Abstract
Background
High intraabdominal pressure (IAP) during laparoscopic surgery has been associated with postoperative discomfort. Effects on nausea and access have not been subjected to randomized studies. In cholecystectomy, lower IAP may cause less pain, but nausea and surgical access in RYGB surgery have not been investigated. We studied the influence of two IAP levels on surgical access, operation time, postoperative pain, and nausea.
Methods
Fifty consecutive female gastric bypass patients were randomized to intraabdominal pressure of 12 (IAP12) or 18 (IAP18) mm Hg. Surgeons and personnel were blinded to randomization; study groups were well matched for age and BMI. Operative time was noted in minutes. Visual analogue scales were used for assessing access and for patients assessing pain (abdomen-shoulder) and nausea (supine-standing) at six time points during the first 16 postoperative hours. Rescue medication was recorded.
Results
In 3/25 patients in the IAP12 group, the code was broken due to access problems vs. 0/25 in the IAP18 group (p = 0.1398). Operative time did not differ. Access was significantly better for IAP18 (92.2 ± 2.3 vs. 69.3 ± 4.2; p = 0.0001). Postoperative shoulder pain was maximal after 6 h but throughout less than in the abdomen (p < 0.0001); there were no differences in pain between IAP18 and IAP12 (p = 0.7408). Postoperative nausea was significantly greater standing than supine but without differences between groups.
Conclusion
Higher IAP gives better surgical access in laparoscopic Roux-en-Y gastric bypass with no negative effect on pain or nausea.
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Acknowledgments
This study was approved by the Institutional Review Board and the Lund University Ethics Committee and performed after informed consent by all participants according to the principles of the Helsinki declaration.
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Yvette Caesar, Ilona Sidlovskaja, Andreas Lindqvist, Hjörtur Gislason, and Jan L. Hedenbro report no conflict of interest.
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None of the authors has anything to disclose in relation to the present article.
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Y. Caesar and I. Sidlovskaja contributed equally to this work.
Parts of this study have been reported in abstract form to the IFSO meeting in Vienna, August 2015.
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Caesar, Y., Sidlovskaja, I., Lindqvist, A. et al. Intraabdominal Pressure and Postoperative Discomfort in Laparoscopic Roux-en-Y Gastric Bypass (RYGB) Surgery: a Randomized Study. OBES SURG 26, 2168–2172 (2016). https://doi.org/10.1007/s11695-016-2091-6
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DOI: https://doi.org/10.1007/s11695-016-2091-6