Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Concomitant Laparoscopic Adjustable Gastric Banding and Laparoscopic Cholecystectomy in a Super-Obese Patient with Situs Inversus Totalis Who Previously Underwent Intragastric Balloon Placement

Laparoscopic adjustable gastric banding has been increasingly performed since its introduction in 1990. Situs inversus totalis is a rare anomaly in which transposition of organs to the opposite side of the body occurs. Laparoscopic gastric banding in such few patients has been reported in the literature. We discuss a super-obese patient with situs inversus totalis and asymptomatic cholelithiasis who previously underwent endoscopic intragastric balloon placement in preparation for bariatric surgery. Afterwards, laparoscopic cholecystectomy and laparoscopic adjustable gastric banding were performed in the same session. Special attention is paid to the literature review and the mirror-image modification of the laparoscopic cholecystectomy and laparoscopic gastric banding procedures. With preoperative assessment, modifications in the surgical team, and equipment, the operation can be performed safely

Diagnostic value of terminal ileum biopsies in patients with abnormal terminal ileum mucosal appearance

Objective: To investigate the necessity of obtaining routine ileal biopsy during colonoscopy in the patients with abnormal terminal ileum mucosal appearance if the inflammatory bowel disease is not considered

Plasma protein carbonyl and thiol stress before and after laparoscopic gastric banding in morbidly obese patients

Background: The aim of this study is to examine the relationship between oxidative plasma protein and thiol stress and weight loss after laparoscopic adjustable gastric banding (LAGB)

Tretament approaches to rectus sheat hematoma

BACKGROUND Rectus sheath hematoma (RSH) is one of the rare causes of acute abdominal pain. This clinical entity is frequently misdiagnosed and leads to unnecessary surgical intervention. We investigated the critical points of the diagnosis and therapy in preventing these mistakes

Laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy in metabolic surgery A single center experience

AIM: The safety and effectiveness of MGB versus LSG remain unclear. In this study, we It has been shown by many clinical studies that laparoscopic sleeve gastrectomy (LSG) and mini-gastric bypass (MGB), two current methods in meta-bolic surgery, may be alternatives to Roux-en-Y gastric aimed to compare the postoperative outcomes of MGB and LSG procedures performed in bariatric surgery.MATERIAL METHODS: A total of 175 patients who underwent MGB and LSG surgery between 2016 and 2018 at a single metabolic surgery center were analyzed retrospectively. Two surgical procedures were compared in terms of the peri-operative, early and late postoperative outcomes.RESULTS: There were 121 patients in the MGB group and 54 patients in the LSG group. No significant difference was found between the groups regarding the operating time, the conversion to open surgery and the early postoperative com-plications (p>0.05). The length of hospital stay was significantly shorter in the MGB group (p:0.001). The excess weight loss (EWL%) and total weight loss (TWL%) were significantly higher in the MGB group (90.3 vs. 79.2; and 36.4 vs 30.5, respectively). No significant difference was found between the two groups in terms of the remission rates of comor-bidities. The symptoms of gastroesophageal reflux were observed in a significantly fewer number of the patients in the MGB group (6 patients 4.9% vs. 10 patients 18.5%).CONCLUSIONS: Both LSG and MGB are effective, reliable, and useful methods in metabolic surgery. The MGB proce-dure is superior to the LSG in terms of the length of hospital stay, EWL%, TWL% and the postoperative gastroe-sophageal reflux symptoms