A Simple Way to Estimate a Difficult Sleeve Gastrectomy Prior to Operating.

BACKGROUND: Today, bariatric procedures are common. These surgeries' difficulties are classified as patient- or surgical team-related and are estimated by body mass index (BMI). More efficient methods are needed to help surgeons. This study evaluated the effect of measuring patients' subcutaneous fat tissue thickness (SFT) and umbilicus-xiphoid (DXU) to anticipate surgical difficulties. MATERIAL AND METHODS: This was a prospective retrospective data analysis study. Laparoscopic sleeve gastrectomy patients seen between May and October 2022 were included in the analysis and divided into three groups, according to a surgeon's assessment. All patients' SFT, DXU, rectus muscle thickness, total fat tissue amount (TFT), and operational time were recorded prospectively and analyzed. RESULTS: In all, 151 patients were included in the study; of these, 124 (82.1%) were women and 27 (17.9%) were men. Their mean BMI value was 41.1 ± 6.2. Based on expert's opinion, we classified three groups: easy (n = 123, 81.5%), intermediate (n = 22, 14.6%), or difficult (n = 6, 4%). When the easy group was compared to the intermediate/difficult groups, we found that intermediate/difficult groups' SFT values were statistically significantly higher than the easy group (p = 0.000). Also, the intermediate/difficult group's TFT value was statistically significantly higher than the easy group (p = 0.000). We found no statistically significant differences between groups' DXU and rectus muscle thickness. CONCLUSION: This is the first study to anticipate sleeve gastrectomy difficulty using SFT and TFT. This is an easy technique to apply and no additional costs. Anticipating difficulties based on these criteria can ensure necessary preparations are made and help avoid complications.

Ultrasonography Guided Modified BRILMA (Blocking the Cutaneous Branches of Intercostal Nerves in the Middle Axillary Line) Block in Bariatric Surgery.

Background: Postoperative pain is one of the major problems after laparoscopic sleeve gastrectomy besides complications. Management of pain control is still unclear in the obese population. Modified BRILMA (blocking the cutaneous branches of intercostal nerves in the middle axillary line) is a new analgesia technique which is performed by ultrasonography guided through the way between eighth and ninth rib level. This study is to evaluate the efficiency of modified BRILMA in bariatric patients while comparing with trocar site infiltration. Materials and Methods: This is a prospective designed retrospective data analysis study. Patients undergoing laparoscopic sleeve gastrectomy between June 2019 and January 2020 were divided into two groups. One group underwent BRILMA block; the other group used traditional trocar site injection. Postoperative pain was followed by using visual analogue scale (VAS) (at 1, 3, 6, 12, 24, 36, 48 hours postoperatively). Results: Thirty patients were included in the study. Twenty-four (80%) of the patients were women, and 6 (20%) of the patients were men. Mean body mass index of patients were 39.83 ± 4.02 kg/m2. Mean operational time was calculated 86.16 ± 19.94 minutes. When the patients' VAS was compared, 12th hour VAS value was statistically less in the BRILMA group. There were no significant differences in other hours' VAS between two groups. When compared with the use of opioid amount, there were no statistically significant difference between the two groups (P = .66), but BRILMA group had less amount. Conclusion: Modified BRILMA is an alternative technique to the use of trocar site bupivacain injection in bariatric surgery. It is new technique that is tried in bariatric population, which is also cost-effective and has less opioid consumption.

Subcostal Transversus Abdominis Plane Block for Laparoscopic Sleeve Gastrectomy, Is It Worth the Time?

BACKGROUND: Obesity is a complex and multifactorial disease whose incidence has increased, making it a serious public health issue. Laparoscopic sleeve gastrectomy (LSG) is one of the most common surgical procedures that is chosen for bariatric surgery. Decreasing postoperative pain in these patients which will increase patients' compliance and quality of life will lead to better surgical results. This study aims to compare the effectiveness of trocar site infiltration versus bilateral subcostal transversus abdominis plane block (TAP) in controlling postoperative pain in patients. METHODS: Forty-five consecutive patients who have undergone LSG in xxx General Surgery Department have been enrolled in the study. Patients were divided into two groups according to the surgeon's choice. The first group underwent TAP block, while the second group underwent trocar site infiltration. Patients' pain was recorded via visual analogue scale (VAS) in postoperative periods. RESULTS: Twenty-nine female (69%) and 13 (31%) male patients were included in the study. Median age was 41 (18-58) and median BMI was 48 (41.1-68). When the VAS values were compared, in the TAPB group, 6th hour resting and coughing pain was statistically significantly less. Other VAS values measured while resting, coughing, and post-mobilization did not show significant differences. There were no significant differences between the groups' tramadol use. CONCLUSIONS: After LSG, TAP block and trocar site infiltration yield similar pain control. Due to the faster application and fewer side effects, we concluded that trocar site infiltration should be the intervention of choice in controlling postoperative pain in LSG.

A Simple Method to Evaluate Whether Pancreas Texture Can Be Used to Predict Pancreatic Fistula Risk After Pancreatoduodenectomy.

INTRODUCTION: Soft pancreas is one of the most important risk factor for postoperative pancreatic fistula after pancreatoduodenectomy. The aim of this study is to investigate whether pancreatic attenuation index utilized to assess the pancreatic texture with computed tomography can be used to predict the risk of developing a clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. METHODS: We reviewed 76 consecutive patients undergoing pancreatoduodenectomy between 2012 and 2014. The pancreatic attenuation index is found by dividing the pancreas density by the spleen density achieved with non-enhanced computed tomography. The independent predictors of clinically relevant postoperative pancreatic fistula were investigated. RESULTS: Clinically relevant postoperative pancreatic fistula occurred in 13 patients (17.1%). The group of patients with postoperative pancreatic fistula is compared with the group of patients without postoperative pancreatic fistula in terms of age, gender, body mass index, the American Society of Anesthesiologists (ASA) score, smoking, alcohol consumption, medical comorbidities, preoperative biliary drainage, type of anastomosis, and pancreatic duct size and pancreatic attenuation index. Univariate analyses have shown a significant difference in relation to chronic obstructive pulmonary disease and pancreatic attenuation index. The multivariate analyses showed that only pancreatic attenuation index was associated with a high postoperative pancreatic fistula rate (P = 0.012). CONCLUSION: A preoperative non-contrast computed tomography scan evaluating pancreatic attenuation index could help to predict the occurrence of clinically significant postoperative pancreatic fistula after pancreatoduodenectomy.