title: Comparison of Postoperative Pain Following Laparoscopic Versus Open Gastrostomy/Jejunostomy in Patients with Complete Obstruction Caused by Advanced Esophageal Cancer.
abstract: BACKGROUND
  When percutaneous endoscopic gastrostomy is not feasible, a gastrostomy tube may be inserted for enteral access by a laparoscopic or open technique. The aim of this study was to compare the postoperative pain of laparoscopic versus open gastrostomy in patients with complete obstruction caused by advanced esophageal cancer.
  
  
  METHODS
  Fifteen patients who had undergone either a reduced port access laparoscopic gastrostomy/jejunostomy (LGJ, n=7) or open gastrostomy/jejunostomy (OGJ, n=8) between July 2011 and December 2015 were retrospectively studied. Variables examined comprised age, sex, body mass index (BMI), operative time, blood loss volume, and American Society of Anesthesiologist physical status (ASA-PS) scores. The degree of postoperative pain was also assessed in both groups during the first seven postoperative days.
  
  
  RESULTS
  The patients in the two groups were comparable in age, sex, BMI, ASA-PS scores, intraoperative blood loss or postoperative complication rates. Operative time was shorter in the LGJ group than the OGJ group. No patients in the LGJ group required conversion to open laparotomy. Tube feedings were started on postoperative Day 1 in both groups; there were no postoperative complications. The duration of rescue nonopioid analgesic use was significantly shorter in the LGJ than the OGJ group (1.3 versus 3.5 days; P=0.0005). There was a significant difference in frequency of postoperative nonopioid analgesic use: 7.9 times in the LGJ group versus 17.9 times in the OGJ group (P=0.0219).
  
  
  CONCLUSIONS
  LGJ is associated with less postoperative pain than OGJ in patients with complete obstruction caused by advanced esophageal cancer.
authors.affiliation: Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsutani
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nomura
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Hagiwara
authors.forename: Itsuo
authors.initials: I
authors.lastname: Fujita
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kanazawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kakinuma
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kanno
authors.forename: Akihisa
authors.initials: A
authors.lastname: Matsuda
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Ohta
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000150:complications*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D007582:Jejunostomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D007829:Laryngostenosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D012189:Retrospective Studies