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Effects of CPAP on Gastric Pouch Pressure After Bariatric Surgery

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Abstract

Background

The purpose of this study was to determine if the routine use of postoperative continuous positive airway pressure (CPAP) in patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with an increase in transmural gastric pouch pressure, which may create the risk for anastomotic leak.

Methods

Transmural gastric pressures (difference between gastric pouch and bladder pressures) were measured postoperatively [post-anesthesia recovery care unit (PACU) arrival (prior to initiation of CPAP), 5 min, 30 min, and PACU discharge] in 28 patients (19 patients used CPAP, 9 patients did not) following laparoscopic RYGB. Changes in pressure over time were assessed using a generalized estimating equation, taking into account the repeated measurements obtained for each subject. In all cases, two-tailed P values ≤0.05 were considered statistically significant.

Results

Among patients that used CPAP, there were no changes in transmural pouch pressure from baseline at any point in time (P = 0.628). However, in patients that did not use CPAP, there was a trend towards increased transmural gastric/pouch pressure (P = 0.053), which could be attributed to a transient decrease in bladder pressure at the 5-min measurement interval.

Conclusions

Application of CPAP did not increase transmural gastric pouch pressure in our bariatric patients; therefore, its use in the post-RYGB patients does not pose a risk for pouch distension, which could lead to the disruption of anastomotic integrity.

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Acknowledgment

We are thankful to Minelle Hulsebus for the assistance in the construction of gastric pouch pressure measurement catheters.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Toby N. Weingarten, Lavonne M. Liedl, Christopher P. Johnson & Juraj Sprung

  2. Department of Surgery, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Michael L. Kendrick & James M. Swain

  3. Division of Biostatistics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Darrell R. Schroeder

  4. Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Bruce D. Johnson

Authors
  1. Toby N. Weingarten
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  2. Michael L. Kendrick
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  3. James M. Swain
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  4. Lavonne M. Liedl
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  5. Christopher P. Johnson
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  6. Darrell R. Schroeder
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  7. Bruce D. Johnson
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  8. Juraj Sprung
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Corresponding author

Correspondence to Toby N. Weingarten.

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Funding Sources

Support was provided by the Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

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Weingarten, T.N., Kendrick, M.L., Swain, J.M. et al. Effects of CPAP on Gastric Pouch Pressure After Bariatric Surgery. OBES SURG 21, 1900–1905 (2011). https://doi.org/10.1007/s11695-011-0419-9

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  • DOI: https://doi.org/10.1007/s11695-011-0419-9

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