Laparoscopic Bariatric Surgery Research Articles

Comment on "Feasibility and efficacy of erector spinae plane block versus transversus abdominis plane block in laparoscopic bariatric surgery: a randomized comparative trial".

See letter "Response to "Comment on Feasibility and efficacy of erector spinae plane block versus transversus abdominis plane block in laparoscopic bariatric surgery: a randomized comparative trial"" in Volume 76 on page 81.

A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial

Abstract
 Background: Laparoscopic bariatric surgery has become a regular procedure, and it has largely replaced traditional open surgery. Patients experience postoperative pain even after laparoscopic surgery, although the intensity is low compared to open surgery. We compared the effectiveness of intravenous (IV) vs. intraperitoneal (IP) magnesium sulphate (MgSO4) injection in pain management in laparoscopic mini-gastric bypass surgery. 
 Methodology: We selected 100 patients based on convenient sampling and randomly divided into two groups; the IV group (50 patients) received MgSO4 50 mg/kg in 250 ml normal intravenously, and the IP group (50 patients) received MgSO4 50 mg/kg in 30 ml normal saline intraperitoneally. Nalbuphine was used as rescue analgesic and its total postoperative consumption during the first 24 h was recorded based on VAS score. Postoperative nausea and vomiting (PONV), sedation score and hemodynamic changes with pneumoperitoneum were also assessed.
 Results: Total nalbuphine consumption postoperatively was more in IV group than IP group (12 ± 3.03 mg vs. 8.3 ± 2.8 mg; P < 0.001). Postoperative pain score was significantly lower in IP group in comparison to IV group (P < 0.001). Intraoperative hypotension and bradycardia were significantly more (P = 0.03) in IV group (21% and 17% respectively) compared to IP group (10% and 7% respectively). Postoperative sedation and nausea and vomiting scores were reduced in IP group compared to IV group, the difference being highly significant (P < 0.001).
 Conclusion: Intraperitoneal MgSO4 instillation has better results than intravenous infusion in attenuation of postoperative pain and hemodynamic response associated with pneumoperitoneum, and results in less PONV when used in laparoscopic minigastric bypass patients.
 Key words: Analgesics / administration & dosage; Analgesics / pharmacology; Analgesics / therapeutic use; Bariatric; Magnesium Sulfate / administration & dosage; Magnesium Sulfate / pharmacokinetics; Magnesium Sulfate / therapeutic use; Mini-gastric bypass; Pain management; Pneumoperitoneum
 Citation: El-Sesy MG, Abdel Hameed AE, Abdelaziz AA, Ahmed IM, Elhennawy AM. A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):450-457; DOI: 10.35975/apic.v26i4.1947
 Received: April 18, 2022; Reviewed: June 16, 2022; Accepted: July 10, 2022

Effect of Dexmedetomidine Compared to Remifentanil During Bariatric Surgery on Postoperative Nausea and Vomiting: a Retrospective Study.

Postoperative nausea and vomiting (PONV) occurs frequently after bariatric surgery and is a major cause of adverse outcomes. This retrospective study investigated whether opioid-restricted total intravenous anesthesia using dexmedetomidine as a substitute for remifentanil can reduce PONV in bariatric surgery. The electronic medical records of adult patients who underwent laparoscopic bariatric surgery between January and December 2019 were reviewed. The patients were divided into two groups according to the agents used for anesthesia: Group D, propofol and dexmedetomidine; Group R, propofol and remifentanil. A total of 134 patients were included in the analyses. The frequency of postoperative nausea was significantly lower in Group D than that in Group R until 2h after discharge from the postanesthesia care unit (PACU) (P = 0.005 in the PACU, P = 0.010 at 2h after PACU discharge) but failed to significantly reduce the overall high incidence rates of 60.5% and 65.5%, respectively (P = 0.592). Postoperative pain score was significantly lower in Group D until 6h after PACU discharge. The rates of rescue antiemetic and analgesic agent administration in the PACU were significantly lower in Group D than those in Group R. Opioid-restricted total intravenous anesthesia using dexmedetomidine reduces postoperative nausea, pain score, antiemetic, and analgesic requirements in the immediate postoperative period after bariatric surgery.

Effect of Intraperitoneal Local Anesthetics in Laparoscopic Bariatric Surgery: A Meta-Analysis of Randomized Controlled Trials.

