Introduction:
Laparoscopic sleeve gastrectomy (LSG), first introduced in the treatment
of morbid obesity in 1993 by Marceau et al., is a bariatric surgical
procedure defined as an alternative to distal gastrectomy, which is the
restrictive part of malabsortive duodenal switch surgery. Today, the
popularity of LSG is increasing. The procedure usually involves
resection of 80% of the stomach with the help of a vertical or
laparoscopic stapler, starting approximately 4 cm proximal to the
pylorus and extending 1 cm lateral to the esophagogastric junction along
the greater curvature (1,2). Although LSG is relatively safe, any
complication that may arise can be serious, as well as being
irreversible and amputatory. In LSG, postoperative complications are
observed at a rate of 0 to 24%, and the overall mortality rate is
around 0.5% (3). Patient compliance in the postoperative period plays
an important role in the treatment of complications. While major
complications that can lead to organ failure and death may rarely
develop, minor complications, such as nausea, gastroesophageal reflux,
cholelithiasis, ventral hernia, and wound infection are frequently
encountered and can be successfully treated (4).
As in other laparoscopic procedures, LSG is performed by the
insufflation of CO2 gas into the peritoneal cavity at a
pressure of 13-15 mmHg. CO2 is easily excreted through
the lungs after being absorbed from the peritoneum and dissolved 20
times more in serum than room air or oxygen (5). Although laparoscopic
operations have many advantages over laparotomy, pneumoperitoneum (PP)
has negative effects, especially on the cardiovascular and respiratory
systems (6). Studies have shown that PP can increase systemic vascular
resistance and decrease stroke volume, cardiac output, and vascular
return. These side effects are especially important in the elderly and
individuals with additional diseases (7). One of the important
hemodynamic changes due to PP is a temporary decrease in the hepatic
blood flow. Pressure generated by the intrabdominal route and elapsed
time have been found to be directly related to hepatic ischemia. This
may be demonstrated by an increase in the liver enzymes alanine
aminotransferase (ALT), aspartate aminotransferase (AST), alkaline
phosphatase (ALP), gamma-glutamyl transferase (GGT), total/direct
bilirubin, and international normalized ratio (INR) (8,9). In addition,
changes in the internal jugular vein (IJV) and central venous pressure
can be seen in LSG due to increased intraabdominal pressure (IAP) caused
by the Trendelenburg position and especially CO2insufflation. Therefore, less CO2 insufflation and lower
IAP may reduce patient morbidity (10).
In this study, we aimed to investigate whether there was a difference
between the effects of 10 mmHg or 13 mmHg IAP during LSG on the IJV
diameter, blood volume, and liver and kidney functions.