Effects of different intraabdominal pressures on internal jugular vein, liver and kidney functions in obese patients undergoing laparoscopic sleeve gastrectomy

Akkurt, Gökhan; Birben, Birkan; Akçay, Feryal; Altay, Cetin Murat; Başkan, Semih; Yıldız, Barış

doi:10.1080/00015458.2021.1976473

Cited by 1 publication

(2 citation statements)

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“…Not surprisingly, the vast majority of the previous reports on low vs standard pneumoperitoneum were on laparoscopic cholecystectomy, and to our knowledge, only 2 studies [ 15 , 20 ] were reported comparing low vs standard pressure pneumoperitoneum outcomes after bariatric operations. Recently, Leeman et al [ 15 ] failed to show any clinical benefit of LPP in 29 patients undergoing laparoscopic Roux-en-Y gastric bypass.…”

Section: Discussionmentioning

confidence: 99%

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Low-Pressure Pneumoperitoneum During Laparoscopic Sleeve Gastrectomy: a Safety and Feasibility Analysis

2023

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Purpose Laparoscopy is advised under the lowest possible intra-peritoneal pressure. The aim of this study is to analyze the safety/feasibility of low pneumoperitoneum pressure (LPP) during laparoscopic sleeve gastrectomy (LSG). Materials and Methods All primary LSGs who completed a 3-month follow-up were included. Re-do operations and LSGs performed with concomitant procedures were excluded. All LSGs were performed by the senior author. Upon trocar insertions, pressure was set to 10 mmHg, and the procedure was started. The pressure was increased step-wise, according to the senior author’s assessment of the quality of exposure. Doing so, three pressure groups were formed: groups 1 (10 mmHg), 2 (11–13 mmHg), and 3 (14 mmHg). All data was retrieved from our database. Statistical analysis was performed using one-way ANOVA/Tukey’s HSD test/Chi-square test. P values < 0.05 were regarded as significant. Results Between February 2018 and October 2022, 708 consecutive/primary LSGs were studied. No mortality/conversion/thromboembolic event was observed. Groups 1, 2, and 3 comprised 376 (53.1%), 243 (34.3%), and 89 (12.6%) patients, respectively. Demographics, initial weight, duration of surgery, history for abdominoplasty, drain output, length of stay, and %total weight loss were evenly distributed among groups. Among 16 bleeding episodes, 14 occurred in the LPP group ( p = 0.019). Including the only leak and stenosis, 8/9 of Clavien-Dindo 3b + 4 complications were observed in the LPP group ( p = 0.092). Conclusions LSG with LPP is feasible in about half of the patients. However, almost all potentially life-threatening complications occurred in the LPP group where a significantly higher rate of bleeding was observed. Our findings suggest caution for routinely using LPP during LSG. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

“…No advantage in pain was observed, and surgery took longer when LPP was used. The other article reported the use of LPP during LSG in only 20 patients and reported no advantage on hepatic/renal function compared to standard pressure [ 20 ]. This study was not a safety/feasibility analysis, and the step-wise approach was not used.…”

Section: Discussionmentioning

confidence: 99%