The effectiveness of intraperitoneal local anesthesia (IPLA) has been confirmed in other fields, but its use in bariatric surgery remains debatable. This study aimed to evaluate the analgesic effect of IPLA in bariatric surgery. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to February 2022. All randomized controlled trials (RCTs) assessing IPLA's analgesic effect in bariatric surgery were included in this study. Pain-related indicators were the outcome. Ten RCTs with 979 patients were included. Postoperative pain scores were significantly lower in IPLA group. Subgroup analysis demonstrated that IPLA was associated with lower pain scores in 6h and at 24h compared to the control group, without significant differences at 8, 12, and 48h. Meanwhile, IPLA reduced the dose of opioids taken postoperatively. Additionally, there were no differences in adverse events between the two groups. As far as the number of postoperative analgesics used and hospital stays were concerned, our results did not show statistical differences between the two groups. IPLA can reduce postoperative pain safely and effectively, particularly during the early postoperative stage.

Individualized positive end-expiratory pressure with and without recruitment maneuvers in obese patients during bariatric surgery.

This study aimed to determine whether regular recruitment maneuvers (RMs) are essential for obese patients (OPs) undergoing elective laparoscopic bariatric surgery (LBS) during intraoperative ventilation with individualized positive end-expiratory pressure (PEEP). Patients were randomly assigned to two arms: the RM + PEEP-EIT arm consisted of individualized PEEP titrated by electrical impedance tomography (EIT) with two regular RMs and the PEEP-EIT arm consisted of individualized PEEP titrated by EIT without additional RMs. For these two arms together, EIT-guided PEEP varied among individuals. The partial pressure of oxygen in arterial blood to fractional inspired oxygen (PaO2 /FiO2 ) ratio in the RM + PEEP-EIT arm was higher than that in the PEEP-EIT arm at 1 h after pneumoperitoneum (p=0.024) and at the end of surgery (p=0.035). There was no great difference in the PaO2 /FiO2 ratio between these two arms when measured 5min prior to postanesthesia care unit (PACU) departure and on postoperative day 1. Compared with the PEEP-EIT arm, patients in the RM + PEEP-EIT arm had significantly higher intraoperative dynamic respiratory system compliance (p < 0.001) but consumed more vasopressors (p=0.036). Postoperative pulmonary complications occurred in 1 of 29 patients in the RM + PEEP-EIT arm compared with 2 of 31 patients in the PEEP-EIT arm. Regular lung RMs can improve intraoperative oxygenation and respiratory system compliance among OPs undergoing LBS with EIT-guided individual PEEP. However, the improvement might disappear before leaving the PACU, and regular RMs resulted in more vasopressor consumption.

Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial

Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial

A074 Robotic-assisted bariatric surgery is associated with increased post-operative complications compared to laparoscopic bariatric surgery

A074 Robotic-assisted bariatric surgery is associated with increased post-operative complications compared to laparoscopic bariatric surgery

Effects of opioid-free anesthesia on postoperative morphine consumption after bariatric surgery

Study objectivesThe objective of this study was to determine whether postoperative morphine requirement in obese patients undergoing laparoscopic bariatric surgery was reduced by opioid-free anesthesia (OFA), as compared to an anesthetic strategy using opioids (opioid balanced anesthesia (OBA)) and to investigate the differences that may exist between the use of clonidine and dexmedetomidine in the context of OFA. DesignRetrospective cohort study. SettingAcademic medical center in Lyon, France. Patients257 patients who underwent laparoscopic bariatric surgery between March 2017 and March 2019. 77 patients were included in the OBA group and 180 in the OFA group. The OFA group was subdivided in two: 90 patients received OFA with clonidine (OFAC) and 90 received OFA with dexmedetomidine (OFAD). MeasurementsProportion of patients who did not receive morphine during the first 24 postoperative hours. Main resultsDuring the first 24 postoperative hours, the proportion of patients who did not require morphine was significantly higher in the OFA (87%) than in the OBA (52%) group (OR: 6.31; 95% CI [3.38; 11.80], P < 0.001). This difference remained significant after adjustment for age, body mass index, sex, type and duration of surgery (OR: 7.99; 95% CI [4.05; 16.48], P < 0.001). A greater proportion of patients in the OFAD (93%) than in the OFAC group (81%, P = 0.026) did not receive morphine during the same period. ConclusionsOFA is associated with a lower morphine requirement than with OBA during the first 24 h after bariatric surgery. In addition, OFAD seems to be more effective than OFAC in order to reduce morphine consumption.

