Comparative analysis of postoperative pain after transvaginal hybrid NOTES versus traditional laparoscopic cholecystectomy in obese patients.

PURPOSE: Even though obesity is a known risk factor for needing cholecystectomy, most research excludes patients with higher degrees of obesity. The aim of this retrospective study was to compare postoperative pain and analgesic consumption in obese patients, who underwent either transvaginal hybrid Natural Orifice Transluminal Endoscopic Surgery (NOTES) cholecystectomy (NC) or traditional laparoscopic cholecystectomy (LC). METHODS: Between 12/2008 and 01/2017, 237 NC were performed, of which 35 (14.8%) showed a body mass index (BMI) of 35 kg/m2 or more (obesity II and III according to the World Health Organization). Of these, procedural time, postoperative pain, analgesic requirements, and other early postoperative parameters were collected and compared with 35 matched LC patients from the same time period. RESULTS: There were no differences in the baseline characteristics between the two groups, but we found significant benefits for the hybrid NOTES technique in terms of less pain (P = 0.006), coherent with significantly less intake of peripheral (paracetamol; P = 0.005), and of centrally acting analgesics (piritramide; P = 0.047) within the first two-day post-surgery. We also found that those in the NC group had shorter hospital stays (P < 0.001). The postoperative complication rates and the procedural time did not differ between the two groups. CONCLUSION: With regard to postoperative pain and analgesic requirements and without an increase in postoperative complications, obese patients experience short-term benefits from the hybrid NOTES technique compared to traditional laparoscopic cholecystectomy.

[Treatment of a severely injured with active bleeding under apixaban and residual anticoagulatory activity]. / Schwerstverletztenversorgung mit aktiver Blutung unter Apixaban und gerinnungsrelevanter Restaktivität.

Direct oral anticoagulants (DOAC) are increasingly being prescribed for prophylaxis of thromboembolic events. Their use, particularly in emergency settings is difficult as blood level measurements are often not immediately available and until recently there was no possibility for reversal. This article presents the case of a severely injured patient with life-threatening traumatic bleeding under long-term treatment with the factor Xa inhibitor apixaban, viscoelasticity-based detection of residual systemic anticoagulatory activity and targeted reversal.