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Laparoscopy-assisted subtotal gastrectomy under thoracic epidural-general anesthesia leading to the effects on postoperative micturition

Surgical Endoscopy volume 22, pages 724–730 (2008)Cite this article

Abstract

Background

Recently, the laparoscopic surgical technique has been widely applied to major surgery as it can minimize surgical incision, reduce blood loss, and shorten hospital stay. In this study, we evaluated the effectiveness of the laparoscopic surgery on postoperative micturitional function in comparison to open surgery.

Method

Sixty patients undergoing subtotal gastrectomy were assigned to either laparoscopic (L group, n = 30) or open surgery (O group, n = 30) groups. The combined thoracic epidural-general anesthesia was performed on all patients, and epidural patient-controlled analgesia (PCA) using ropivacaine and sufentanil was maintained for two days following surgery. After surgery, visual analog pain score (VAS), levels of sensory and motor block, observer’s assessment of alertness/sedation score (OAA/S), time to first flatus, ambulation and oral intake, and micturition function were assessed.

Results

The L group showed much earlier ambulation, flatus and oral intake than the O group. Although the scores of VAS and OAA/S were not significantly different between the two groups, the micturition problem scores of the L group were lower than that of the O group (P < 0.05). All patients of the L group had no difficulty in self-voiding, whereas four patients in the O group required urinary catheterization on the first postoperative day (POD1).

Conclusions

Patients who underwent laparoscopic subtotal gastrectomy had a low incidence of micturitional problem and showed early recovery. Therefore, urinary catheterization on POD1 may not be a routine procedure for those who undergo laparoscopic subtotal gastrectomy under combined thoracic epidural-general anesthesia.

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Acknowledgements

Authors especially thank Drs. KT Min (Department of Anesthesiology and Pain Medicine, Yonsei University) and SL Kim (Department of Anesthesiology and Pain Medicine, Soonchunhyang University) for valuable discussions.

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Affiliations

  1. Department of Anesthesiology, Pain Medicine and Anesthesia, Pain Research Institute, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, C.P.O. Box 8044, Seoul, 120-752, Korea

    Sung Jin Lee, Bon Nyeo Koo, Ji Yeon Lee, Na Hyung Jun & Ki Jun Kim

  2. Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, C.P.O. Box 8044, Seoul, 120-752, Korea

    Woo Jin Hyung

  3. Department of Anesthesiology and Pain Medicine, Soonchunhyang University, Hannamdong 657, Yong sang Gu, Seoul, Korea

    Sun Chung Kim

  4. Department of Anesthesiology and Pain Medicine, Ilsanpaik Hospital, Inje University, Daewa dong, 2240, Ilsan, Korea

    Jung Won Kim

  5. Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, 94143, USA

    Jia Liu

  6. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, C.P.O. Box 8044, Seoul, 120-752, Korea

    Ki Jun Kim

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  1. Sung Jin Lee
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Correspondence to Ki Jun Kim.

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Lee, S.J., Hyung, W.J., Koo, B.N. et al. Laparoscopy-assisted subtotal gastrectomy under thoracic epidural-general anesthesia leading to the effects on postoperative micturition. Surg Endosc 22, 724–730 (2008). https://doi.org/10.1007/s00464-007-9475-6

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  • DOI: https://doi.org/10.1007/s00464-007-9475-6

Keywords

  • Combined anesthesia
  • Gastrectomy
  • Laparoscopy
  • Postoperative micturition