Material and Method:
Forty patients between the ages of 18-60, who underwent LSG (11) for
morbid obesity with the standard technique by the same surgeon at the
General Surgery Clinic of Health Sciences University Ankara Numune
Training and Research Hospital between July 2018 and April 2019 were
included in the study. The study sample was divided into two equal
groups: 20 patients that underwent LSG with 10 mmHg pressure and 20
patients that underwent LSG at 13 mmHg pressure. The demographic
characteristics of the patients in both groups, comorbidities, surgery
history, height, weight, body mass index (BMI), family history, IAP
applied during surgery, operation time, length of hospital stay, and the
right IJV diameter and volume on the Doppler ultrasound before
intubation during surgery (t1), 10 minutes after insufflation (t2), and
at the end of insufflation (t3) were recorded.
An ultrasonography (USG) examination was performed using a GE Logiq E9
USG (General Electric Company, Boston, USA, 2016) device in all patients
by two radiologists with at least eight years’ experience. A GE 11L
Linear Probe (GE, General Electric Company, Boston, USA, 2016)
high-resolution (3-11 MHz) probe was used for the grayscale mode and
Doppler mode. IJV was visualized at the carotid bifurcation level, and
then all measurements were performed at this level. The IJV diameter was
measured in the transverse plane using the grayscale mode. Doppler USG
was undertaken to measure the blood velocity of IJV. Grayscale USG and
Doppler USG were performed in the same session by the same radiologist.
All sonographic data were recorded separately.
Blood urea, creatine, AST, ALT, GGT, ALP, total bilirubin, direct
bilirubin, prothrombin time (PT) and INR values were measured
preoperatively and at postoperative hours 6, 12 and 48. Patients with a
history of intraabdominal surgery, an acute/chronic liver, kidney and
cardiovascular disease, an active infection or cancer, those that had
undergone intraabdominal radiotherapy, and cases in which IAP was
changed during surgery were excluded from the study.