Transversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis.

BACKGROUND: The efficacy of transversus abdominis plane (TAP) block compared with thoracic epidural analgesia (TEA) in abdominal surgery has been controversial. We conducted this systematic review and meta-analysis to assess outcomes of TAP block and TEA in a procedure-specific manner in colorectal surgery. METHODS: A systematic literature search of the PubMed, Embase, Cochrane Library, and Scopus databases was conducted through July 10, 2020, to identify randomized controlled trials (RCTs) comparing TAP block with TEA in colorectal surgery. Primary outcomes were pain scores at rest and movement at 24 h postoperatively. Secondary outcomes included postoperative pain scores at 0-2 and 48 h, opioid consumption, postoperative nausea and vomiting (PONV), functional recovery, hospital stay, and adverse events. RESULTS: Six RCTs with 568 patients were included. Methodological quality of these RCTs ranged from moderate to high. TAP block provided comparable pain control, lower 24 h and total opioid consumption, shorter time to ambulation and urinary catheter time, and lower incidence of sensory disturbance and postoperative hypotension compared with TEA. Meanwhile, the 48-h opioid consumption, PONV incidence, and hospital stay were similar between groups. When laparoscopic surgery was the only surgical approach employed, TAP block provided additional benefits of shorter time to first flatus and lower incidence of PONV compared with TEA. CONCLUSIONS: Perhaps more germane to minimally invasive procedures, TAP block is equivalent to TEA in terms of postoperative pain control and provides better functional recovery with lower incidence of adverse events in patients undergoing colorectal surgery.

Assessment of body composition in obese patients undergoing one anastomosis gastric bypass: cross-sectional study.

Bariatric surgery is the most effective long-term treatment to obesity, and it is necessary to assess changes in body composition and to be able to establish better follow-up of patients. Cross-sectional, observational study in patients undergoing One Anastomosis Gastric Bypass (OAGB) bariatric surgery. We analysed changes in weight and body composition during the first postoperative year. 405 patients (68.9% women. 31.1% men), mean age 44 years, mean weight 110.02 kg, Body Mass Index (BMI) 39.76 kg/m2, height 1.66 m. The variables analyzed were substantially decreased compared to the preoperative values one year after surgery in every case: weight (110.02 ± 22.03 kg vs. 69.36 ± 13.60 kg), BMI (39.76 ± 6.65 vs. 24.52 ± 3. 76), fat free mass (61.12 ± 12.43 kg vs. 53.61 ± 11.61 kg), fat mass (50.44 ± 14.36 kg vs. 15.74 ± 6.74 kg), bone mass (58.06 ± 11.85 kg vs. 50.92 ± 11.06 kg) and water (45.08 ± 9.99 kg vs. 37.39 ± 9.23 kg), P < 0.001. The results show noticeable improvements in weight reduction and changes in body composition, and will contribute to develop a thorough understanding of both of them, contributing also to perform a better patients' follow-up.

Short-Term Changes on Body Composition and Bone Mass After One-Anastomosis Gastric Bypass: a Prospective Observational Study.

PURPOSE: Bariatric surgery generates a large weight loss. It is considered a successful surgery when 50% of the excess weight loss is reached. However, this measure does not include some variables that may have a direct impact on a patient's health, such as fat-free mass (FFM) or bone mass. Therefore, the aim of this study is to evaluate body composition and bone mass in patients undergoing one-anastomosis gastric bypass (OAGB). METHODS: A prospective observational study was performed in patients undergoing OAGB. Body composition and bone mass were evaluated by bioelectrical impedance analysis at baseline (1 day prior to surgery), at 6 and 12 months after surgery. RESULTS: A total of 94 patients (67% females and 33% males) were included in the study. The excess BMI loss at 6 and 12 months after surgery was 97.9 ± 20.1% and 110.2 ± 30.5% respectively. The FFM showed a reduction of 6.6 ± 4.8 kg (p < 0.01) 6 months after surgery and of 7.9 ± 4.9 kg (p < 0.01) at 12 months, meaning a decrease of 10.5 ± 7.3% and a 12.9 ± 6.6% respectively. The bone mass decrease was 10.1 ± 6.9% (p < 0.01) and 12.9 ± 6.5% (p < 0.01) at 12 months after OAGB. CONCLUSIONS: OAGB obtains a relevant weight loss in patients with morbid obesity, mainly, due to fat mass reductions. However, this procedure also provokes FFM and bone mass decreases, especially in females, but not significantly greater than other restrictive or mixed procedures.

Rehabilitación multimodal en cirugía bariátrica / Enhanced recovery after bariatric surgery

Los protocolos de rehabilitación multimodal o recuperación intensificada (PRI) son programas de cuidado del paciente basados en la evidencia científica y orientados a mejorar su recuperación postoperatoria. Abarcan todos los aspectos implicados en el cuidado del paciente y requieren un manejo multidisciplinar, en el que intervienen varios especialistas. La aplicación de estos protocolos se está extendiendo ampliamente por diferentes tipos de cirugías abdominales y extraabdominales, incluyendo la cirugía bariátrica. Facultativos de diferentes especialidades, con experiencia en el tratamiento de pacientes obesos mórbidos, han formado parte del grupo de trabajo que desarrolló este protocolo. Para evaluar la evidencia científica actualizada, se realizó una búsqueda bibliográfica sobre PRI en cirugía bariátrica en diferentes bases de datos, estableciendo los niveles de calidad de evidencia y el grado de recomendación según la metodología GRADE. Se agruparon las actuaciones incluidas en la matriz temporal en 3 etapas: preoperatorio, perioperatorio y postoperatorio

Enhanced recovery after surgery (ERAS) protocols are care programs based on scientific evidence and focused on postoperative recovery. They encompass all aspects of patient care and require multidisciplinary management, with the participation of diverse specialists. The implementation of these protocols is being extended to several abdominal and extra-abdominal surgeries, including bariatric approaches. Diverse specialists with wide experience in the management of morbidly obese patients have taken part in the working group that developed this protocol. A bibliographic search about ERAS in bariatric surgery in several databases was performed to evaluate the current scientific evidence, establishing evidence levels and recommendations according to the GRADE methodology. The items included in this protocol are separated into preoperative, perioperative and postoperative guidelines