Effect of TAP Block on GI Function After Sleeve Gastrectomy Using PRO-diGI Scale and Perlas Score

Bariatric surgery, particularly laparoscopic sleeve gastrectomy, is an effective intervention for morbid obesity. However, postoperative gastrointestinal dysfunction, including delayed gastric emptying and impaired gut motility, can adversely impact recovery, prolong hospital stay, and reduce patient satisfaction. Factors such as opioid-based analgesia are known contributors to postoperative ileus and gastrointestinal dysmotility. Therefore, optimizing pain management strategies while minimizing opioid use is critical for enhanced recovery.

The Transversus Abdominis Plane (TAP) block is a regional anesthesia technique that provides effective abdominal wall analgesia, reducing opioid consumption and associated adverse effects. While its role in postoperative pain control is well established, limited evidence exists regarding its impact on gastrointestinal function, particularly in the context of bariatric surgery.

Study Objective:

The primary objective of this study is to evaluate whether the application of ultrasound-guided TAP block affects postoperative gastrointestinal function after laparoscopic sleeve gastrectomy. Gastrointestinal recovery will be assessed using the PRO-diGI scale, which captures patient-reported symptoms of gastrointestinal motility, and the Perlas gastric ultrasound score, which provides an objective estimate of gastric content and residual volume.

Study Design:

This is a prospective, single-center clinical study conducted at Elazığ Fethi Sekin City Hospital. Adult patients scheduled for elective laparoscopic sleeve gastrectomy will be enrolled. All participants will receive standardized general anesthesia. TAP block will be administered as part of the perioperative analgesia strategy in eligible patients, based on clinical decision-making and patient consent.

Assessments:

Primary Outcome:

PRO-diGI score measured at predefined postoperative intervals (e.g., 6, 24, and 48 hours after surgery).

Secondary Outcomes:

Perlas score obtained via gastric ultrasonography in the early postoperative period.

Postoperative opioid consumption within the first 48 hours.

Incidence of postoperative nausea, vomiting, and ileus.

Length of hospital stay.

Ethics and Compliance:

The study will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Ethical approval has been obtained from the institutional review board. Written informed consent will be obtained from all participants prior to study inclusion.

Expected Impact:

By integrating both subjective and objective measures of gastrointestinal function, this study will provide high-quality evidence regarding the potential benefits of TAP block beyond pain control. The results may contribute to optimizing perioperative care strategies for bariatric surgery and improving patient outcomes.

Inclusion criteria

• Adult patients aged 18-65 years
• Scheduled for primary laparoscopic sleeve gastrectomy (LSG)
• Body Mass Index (BMI) ≥ 35 kg/m²
• ASA Physical Status II-III
• Ability to provide written informed consent

Exclusion criteria

• Previous major abdominal surgery
• Known allergy to local anesthetics
• Severe hepatic or renal dysfunction
• Pregnancy or breastfeeding
• Conversion to open surgery during the procedure
• Patients refusing TAP block or general anesthesia