Punam Patel, MD, Steven Udelhofen, MD, Mustafa Alibhai, MD, Lauren Reeves, Alejandra Mora, Terive Duperier, MD, Michael Seger, MD, Richard Englehardt, MD. BMI of Texas
Introduction: Laparoscopic sleeve gastrectomy (LSG) has moved to the forefront as a primary bariatric operation and postoperative recovery has been reduced to a single day hospital stay at many centers. Often, the limiting factor for patients is pain at the extraction site due to the spreading of the fascia. We developed a technique of sharp dissection of the fascia using a specially designed trocar knife to attempt to reduce the pain that is experienced and enhance the recovery process.
Methods: This study is an interim analysis of a project approved by Methodist Institutional Review Board and is designed to randomize 100 patients undergoing LSG as their primary bariatric operation at a single institution. Patients are randomized to four groups: Blunt dissection versus Sharp dissection (trocar knife) with and without local anesthetic.. Intra-operatively collected data during each operation includes specimen extraction time and fascial closure time. Post-operatively, the McGill Pain Scale short form and the Wong Baker visual pain scale are used to assess post-operative pain at Day 1, Day 2, Week 2, Week 6, and Month 3. For preliminary analysis, categorical variables were analyzed using Fisher's Exact and continuous variables were analyzed using Kruskal-Wallis Tests. To compare groups over time, repeated measure MANOVA test was performed.
Results: A total of 42 subjects have been enrolled: Blunt with local (n=9); Blunt no local (n=14); Sharp with local (n=8); Sharp no local (n=11). Median time to extraction was 39 seconds (interquartile range 30-58) and time to closure was 57 seconds (Interquartile range 50-76). Time to extraction was faster with Blunt with local compared to other groups (p=0.0146). Time to closure was similar among groups. Pain assessments were similar across the four groups. There were no differences in post-operative pain when comparing groups over each timepoint.
Conclusions: Interim analysis demonstrates that operative and post-operative measures (patient pain assessments) are similar between Blunt and Sharp dissection with and without local anesthetic. Sharp dissection using the trocar knife is equivalent to standard Blunt dissection practices. Further analysis of BMI correlation with pain responses will help to stratify patients who will respond better to trocar knife usage. We plan to continue enrollment until the study goal is reached and repeat analysis at that time.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79807
Program Number: P426
Presentation Session: Poster (Non CME)
Presentation Type: Poster
