3D volumetry CT scans accurately estimate GV after SG. A significant relationship between GV and EWL 6 months after SG was established, seeming that GV ≥ 100 ml at 6 months of SG is associated with poor EWL.

Background Visceral pain (VP) following laparoscopic sleeve gastrectomy remains a substantial problem. VP is associated with autonomic symptoms, especially nausea and vomiting, and is unresponsive to traditional pain management algorithms aimed at alleviating somatic (incisional) pain. The present study was performed to evaluate the safety and effectiveness of laparoscopic paragastric autonomic neural blockade (PG-ANB) in managing the symptoms associated with VP following sleeve gastrectomy. Study Design This prospective, double-blinded, randomized clinical trial involved patients undergoing laparoscopic sleeve gastrectomy at two high-volume institutions. The patients were randomized to laparoscopic transversus abdominis plane block with or without PG-ANB. The primary outcome was patient-reported pain scores assessed at 1, 8, and 24 h postoperatively. The secondary outcome measures were analgesic requirements, nausea, vomiting, hiccups, and hemodynamic changes immediately after PG-ANB and postoperatively. Results In total, 145 patients (block group, n = 72; control group, n = 73) were included in the study. The heart rate and mean arterial pressure significantly decreased 10 min after PG-ANB. The visual analog scale score for pain was significantly lower in the PG-ANB than in the control group at 1 h postoperatively (p < 0.001) and 8 h postoperatively (p < 0.001). Vomiting, nausea, sialorrhea, and hiccups were significantly less prevalent in the PG-ANB group. Patients in the PG-ANB group received fewer cumulative doses of analgesics at 1 h postoperatively (p = 0.003) and 8 h postoperatively (p < 0.001). No differences between the groups were detected at 24 h (p = 0.298). No complications related to PG-ANB occurred. Conclusion PG-ANB safely and effectively reduces early VP, associated autonomic symptoms, and analgesic requirements after laparoscopic sleeve gastrectomy. Graphical abstract

The somatic pain induced by surgical trauma to the abdominal wall after laparoscopic sleeve gastrectomy (LSG) is effectively managed using conventional analgesia and transversus abdominis plane (TAP) blocks. In contrast, the visceral, colicky, pain that patients experience after LSG does not respond well to traditional pain management. Patients typically experience epigastric and retrosternal pain that begin immediately after LSG and lasts up to 72 hours after LSG. This visceral type of pain has been ascribed to the spasm of the neo-gastric sleeve. The pain is often severe and requires opioid derivatives. Patients frequently have associated autonomic symptoms such as nausea, retching and vomiting. In the last 15 years at our institutions, we have used many analgesic strategies to manage this burdensome symptom in the more than 2000 LSG procedures we have performed, but none have been satisfactorily effective1,2.

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