of stay in PARR and hospital in addition to less time with venous catheter, with a statistical significance. (14) All our patients were operated by videolaparoscopy. Mean time of surgery in our study was 105.0 ± 28.6 minutes, compatible with literature, with a mean time of 120 minutes (17,18) and our length of hospital stay was only 47.7 ± 12.4 hours, much shorter than that in literature , which ranged from an average of 2.3 to 10 days.…”

“…Immobility increases risk of adverse thromboembolitic events, especially in surgeries of the upper abdomen. (14) On the other hand, early walking reduces the risk of pulmonary thromboembolism and other respiratory problems at postoperative affording and improving lung expansion, minimizing and reverting actelectasias formed by the prolonged decubitus in the bed. (5) Patients in the ICU, even if their clinical conditions allow, have difficulty with early walking, due to limitation of the physical space in most of these units, lack of standardization and encouragement by the healthcare professional working there.…”

“…Mortality rates at postoperative of bariatric surgery are variable, ranging from 0 to 2.9% (2,6,14) and is more prevalent in bearers of PTE, patients admitted to the ICU and those requiring reoperation. (12,19,21) In our survey there was no mortality, nor any event of thromboembolism, furthermore, no admission to the ICU.…”

Anestesia para obesidade mórbida

“…Juvin comparou o intra-e o pós-operató-rio após gastroplastia convencional e laparoscópica em pacientes obesos; não houve diferença significativa no tempo cirúrgico, nos tempos de permanência na UTI e no hospital foram maiores na técnica convencional, bem como a necessidade de analgésicos. Além disso, o tempo de aceitação da dieta líquida e a deambulação foram mais precoces com a técnica laparoscópica 35 . Estudo que avaliou 4.047 obesos Vol.…”