Gastropericardial Fistula as a Life-Threatening Complication after Intragastric Balloon Insertion

Laparoscopic bariatric surgery, while highly effective, is an invasive method for sustainable weight loss [1]. Less than 1% of patients with clinically severe obesity undergo bariatric surgery [2], in part because of concerns regarding surgical complications [3].

Analgesic Efficacy of Gabapentin and Pregabalin in Patients Undergoing Laparoscopic Bariatric Surgeries: a Systematic Review and Meta-analysis.

This meta-analysis investigated the effect of oral gabapentinoids (i.e., pregabalin and gabapentin) on analgesic consumption (i.e., primary outcome) and pain relief (i.e., secondary outcome) in patients following bariatric surgery. Analysis of five eligible trials published between 2010 and 2019 including 363 participants receiving gabapentinoids revealed a significantly lower morphine consumption [mean difference (MD) = - 15.1mg, p = 0.004; evidence certainty: low] and risk of nausea/vomiting [risk ratio (RR) = 0.49, p = 0.002; evidence certainty: high] at postoperative 6-24h. There was also a lower pain score at postoperative 0-4h (MD = - 1.41, p < 0.00001; evidence certainty: low) and 6-12h (MD = - 0.9, p = 0.007; evidence certainty: low) compared with controls, while pain severity at postoperative 24h was comparable between two groups. In summary, preoperative oral gabapentinoids optimized postoperative pain outcomes and reduced risk of nausea/vomiting following bariatric surgery.

Feasibility of an Opioid Sparing Discharge Protocol Following Laparoscopic Bariatric Surgery.

Opioids are commonly prescribed after laparoscopic bariatric surgery but have untoward effects including dependence and diversion. Prior investigation revealed that over three-fourths of discharge opioids prescribed to our patients went unused. To determine the feasibility of an opioid sparing discharge protocol following laparoscopic bariatric surgery. A total of 212 opioid-naïve patients undergoing laparoscopic bariatric surgery were examined and divided into two groups; 106 prior to (Cohort A) and 106 after implementation of an opioid sparing discharge protocol (Cohort B). Opioids were converted to morphine milligram equivalents (MME) and post-operative consumption was examined. Data was described as mean ± standard deviation. No patients in Cohort B and 54.7% (58) in Cohort A received an opioid discharge prescription (37.5 MME). Of the 154 patients that remained, only 1.3% (2) received one after discharge. Cohort A took greater amounts of opioids than Cohort B after discharge (4.74 ± 11 vs. 0.21 ± 2 MME; p < 0.001). During hospitalization, Cohort A took greater amounts of opioids (6.92 ± 11 vs. 2.74 ± 5 MME; p < 0.001) but lower amounts of methocarbamol (759 ± 590 vs. 966 ± 585 mg; p = 0.011). No patient requested an opioid prescription refill or presented to the emergency room secondary to pain. Following laparoscopic bariatric surgery, an opioid sparing discharge protocol is feasible with < 2% of patients receiving opioids after discharge and no increase in emergency room visits. Education regarding these protocols may impact the amount of opioids taken during hospitalization.

Intraperitoneal Instillation of Local Anesthetic (IPILA) in Bariatric Surgery and the Effect on Post-operative Pain Scores: a Randomized Control Trial

BackgroundEffective analgesia after bariatric procedures is vital as it can reduce post-operative opioid use. This leads to less nausea which may be associated with shorter post-operative length of stay (LOS). Understanding analgesic requirements in patients with obesity is important due to the varied physiology and increased number of comorbidities.ObjectivesThe aim of this study was to evaluate the efficacy of intraperitoneal instillation of local anesthetic (IPILA) to reduce opioid requirements in patients undergoing laparoscopic bariatric surgery.MethodsA double-blinded randomized control trial was conducted to compare intraperitoneal instillation of ropivacaine to normal saline in 104 patients undergoing bariatric surgery. The primary endpoint was pain in recovery with secondary endpoints at 1, 2, 4, 6, 24, and 48 h post-operatively. Further endpoints were post-operative analgesic use and LOS. Safety endpoints included unexpected reoperation or readmission, complications, and mortality.ResultsThere were 54 patients in the placebo arm and 50 in the IPILA. Pain scores were significantly lower in the IPILA group both at rest (p = 0.04) and on movement (p = 0.02) in recovery with no difference seen at subsequent time points. Equally, IPILA was independently associated with reducing severe post-operative pain at rest and movement (adjusted odds ratio [aOR] 0.28, 95% CI 0.11–0.69, p = 0.007 and aOR 0.25, 95% CI 0.09–0.62, p = 0.004, respectively). There was no significant difference in LOS, opioid use, antiemetic use, morbidity, or mortality between the intervention and placebo groups.ConclusionThe administration of ropivacaine intraperitoneally during laparoscopic bariatric surgery reduces post-operative pain in the recovery room but does not reduce opioid use nor LOS.

Robotic vs. Laparoscopic Metabolic and Bariatric Surgery, Outcomes over 5 Years in Nearly 800,000 Patients.

Studies assessing outcomes between laparoscopic and robotic bariatric metabolic surgery (BMS) have been limited by the relatively small percentage of robotic cases. However, in recent years, the number of robotic BMS cases has doubled. We report the largest US study comparing robotic versus laparoscopic outcomes in BMS over the longest time period (5years). Analysis of the MBSAQIP database was undertaken. This included information on 791,423 patients from 2015-2019 in the USA. Within this retrospective case-control study, 13.7% of SG and 16.6% of RYGB cases were done robotically. USA, MBSAQIP database. Robotic BMS increased mean operative time by 26min for SG and 40min for RYGB. However, this did not increase the 30-day venous thromboembolism (VTE) or organ dysfunction complications between the 2 groups. Robotic SG had slightly higher risks of multiple infectious complications (OR 1.26 to 1.76). Robotic RYGB had slightly lower infectious complications and transfusion requirements. Robotic BMS had higher 30-day readmission rates and 30-day reoperative rates for both SG and RYGB. Both robotic SG and RYGB were found to have significantly longer operative times than laparoscopic SG and RYGB. Potential outcome benefits from robotic BMS can include a reduction in infectious complications and transfusion requirements with robotic RYGB cases. SGs were found to have slightly higher infectious complications.

Comparison of Pressure and Volume-Controlled Mechanical Ventilation in Laparoscopic Bariatric Surgery: A Randomized Crossover Trial.

BackgroundThe number of patients with obesity undergoing various surgeries is increasing annually, and ventilation problems are highly prevalent in these patients.ObjectivesWe aimed to evaluate ventilation effectiveness with pressure-controlled (PC) and volume-controlled (VC) ventilation modes during laparoscopic bariatric surgery.MethodsIn this open-label randomized crossover clinical trial, 40 adult patients with morbid obesity candidates for laparoscopic bariatric surgery were assigned to VC-PC or PC-VC groups. Each patient received both ventilation modes sequentially for 15 min during laparoscopic surgery in a random sequence. Every 5 min, exhaled tidal volume, peak and mean airway pressure, oxygen saturation, heart rate, mean arterial pressure, and end-tidal CO2 were recorded. Blood gas analysis was done at the end of 15 min. Dynamic compliance, PaO2/FiO2 ratio, P (A-a) O2 gradient, respiratory dead space, and PaCO2-ETCO2 gradient were calculated according to the obtained results.ResultsThe study included 40 patients with a mean age of 35.13 ± 9.06 years. There were no significant differences in peak and mean airway pressure, dynamic compliance, and hemodynamic parameters (P > 0.05). There was no significant difference between the two ventilation modes in pH, PaCO2, PaO2, PaO2/FIO2, dead space volume, and D (A-a) O2 at different time intervals (P > 0.05).ConclusionsIf low tidal volumes are used during adult laparoscopic bariatric surgery, mechanical ventilation with PC mode is not superior to VC mode.

Effect of high-flow nasal oxygen on postoperative oxygenation in obese patients: A randomized controlled trial.

Background and AimPostoperative hypoxemia is common after general anesthesia in obese patients. We investigated if early application of high‐flow nasal oxygen (HFNO) improved postoperative oxygenation in obese patients compared with standard oxygen therapy following general anesthesia for laparoscopic bariatric surgery.MethodsThis was an open labeled randomized controlled trial conducted at a university hospital in Sweden between October 23, 2018 and February 11, 2020. The study was performed as a substudy within a previously published trial. After ethics committee approval and written informed consent, 40 obese patients (body mass index [BMI] ≥ 35 kg m−2) scheduled for laparoscopic bariatric surgery were randomized to receive oxygen using a standard low‐flow nasal cannula (NC group) or HFNO at 40 L min−1 (HF group) immediately upon arrival to the post‐anesthesia care unit. Flow rate (NC group) or FiO2 (HF group) was titrated to reach an initial SpO2 of 95%–98% after which settings were left unchanged. The primary outcome was PaO2 at 60 min following postoperative baseline values. Secondary outcomes included PaCO2, SpO2, hemodynamic variables, and patient self‐assessed discomfort.ResultsThirty‐four patients were available for analysis. PaO2 was similar between groups at postoperative baseline. After 60 min, PaO2 had increased to 12.6 ± 2.8 kPa in the NC group (n = 15) and 14.0 ± 2.7 kPa in the HF group (n = 19); (mean difference 1.4 kPa, 95% confidence interval −0.6 to 3.3; p = 0.16). There were no differences in PaCO2, hemodynamic variables, or self‐assessed discomfort between groups after 60 min.ConclusionIn obese patients, HFNO did not improve postoperative short‐term oxygenation compared with standard low‐flow oxygen following general anesthesia for laparoscopic bariatric surgery.

