Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures

Abstract

Background Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. Methods The 2005–2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. Results A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P < .001). After multivariable adjustment, laparoscopy seemed to have a protective effect against mortality (adjusted odds ratio, 0.45; P = .04), but no differences in other secondary endpoints. Conclusion For patients with CHF, an open operative approach seems to be utilized more frequently in general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this population is necessary.

Evaluation of Effect of Infusion of Dexmedetomidine on Attenuation of Hemodynamic Response During Laparoscopic Surgeries

“…Patients with pre-existing co-morbid conditions and cardiovascular disorders are more prone for developing exaggerated hemodynamic instability in patients undergoing laparoscopic surgeries [13] . Cephalad displacement of diaphragm causes decrease vital capacity decreased functional reserve capacity and increased intrathoracic pressure.…”

Laparoscopic surgery in patients with cystic fibrosis: A systematic review

“…Laparoscopic surgery, when performed by trained surgeons, is known to have fewer overall complications than open surgery. Some of the known benefits of laparoscopic surgery include diminished postoperative pain, reduced intraoperative and postoperative bleeding, shorter hospital stay, shorter recovery time, decreased risk of adhesions, and minimal surgical scarring 27 . However, there is still an ongoing debate about the safety of laparoscopic surgery for patients with cardiovascular and pulmonary diseases.…”

“…The chart method was used to confirm the accuracy of each article's title, abstract, introduction, rational for the report, research question(s), design, inclusion and exclusion criteria, subject selection method, subjects' missing status, where and when the study was performed, data collection, measurements and statistics, results, implications and limitations, conclusions, ethical considerations, and internal and external validity of the study. The quality ratings adhered to the following strict principles: high‐quality studies fulfilled 90% of 30 criteria 26‐28 moderate‐quality studies fulfilled 80% of 30 criteria, 23‐25 low‐quality studies fulfilled 70% of 30 criteria, 20‐22 and studies with insufficient quality fulfilled ≤69% of 30 criteria (ie, ≤20 criteria) (Table 1).…”

Argon Application for Creation of Pneumoperitoneum in Laparoscopic Surgeries

“…В частности, применение карбоксиперитонеума, ставшее наиболее распространенным способом создания рабочего пространства для хирургического пособия, неоднократно обсуждалось в научных источниках как причина различных осложнений. Изучалось влияние повышенного давления углекислого газа в брюшной полости на состояние сердечно-сосудистой и дыхательной систем [1,2,3]. Наряду с научными данными, свидетельствующими об удовлетворительной компенсации организмом пациента повышенного содержания СО 2 в крови и в выдыхаемом воздухе [2], приводятся сведения о повышении риска нарушения функциональных систем при наличии сопутствующих заболеванийсоответствующих органов [3].…”

“…Изучалось влияние повышенного давления углекислого газа в брюшной полости на состояние сердечно-сосудистой и дыхательной систем [1,2,3]. Наряду с научными данными, свидетельствующими об удовлетворительной компенсации организмом пациента повышенного содержания СО 2 в крови и в выдыхаемом воздухе [2], приводятся сведения о повышении риска нарушения функциональных систем при наличии сопутствующих заболеванийсоответствующих органов [3]. Изучалось влияние карбоксиперитонеума на состояние плода во время операции у беременных [4].…”