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.