Safety of Non-steroidal Anti-inflammatory Drugs as Part of Enhanced Recovery After Laparoscopic Sleeve Gastrectomy-A Systematic Review and Meta-Analysis.

Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery option for managing extreme obesity in most patients. While non-steroidal anti-inflammatory drugs (NSAIDs) promise postoperative pain management after bariatric surgeries, their safety in LSG remains unexplored. In this systematic review, we studied the safety of NSAIDs following LSG reported by six studies involving 588 patients. Our study demonstrated that NSAIDs effectively alleviated the postoperative pain after LSG without major safety concerns. Most reported (>20% incidence) adverse events included postoperative nausea and vomiting (PONV, 21%). For patients undergoing LSG, NSAIDs offer a valuable option for pain management and improved care, potentially reducing opioid consumption. However, additional research is required to optimize NSAID usage and ensure safety, especially concerning renal and gastrointestinal issues.

Partial dehiscence of an intraoperative staple line during laparoscopic sleeve gastrectomy: A case report.

INTRODUCTION: Leakage along a staple line during sleeve gastrectomy is a serious complication. Mechanical causes are uncommon; however, they should be considered as sources of acute postoperative leaks. The presented case discusses an important intraoperative complication with an avoidable cause that could benefit practicing surgeons as well as residents in training programs. PRESENTATION OF CASE: This case describes the mechanical failure of a stapler that was identified intraoperatively. The staple line was oversewn using a 3-0 V Lok suture. The methylene blue test was negative, and the patient had an uneventful postoperative recovery. DISCUSSION: While most leaks were attributed to ischemia of the upper third of the stomach, leaks occurring within the first three postoperative days have a different pathophysiology. This may involve mechanical complications (stapler failure), direct gastric tissue trauma from aggressive handling, or thermal injuries. In our case, the likely cause of the partial dehiscence was the proximity of the stapler to the bougie and an unnoticed small fold at the antrum. CONCLUSION: Surgeons should avoid placing the stapler too close to the bougie. Furthermore, surgeons should ensure that the stomach is flat and there are no gastric folds that could lead to stapling failure.

Effect of epidural analgesia on postoperative opioid requirements following elective laparotomies performed at Vancouver General Hospital.

BACKGROUND: Enhanced recovery pathways aim to reduce postoperative opioid use and opioid-related complications. These pathways often include epidural analgesia (EA). This study examines postoperative opioid use after elective laparotomy with and without EA. METHODS: Retrospective chart review of elective laparotomies performed by General Surgery at a tertiary academic center during 2017 was completed. Primary outcome was postoperative opioid usage. Secondary outcomes were time to mobilization, duration of urinary catheterization and postoperative ileus. RESULTS: Among 236 patients, 213 (90%) received EA. There was no significant difference in mean total oral morphine equivalent (OME) usage between EA and non-EA groups. Mean OME use on postoperative day three was higher in the EA group (38.0 vs 22.4 mg, p = 0.02). On multivariate analysis, preoperative opioid use was associated with increased postoperative OME consumption (regression coefficient 147.5, p < 0.001). CONCLUSIONS: In this cohort, epidural analgesia did not reduce postoperative opioid consumption.

Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review.

Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts.