Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA.
Surg Endosc. 2022 Oct;36(10):7700-7708. doi: 10.1007/s00464-022-09124-x. Epub 2022 Feb 23.
The benefits of minimally invasive surgery using laparoscopy on postoperative pain and opioid use are well established. Our goal was to determine whether patients who underwent Roux-en-Y gastric bypass using a robotic approach (RA-RYGB) had lower postoperative pain and required less opioids than those undergoing laparoscopic Roux-en-Y gastric bypass (L-RYGB). Secondary outcomes evaluated included length of stay, operative time, and readmissions.
This was a retrospective cohort study from a tertiary academic medical center. Patients who underwent L-RYGB or RA-RYGB between 5/1/2018 and 10/31/2019 were included. Cases with concomitant hernia repair, chronic opioid use, and those who did not receive a TAP block or multimodal pain control were excluded. Baseline demographics were compared. Inpatient and outpatient opioid use in Morphine Milligram Equivalents (MME) and pain scores (10-point Likert scale) were compared.
There were 573 RY patients included (462 L-RYGB; 111 RA-RYGB). Median and maximum inpatient pain scores were similar for L-RYGB and RA-RYGB (3.0 vs 3.1, p = 0.878; 7.0 vs 7.0, p = 0.688). Median inpatient opioid use and maximum single day use were similar for L-RYGB and RA-RYGB (40.0 MME vs. 42.0 MME, p = 0.671; 30.0 MME vs 30.0 MME, p = 0.648). Both the outpatient prescribing of opioids (50.2% vs. 42.3%, p = 0.136) and outpatient opioid MME at 2 weeks (L-RYGB 30.0 MME vs. 33.8 MME, p = 0.854) were comparable between cohorts. Patient reported pain at 2-week follow-up was significantly higher for RA-RYGB (68.1%) than L-RYGB (55.6%) (p = 0.030). RA-RYGB had a higher rate of 30-day readmission and longer operative times compared to the L-RYGB (6.3% vs 13.5%, p = 0.010; 144.5 vs 200.0 min, p < 0.001).
This study identified no benefit for postoperative pain or opioid requirements in patients undergoing RA-RYGB compared to L-RYGB. The RA-RYGB group was significantly more likely to report pain at the two-week follow-up.
腹腔镜微创手术在术后疼痛和阿片类药物使用方面的益处已得到充分证实。我们的目标是确定接受机器人辅助 Roux-en-Y 胃旁路术（RA-RYGB）的患者与接受腹腔镜 Roux-en-Y 胃旁路术（L-RYGB）的患者相比，术后疼痛是否更低，需要的阿片类药物是否更少。次要结局评估包括住院时间、手术时间和再入院率。
这是一项来自三级学术医疗中心的回顾性队列研究。纳入 2018 年 5 月 1 日至 2019 年 10 月 31 日期间接受 L-RYGB 或 RA-RYGB 的患者。排除合并疝修补术、慢性阿片类药物使用者以及未接受 TAP 阻滞或多模式疼痛控制的患者。比较基线人口统计学特征。比较住院和门诊吗啡毫克当量（MME）和疼痛评分（10 分李克特量表）的阿片类药物使用情况。
共纳入 573 例 RY 患者（462 例 L-RYGB；111 例 RA-RYGB）。L-RYGB 和 RA-RYGB 的中位数和最大住院疼痛评分相似（3.0 对 3.1，p=0.878；7.0 对 7.0，p=0.688）。L-RYGB 和 RA-RYGB 的中位数住院阿片类药物使用量和最大单日使用量相似（40.0 MME 对 42.0 MME，p=0.671；30.0 MME 对 30.0 MME，p=0.648）。两组在门诊开阿片类药物的处方（50.2%对 42.3%，p=0.136）和 2 周时的门诊 MME（L-RYGB 30.0 MME 对 33.8 MME，p=0.854）方面相似。RA-RYGB 组患者在 2 周随访时报告的疼痛明显高于 L-RYGB 组（68.1%比 55.6%，p=0.030）。RA-RYGB 组的 30 天再入院率和手术时间均高于 L-RYGB 组（6.3%对 13.5%，p=0.010；144.5 对 200.0 分钟，p＜0.001）。
与 L-RYGB 相比，RA-RYGB 患者在术后疼痛或阿片类药物需求方面没有获益。RA-RYGB 组在两周随访时更有可能报告疼痛。
