Effect of laparoscopic versus open gastric bypass surgery on postoperative pain and bowel function.
BACKGROUND
This study was designed to assess postoperative pain and bowel function in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGBP) performed either by open or laparoscopic technique.


METHODS
We prospectively studied patients scheduled for RYGBP between July 2002 and June 2003. Patients were assigned to the laparoscopic or open procedure by one surgeon. All patients received patient controlled analgesia (PCA) with intravenous morphine and rectal naproxen 500 mg every 12 hours. Postoperative analgesia was assessed daily using a visual analog scale (VAS) at rest, on walking and coughing. The amount of morphine used during the first 48 hours, the time of return of gastrointestinal motility and the time until first oral food intake were recorded.


RESULTS
53 patients were enrolled and studied (laparoscopic group n=33, open group n=20). Patients undergoing laparoscopic RYGBP requested less morphine (P=0.0001) and showed lower VAS pain scores than patients undergoing open RYGBP. The return of bowel movement in the laparoscopic group occurred 1 day earlier than in the open group (P=0.01). The time to first passage of gas (P=0.01) and oral food intake (P=0.06) was shorter after laparoscopic than after open RYGBP. Patients in the laparoscopic group were discharged 1(1/2) days earlier than patients in the open group (P=0.01).


CONCLUSIONS
The laparoscopic RYGBP operation was associated with less postoperative pain and morphine consumption than the open RYGBP, thereby facilitating an earlier recovery of intestinal motility.
El Shobary
Hanan
H
Department of Anesthesia, McGill University, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1.
Christou
Nicolas
N
Backman
Steven B
SB
Gvocdic
Branka
B
Schricker
Thomas
T
D000285:Administration, Rectal; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005769:Gastrointestinal Motility; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009288:Naproxen / Q000008:administration & dosage; D009294:Narcotics / Q000008:administration & dosage; D009767:Obesity, Morbid / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D009288:Naproxen; D009020:Morphine