Abstract
PurposeEven 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).MethodsBetween 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.ResultsThere 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.ConclusionWith 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.
Highlights
Transvaginal hybrid Natural Orifice Transluminal Endoscopic Surgery (NOTES) cholecystectomy with rigid instruments (NC), first performed by Zornig et al in June 2007, has become established in some hospitals as an alternative to traditional laparoscopic cholecystectomy (LC) [1]
In a 2018 comparative analysis, we demonstrated the feasibility of NC in patients with a high body mass index (BMI), showing that these patients required a longer operative time and had a significantly higher probability of additional trocar use, they experienced similar postoperative lengths of stay and complication rates when compared to patients with normal weight [4]
The postoperative pain on the morning of the first postoperative day (P = 0.001) and on the morning of the second postoperative day (P = 0.002) as well as the sum of pain measurements from the day of surgery to the morning of the second postoperative day (P = 0.006) was significantly lower in the NC group compared to the LC group (Fig. 2 and Fig. 3)
Summary
Transvaginal hybrid NOTES cholecystectomy with rigid instruments (NC), first performed by Zornig et al in June 2007, has become established in some hospitals as an alternative to traditional laparoscopic cholecystectomy (LC) [1]. A meta-analysis of 13 studies demonstrated that, compared to LC, NC reduced postoperative pain and postoperative analgesic requirements, while accelerating postoperative convalescence and improving the esthetic surgical outcome without increasing intraoperative or postoperative
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