-Original-

Comparison of Postoperative Pain Following Laparoscopic Versus Open Gastrostomy/Jejunostomy in Patients with Complete Obstruction Caused by Advanced Esophageal Cancer

Takeshi Matsutani, Tsutomu Nomura, Nobutoshi Hagiwara, Itsuo Fujita, Yoshikazu Kanazawa, Daisuke Kakinuma, Hitoshi Kanno, Akihisa Matsuda, Keiichiro Ohta and Eiji Uchida

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

Background: When percutaneous endoscopic gastrostomy is not feasible, a gastrostomy tube may be inserted for enteral access by a laparoscopic or open technique. The aim of this study was to compare the postoperative pain of laparoscopic versus open gastrostomy in patients with complete obstruction caused by advanced esophageal cancer.
Methods: Fifteen patients who had undergone either a reduced port access laparoscopic gastrostomy/jejunostomy (LGJ, n=7) or open gastrostomy/jejunostomy (OGJ, n=8) between July 2011 and December 2015 were retrospectively studied. Variables examined comprised age, sex, body mass index (BMI), operative time, blood loss volume, and American Society of Anesthesiologist physical status (ASA-PS) scores. The degree of postoperative pain was also assessed in both groups during the first seven postoperative days.
Results: The patients in the two groups were comparable in age, sex, BMI, ASA-PS scores, intraoperative blood loss or postoperative complication rates. Operative time was shorter in the LGJ group than the OGJ group. No patients in the LGJ group required conversion to open laparotomy. Tube feedings were started on postoperative Day 1 in both groups; there were no postoperative complications. The duration of rescue nonopioid analgesic use was significantly shorter in the LGJ than the OGJ group (1.3 versus 3.5 days; P=0.0005). There was a significant difference in frequency of postoperative nonopioid analgesic use: 7.9 times in the LGJ group versus 17.9 times in the OGJ group (P=0.0219).
Conclusions: LGJ is associated with less postoperative pain than OGJ in patients with complete obstruction caused by advanced esophageal cancer.

J Nippon Med Sch 2016; 83: 228-234

Keywords
postoperative pain, laparoscopic gastrostomy, reduced port surgery, advanced esophageal cancer

Correspondence to
Takeshi Matsutani, MD, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
matsutani@nms.ac.jp

Received, May 29, 2016
Accepted, June 13, 2016