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Effect of various pneumoperitoneum pressures on femoral vein hemodynamics during laparoscopic cholecystectomy

Abstract

High intra-abdominal pressure and reverse Trendelenburg position during laparoscopic cholecystectomy (LC) are risk factors for venous stasis in lower extremity. Lower limb venous stasis is one of the major pathophysiological elements involved in the development of peri-operative deep vein thrombosis. Low pressure pneumoperitoneum (7–10 mmHg) has been recommended in patients with limited cardiac, pulmonary or renal reserve. The purpose of this study was to observe the effect of various pneumoperitoneum pressures on femoral vein (FV) hemodynamics during LC. A total of 50 patients undergoing elective LC were enrolled and they were prospectively randomized into two groups containing 25 patients each. In group A high pressure pneumoperitoneum (14 mmHg) and in group B low pressure pneumoperitoneum (8 mmHg) was maintained. Comparison of pre-operative and post-operative coagulation profile was done. Preoperative and intraoperative change in femoral vein diameter (FVD) (AP and LAT), cross-sectional area (CSA) and peak systolic flow (PSF) during varying pneumoperitoneum pressure was recorded in FV by ultrasound Doppler. First measurement (pre-operative) was carried out just after the induction of anesthesia before creation of pneumoperitoneum and second measurement (intra-operative) was taken just before completion of surgery with pneumoperitoneum maintained. Changes in coagulation parameters were less significant at low pressure pneumoperitoneum. There was statistical significant difference in the pre-operative and intra-operative values of FVD, CSA and PSF in both groups when analyzed independently (P = 0.00). There was no significant difference in pre-operative values of FVD, CSA and PSF (P > 0.05) among two groups but when the comparison was made between the intra-operative values, there was significant increase in FVD (AP) (P = 0.016), CSA (P = 0.00) and decrease in PSF (P = 0.00) at high pressure pneumoperitoneum. This study provides evidence of using low pressure pneumoperitoneum during LC as changes in FV hemodynamics and coagulation parameters were less pronounced at low pressure pneumoperitoneum.

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References

  1. Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5:89–94

    PubMed  PubMed Central  Google Scholar 

  2. Lenz RJ, Thomas TA, Wilkins DG (1976) Cardiovascular changes during laparoscopy: studies of stroke volume and cardiac output using impedance cardiography. Anaesthesia 31:4–12

    CAS  Article  PubMed  Google Scholar 

  3. Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL (1991) Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 126:997–1001

    CAS  Article  PubMed  Google Scholar 

  4. Critchley LAH, Critchley JAJH, Gin T (1993) Haemodynamic changes in patients undergoing laparoscopic cholecystectomy: measurement by transthoracic electrical bioimpedance. Br J Anaesth 70:681–683

    CAS  Article  PubMed  Google Scholar 

  5. Gulec B, Oner K, Yigitler C, Kocaoglu M, Aydin Y, Saglam M (2006) Lower extremity venous changes in pneumoperitoneum during laparoscopic surgery. ANZ J Surg 76:904–906

    Article  PubMed  Google Scholar 

  6. Deyo GA (1992) Complication of laparoscopic cholecystectomy. Surg Laparosc Endosc 2:41–48

    CAS  PubMed  Google Scholar 

  7. Jorgensen JO, Hanel K, Lalak NJ, Hunt DR, North L, Morris DL (1993) Thromboembolic complications of laparoscopic cholecystectomy. BMJ 306:518–519

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Caprini JA, Arcelus JL (1994) Prevention of postoperative venous thromboembolism following laparoscopic cholecystectomy. Surg Endosc 8:741–747

    CAS  Article  PubMed  Google Scholar 

  9. Beebe DS, Mc Nevin MP, Crain JM, Letourneau JG, Belani KG, Abraham JA et al (1993) Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy. Surg Gynecol Obstet 176:443–447

    CAS  PubMed  Google Scholar 

  10. Mayol J, Vincent-Hamelin E, Sarmiento JM, Oshiro EO, Diaz-Gonzalez J, Tamayo FJ et al (1994) Pulmonary embolism following laparoscopic cholecystectomy: report of two cases and review of the literature. Surg Endosc 8:214–217

    CAS  Article  PubMed  Google Scholar 

  11. Okuda Y, Kitajima T, Egawa H, Hamaguchi S, Yamaguchi S, Yamazaki H et al (2002) A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy. Surg Endosc 16:781–784

    CAS  Article  PubMed  Google Scholar 

  12. Schwenk W, Bohm B, Fugener A, Muller JM (1998) Intermittent pneumatic sequential compression (ISC) of lower extremities prevents venous stasis during laparoscopic cholecystectomy. Surg Endos 12:7–11

    CAS  Article  Google Scholar 

  13. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A et al (2002) The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16:1121–1143

    CAS  Article  PubMed  Google Scholar 

  14. Joris J, Cigarini I, Legrand M, Jacquet N, De Groote D, Franchimont P et al (1992) Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth 69:341–345

    CAS  Article  PubMed  Google Scholar 

  15. Barczynski M, Herman RM (2003) A prospective randomized trial on comparison of low pressure (LP) and standard pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 17:533–538

