Experience of a specialist emergency bariatric surgical service.

BACKGROUND: Bariatric surgery is associated with late and procedure-specific acute surgical complications. There is very little evidence available regarding the volume, nature, and outcomes of acute surgical admissions directly stemming from bariatric surgery. Centralization of bariatric elective services in the United Kingdom may have an adverse impact on the ability of local services to manage such unpredictable complications. To address this potential problem, we set up a comprehensive and specialist emergency bariatric service. OBJECTIVES: The aim of this study was to quantify and characterize the workload of a specialist emergency surgical bariatric service. SETTING: University National Health Service hospital. METHODS: Over 2 years, we prospectively collected data on demographic characteristics, management, and outcomes of all acute surgical admissions related directly to previous bariatric surgery. RESULTS: Between December 2011 and November 2013, 69 patients had 71 emergency admissions due to a surgical emergency directly related to previous bariatric surgery. Thirty-seven (54%) had undergone primary bariatric surgery at our institution, 13 (19%) at a different National Health Service hospital, 16 (23%) at private U.K. hospitals, and 3 (4%) at private overseas hospitals. Forty-four endoscopic or surgical interventions were required, of which 17 (39%) were performed on nights or weekends and within 12 hours of admission. Of 27 operations, 25 (93%) were completed laparoscopically. Median length of stay was 2 days, there were no mortalities, and there was 1 readmission within 30 days. CONCLUSIONS: There is a significant volume of late bariatric surgical emergencies, many requiring urgent intervention. These may be effectively managed by a specialist bariatric service.

Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic.

A best evidence topic was written according to a structured protocol. The question addressed whether local anaesthetic infiltration of the transversus abdominis plane (TAP block) during a laparoscopic cholecystectomy improves pain control. Ten papers were found using the reported search, of which four represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and key results of these papers were tabulated. Three of the randomised controlled trials demonstrated a reduction in analgesic requirements associated with TAP blocks following laparoscopic cholecystectomy as compared to placebo. The remaining randomised study compared TAP blocks with local anaesthetic infiltration of laparoscopic port sites and showed no significant difference in clinical outcomes between these two techniques. We conclude that there is good evidence that TAP block in laparoscopic cholecystectomy leads to a reduction in pain scores and analgesic requirement, however there is no significant difference when compared to local anaesthetic infiltration of trocar insertion sites.