Are alveolar recruitment maneuvers and peep ventilation effective in the intraoperative period of laparoscopic bariatric surgery? A systematic review

The purpose of the study is to systematically review about alveolar recruitment maneuvers followed by mechanical ventilation with PEEP guided by electrical impedance tomography (EIT) in laparoscopic bariatric surgery. Metodology: The primary outcomes were: regional pulmonary ventilation (regional impedance variation), end-expiratory lung impedance, and end-expiratory lung volume. Results: The survey identified three eligible studies. The sample consisted of 136 participants of both genders. The alveolar recruitment maneuver (ARM) was performed through the mechanical ventilator and using the EIT in the patient’s chest. The studies showed moderate to high risk of bias, and the quality of the evidence was classified as very low quality due to the methodological limitations found and absence of directionality. Conclusion: ARM with PEEP guided by EIT does not significantly improve the respiratory system mechanics in the intraoperative period in obese patients undergoing laparoscopic bariatric surgery.

A comparative study between high-flow nasal oxygen therapy and venturi mask oxygen therapy for postoperative laparoscopic bariatric surgery patients with atelectasis: a randomized clinical trial

BackgroundObesity has been identified as an independent risk factor for postoperative respiratory complications in several studies. In the pediatric and newborn populations, high-flow nasal oxygen (HFNO2) therapy was initially demonstrated to be an effective treatment for acute respiratory failure. It becomes increasingly popular as a therapy for adult patients, with a growing range of clinical applications.ResultsOne hundred ten patients were admitted to the ICU for postoperative care after laparoscopic sleeve gastrectomy. They were examined and randomized equally into two groups: group A (HFNO2 therapy group) who received high-flow nasal oxygen therapy, group B (VMO2 therapy group) who received venturi mask oxygen therapy. The partial pressure of oxygen in arterial blood (PaO2), partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2), respiratory rate, and length of ICU stay were recorded. The partial pressure of oxygen in the arterial blood (PaO2) was 131.764 (95% CI 124.562–138.965) in the HFNO2 group versus 106.767 (95% CI 99.565–113.968) in the VMO2 group, partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) was 321.81 (95% CI 307.486–336.153) in the HFNO2 group versus 276.767 (95% CI 262.433–291.100) in the VMO2 group, and respiratory rate was 20.778 (95% CI 20.172–21.385) in the HFNO2 group versus 24.047 (95% CI 23.441–24.654) in the VMO2 group, while the length of ICU stay was the HFNO2 group (1.09 ± .29 days) and (1.00 ± .000 day) in the VMO2 group.ConclusionsIn conclusion, our study has shown that high-flow nasal oxygen therapy in postoperative laparoscopic sleeve gastrectomy patients with atelectasis-maintained oxygenation represented as PaO2 and PaO2/FiO2 higher than the venturi mask and significantly decreased the respiratory rate but did not decrease the length of ICU stay when compared to venturi mask oxygen therapy.Trial registrationClinical trial registered with http://www.pactr.org (PACTR202108492295773).

Is laparoscopic bariatric surgery as safe and effective before and after age 60? Results from a propensity-score analysis.