    CAS  Article  PubMed  Google Scholar 

  16. Schwenk W, Bohm B, Junghans T, Hofmann H, Muller JM (1997) Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopy and conventional colorectal surgery. Dis Colon Rectum 40:1056–1062

    CAS  Article  PubMed  Google Scholar 

  17. Schwenk W, Bohm B, Witt C, Junghans T, Grundel K, Muller JM (1999) Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 134:6–13

    CAS  Article  PubMed  Google Scholar 

  18. Lindberg F, Bergqvist D, Rasmussen I, Haglund U (1997) Hemodynamic changes in the inferior caval vein during pneumoperitoneum. Surg Endosc 11:431–437

    CAS  Article  PubMed  Google Scholar 

  19. Marshall NJ, Bessell JR, Maddern GJ (2000) Study of venous blood flow changes during laparoscopic surgery using a thermodilution technique. Aust NZJ Surg 70:639–643

    CAS  Article  Google Scholar 

  20. Jorgensen JO, Lalak NJ, Hunt DR, North L, Hanel K, Hunt DR et al (1994) Venous stasis during laparoscopic cholecystectomy. Surg Laparosc Endosc 4(2):128–133

    CAS  PubMed  Google Scholar 

  21. Kemen M, Sperling H, Mumme A, Zumotobel V (1991) The thrombin-antithrombin III complex ELISA test in diagnosis surgery-induced blood coagulation activation. Infusiontherapie 18:199–201

    CAS  Google Scholar 

  22. Lundqvist PB, Swedenborg J (1981) Postoperative hypercoagulability, detection and measurement using a modified recalcification time system, effects of low dose heparin and types of surgery. Thromb Hemost 46:16

    Google Scholar 

  23. Bergqvist D, Matzsch T, Jendteg S, Lindgren B, Persson U (1990) The cost-effectiveness of prevention of post-operative thromboembolism. Acta Chir Scand 156:36–41

    Google Scholar 

  24. Dogan IV, Ovali E, Eti Z, Yayci A, Gogus FY (1999) The in vitro effects of isoflurane, sevoflurane, and propofol on platelet aggregation. Anesth Analg 88:432–436

    CAS  PubMed  Google Scholar 

  25. Dalsgaard-Nielsen J, Risbo A, Simmelkjaer P, Gormsen J (1981) Impaired platelet aggregation and increased bleeding time during general anaesthesia with halothane. Br J Anaesth 53:1039–1042

    CAS  Article  PubMed  Google Scholar 

  26. Wu ZM, Li XY, Chen LH, Chen GT, Chiu PWY (2000) Clinical observation of the effect of CO2 pneumoperitoneum on haemorrheology. Ann Coll Surg HK 4:102–105

    Article  Google Scholar 

  27. Rahr HB, Fabrin K, Larsen JF, Thorlacius-Ussing O (1999) Coagulation and fibrinolysis during laparoscopic cholecystectomy. Thromb Res 93:121–127

    CAS  Article  PubMed  Google Scholar 

  28. Martinez-Ramos C, Lopez-Pastor A, Nunez-Pena JR, Sanz-Lopez R, Jorgensen T, Pastor L et al (1999) Changes in hemostasis after laparoscopic cholecystectomy. Surg Endosc 13:476–479

    CAS  Article  PubMed  Google Scholar 

  29. Caprini JA, Arcelus JI, Laubach M, Size K, Hoffman KN, Coats RW et al (1995) Postoperative hypercoagulability and deep-vein thrombosis after laparoscopic cholecystectomy. Surg Endosc 9:304–309

    CAS  PubMed  Google Scholar 

  30. Persson A, Davis R, Villavicencio J (1991) Deep venous thrombosis and pulmonary embolism. Surg Clin N Am 71:1195–1209

    CAS  PubMed  Google Scholar 

  31. Richmond BK (2006) Intestinal ischaemia after laparoscopic cholecystectomy. JSLS 10:236–238

    Google Scholar 

  32. Sammour T, Mittal A, Loveday BPT, Kahokehr A, Phillips ARJ, Windsor JA et al (2009) Systematic review of oxidative stree associated with pneumoperitoneum. Br J Surg 96:836–850

    CAS  Article  PubMed  Google Scholar 

  33. Preventza OA, Habib FA, Young SC, Penney D, Oppat W, Mittal VK (2005) Portal vein thrombosis: an unusual complication of laparoscopic cholecystectomy. JSLS 9:87–90

    PubMed  PubMed Central  Google Scholar 

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Correspondence to Divya Dahiya.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Sharma, A., Dahiya, D., Kaman, L. et al. Effect of various pneumoperitoneum pressures on femoral vein hemodynamics during laparoscopic cholecystectomy. Updates Surg 68, 163–169 (2016). https://doi.org/10.1007/s13304-015-0344-x

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  • DOI: https://doi.org/10.1007/s13304-015-0344-x

Keywords

  • Low pressure pneumoperitoneum
  • Laparoscopic cholecystectomy
  • Femoral vein diameter
  • Femoral vein hemodynamics
  • Hypercoagulability