Laparoscopy-assisted subtotal gastrectomy under thoracic epidural-general anesthesia leading to the effects on postoperative micturition.
BACKGROUND
Recently, the laparoscopic surgical technique has been widely applied to major surgery as it can minimize surgical incision, reduce blood loss, and shorten hospital stay. In this study, we evaluated the effectiveness of the laparoscopic surgery on postoperative micturitional function in comparison to open surgery.


METHODS
Sixty patients undergoing subtotal gastrectomy were assigned to either laparoscopic (L group, n = 30) or open surgery (O group, n = 30) groups. The combined thoracic epidural-general anesthesia was performed on all patients, and epidural patient-controlled analgesia (PCA) using ropivacaine and sufentanil was maintained for two days following surgery. After surgery, visual analog pain score (VAS), levels of sensory and motor block, observer's assessment of alertness/sedation score (OAA/S), time to first flatus, ambulation and oral intake, and micturition function were assessed.


RESULTS
The L group showed much earlier ambulation, flatus and oral intake than the O group. Although the scores of VAS and OAA/S were not significantly different between the two groups, the micturition problem scores of the L group were lower than that of the O group (P < 0.05). All patients of the L group had no difficulty in self-voiding, whereas four patients in the O group required urinary catheterization on the first postoperative day (POD1).


CONCLUSIONS
Patients who underwent laparoscopic subtotal gastrectomy had a low incidence of micturitional problem and showed early recovery. Therefore, urinary catheterization on POD1 may not be a routine procedure for those who undergo laparoscopic subtotal gastrectomy under combined thoracic epidural-general anesthesia.
Department of Anesthesiology, Pain Medicine and Anesthesia, Pain Research Institute, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, C.P.O. Box 8044, Seoul, 120-752, Korea.
Sung Jin
SJ
Lee
Woo Jin
WJ
Hyung
Bon Nyeo
BN
Koo
Ji Yeon
JY
Lee
Na Hyung
NH
Jun
Sun Chung
SC
Kim
Jung Won
JW
Kim
Jia
J
Liu
Ki Jun
KJ
Kim
D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014554:Urination / Q000502:physiology*; D014555:Urination Disorders / Q000453:epidemiology / Q000517:prevention & control