Patients over 60 years old undergoing bariatric surgery is still increasing. First, to assess the impact of age (>60 years) on the 90-day morbidity and mortality of both laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG), and second, to determine the effectiveness of surgical weight loss and resolution of obesity-related comorbidities for patients 60 years of age and older over a 2-year period. Bicentric study from University Hospital of Caen and Memorial Hospital of Saint Lô, France. This is a retrospective review of a prospectively maintained database of patients with morbid obesity undergoing laparoscopic bariatric surgery from October 2005 to April 2019. Patients 60 years of age and older were defined as cases (elderly group [EG], n = 137), and patients younger than 60 years of age were defined as controls (young group [YG], n = 1544). The primary endpoint of the study was the prevalence of severe postoperative complications within 90 days of surgery determined by a propensity-score-matching (PSM) analysis. The PSM population included 133 patients in the EG who were matched 1:2 with 266 patients in the YG. There was no mortality in either group. Although not significant (with an absolute difference of 4.5% between the EG and the YG), the odds of severe postoperative complications were 2.5 times higher in the EG than in the YG (7.5% versus 3.0%, P = .053). At 90 days postoperatively, the prevalences of overall morbidity (31.6% versus 22.9%, P = .044), leakage (5.3% versus 1.1%, P = .026), and reoperation (5.3% versus 1.1%, P = .026) were significantly higher in the EG than in the YG. This propensity-matched study suggests that laparoscopic bariatric surgery is probably an effective treatment in obese elderly patients (EPs) in terms of weight loss and resolution of comorbidities. However, the EP should be warned of the increased risk of severe postoperative complications within 90days, including leakage and reoperation rates, especially after RYGB.

Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery \u2013 a secondary analysis of a prospective observational study

BackgroundOscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial pressure monitoring by NIBP and a non-invasive finger-cuff technology (Nexfin®) with the gold-standard invasive arterial pressure (IAP).MethodsIn this secondary analysis of a prospective observational, single centre cohort study, systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured at 16 defined perioperative time points including posture changes, fluid bolus administration and pneumoperitoneum (PP) in patients undergoing laparoscopic bariatric surgery. Absolute arterial pressures by NIBP, Nexfin® and IAP were compared using correlation and Bland Altman analyses. Interchangeability was defined by a mean difference ≤ 5 mmHg (SD ≤8 mmHg). Percentage error (PE) was calculated as an additional statistical estimate. For hemodynamic trending, concordance rates were analysed according to the Critchley criterion.ResultsSixty patients (mean body mass index of 49.2 kg/m2) were enrolled and data from 56 finally analysed. Pooled blood pressure values of all time points showed a significant positive correlation for both NIPB and Nexfin® versus IAP. Pooled PE for NIBP versus IAP was 37% (SAP), 35% (DAP) and 30% (MAP), for Nexfin versus IAP 23% (SAP), 26% (DAP) and 22% (MAP). Correlation of MAP was best and PE lowest before induction of anesthesia for NIBP versus IAP (r = 0.72; PE 24%) and after intraoperative fluid bolus administration for Nexfin® versus IAP (r = 0.88; PE: 17.2%). Concordance of MAP trending was 90% (SAP 85%, DAP 89%) for NIBP and 91% (SAP 90%, DAP 86%) for Nexfin®. MAP trending was best during intraoperative ATP positioning for NIBP (97%) and at induction of anesthesia for Nexfin® (97%).ConclusionAs compared with IAP, interchangeability of absolute pressure values could neither be shown for NIBP nor Nexfin®, however, NIBP showed poorer overall correlation and precision. Overall trending ability was generally high with Nexfin® surpassing NIBP. Nexfin® may likely render individualized decision-making in the management of different hemodynamic stresses during laparoscopic bariatric surgery, particularly where NIBP cannot be reliably established.Trial registrationThe non-interventional, observational study was registered retrospectively at (NCT03184285) on June 12, 2017.

Assessment of 2D and 3D imaging for patients undergoing laparoscopic bariatric surgery.

&lt;b&gt;Aim:&lt;/b&gt; The aim of this study is to compare the association of 2D and 3D imagery with technical performance and operative time during laparoscopic surgery. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Material and methods:&lt;/b&gt; A systematic review of the literature was conducted through an online search in databases such as PubMed, Cochrane, Embase and CNKI in order to identify articles published in English and Chinese from 2010 to 2020 that compared the clinical results of 2D and 3D laparoscopic gastric bypass surgery. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Results:&lt;/b&gt; A total of 50 articles were included in the qualitative analysis. Out of these, 5 articles that met the inclusion criteria were selected for analysis, according to which 3D laparoscopic surgery had a shorter surgery time than 2D laparoscopic surgery. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Compared with a 2D laparoscopic system, a 3D laparoscopic system can significantly reduce the operative time and errors and can increase the comfort of the surgeons performing laparoscopic gastric bypass surgery.