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.