Conclusion:
We observed that in LSG performed by creating CO2 PP with a low pressure, adequate exposure was achieved when compared with the standard technique, and the complication rates and laboratory parameters were similar in the two IAP groups. In intraoperative emergencies requiring IJV catheterization, due to the IJV diameter and volume being higher than the standard IAB during LSG performed with a low IAP, catheterization may be fasciculate. We consider that LSG performed with a low pressure without compromising patient safety can positively contribute to both anesthesia and the surgical team.
References:
Tekin A, Ögetman Z, Epözdemir S. Morbid Obezite Tedavisinde Laparoskopik Sleeve Gastrektomi. Endoskopik Laparoskopik & Minimal İnvaziv Cerrahi Dergisi 2007;14(4).
Alimogullari M, Bulus H. Predictive factors of gallstone formation after sleeve gastrectomy: a multivariate analysis of risk factors. Surg Today 2020;50(9):1002-1007.
Gentileschi P. Laparoscopic sleeve gastrectomy as a primary operation for morbid obesity: experience with 200 patients. Gastroenterol Res Pract 2012;2012:801325.
Acholonu E, McBean E, Rosenthal RJ, et al. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg 2009;19:1612–6.
Cuschieri A. Laparoscopic Biliary Surgery. 2nd ed. Oxford: Blackwell Scientific Publications; 1992. p. 28.
Junghans T, Böhm B, Gründel K, Schwenk W. Effects of pneumoperitoneum with carbon dioxide, argon, or helium on hemodynamic and respiratory function. Arch Surg 1997;132:272-8.
Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 2004;21:95-105.
Morino M, Giraudo G, Festa V. Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 1998;12:968-72.
Bryant LR, Wiot JF, Kloecker RJ. A study of the factors affecting the incidence and duration of postoperative pneumoperitoneum. Surg Gynecol Obstet 1963;117:145-50.
Lobato E, Florete OG, Paige GB, Morey TE. Cross-sectional area and intravascular pressure of the right internal jugular vein during anesthesia: Effects of trendelenburg position, positive intrathoracic pressure, and hepatic compression. J Clin Anesth. 1998;10:1–5.
Beddy P, Geoghegan T, Ramesh N, Buckley O, O’Brien J, Colville J, Torreggiani WC. Valsalva and gravitational variability of the internal jugular vein and common femoral vein: Ultrasound assessment. Eur J Radiol. 2006;58:307–9.
Diebel L, Wilson R, Dulchavsky S, Saxe J. Effect of increased intra-abdominal pressure on hepatic arterial, portal venous and hepatic microcirculatory blood flow. J Trauma 1992;33:279-282.
Odeberg S, Ljungqvist O, Svenberg Tluence, et al. Haemodynamic effects of pneumoperitoneum and the influence of posture during anesthesia dor laparoscopic surgery. Acta Anesthesiol Scand 1994;38:276.
Kelman G, Swapp G, Smith I, Benzie R, Gordon N. Cardiac output and arterial blood gas tension during laparoscopy. Br J Anaesth 1972;44:1155-1162.
Dexter SP, Vucevic M, Gibson J, Mcmahon MJ. Hemodynamic consequences of high and low pressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc. 1999;13:376–81.
McLaughlin JG, Scheeres DE, Dean RJ, Bonnell BW. The adverse hemodynamic effects of laparoscopic cholecystectomy. Surg Endosc 1995;9:121–4.
Giraudo G, Brachet Contul R, Caccetta M, Morino M. Gasless laparoscopy could avoid alterations in hepatic function. Surg Endosc 2001;15:741-746.
Tan M, Xu FF, Peng JS. Changes in the level of serum liver enzymes after laparoscopic surgery. World J Gastroeneterol 2003;9:364-367.
Morino M, Giraudo G, Festa V. Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 1998;12:968-972.
Bendet N, Morozov V, Lavi R, et al. Does laparoscopic cholecystectomy influence peri-sinusoidal cell activity? Hepatogastroenterology 1999;46:1603-1606.
Volz J, Koster S, Spacek Z, Pawaletz N. Characteristic alterations of the peritoneum after carbondioxide pneumoperitoneum. Surg Endosc 1999;13:611-614.
Hoekstra LT, Ruys AT, Milstein DM, Samkar G, Henegouwen MB, Heger M et al. Effects of Prolonged Pneumoperitoneum on Hepatic Perfusion During Laparoscopy. Ann Surg 2013;257:302–307.
Farrell GC, Teoh NC, Mccuskey NS. Hepatic Microcirculation in FattyLiver DiseaseThe Anatomical Record 2008;291:684–692.
Seraf´n A, Rosello C, Prats N, Xaus C, Gelp E, Peralta C. Ischemic Preconditioning Increases the Tolerance of Fatty Liver to Hepatic Ischemia-Reperfusion Injury in the Rat. American Journal of Pathology 2002;2:161.
Taura P, Lopez A, Lacy AM, et al. Prolonged pneumoperitoneum at 15 mmHg causes lactic acidosis. Surg Endosc 1998;12:198.
Razvi HA, Fields D, Vargas JC, Vaughan ED Jr, Vukasin A, Sosa RE. Oliguria during laparoscopic surgery: evidence for direct renal parenchymal compression as an etiology factor. J Endourol 1996;10:1-4.
Ninomiya K, Kitano S, Yoshida T, Bandoh T, Baatar D, Matsumoto T. Comparison of pneumoperitoneum and abdominal wall lifting as to hemodynamics and surgical stress response during laparoscopic cholecystectomy. Surg Endosc 1998;12:124-128.
Doğan U ,Habibi M ,Bülbüller N ,Ellidağ HY ,Mayir B ,Çakır T et al. Effects of different intraabdominal pressure levels on oxidative stress markers in laparoscopic cholecystectomy. Turk J Surg 2018;34:212-216.
Kudchadkar SJ, Sagar J. Impact of intra-abdominal pressure in laparoscopic surgery on post-operative pain and recovery. J Anaesth Surg Res. 2019;1:1-3.
Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surgendosc. 2002 ;16(7):1121-43.
Sherwani NNR, Kareem TS. The Effect of Intra‑abdominal Carbon Dioxide Pressure on Blood Pressure in Laparoscopic Surgeries. Medical Journal of Babylon 2019;16(4):286-291.
Rebecca AS, Atilio B, Shahar B, Jonathan BM. Cardiovascular monitoring. In:Miller RD, editor. Miller’s Anesthesia. 7th ed. Philadelphia: Elsevier Churchill Livingstone; 2009. p. 1285–328.
Bozzetti F, Mariani L, Bertinet BD, Chiavenna G, Crose N, Cicco MD et al. Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days. Volume 21, Issue 6, December 2002, Pages 475-485.
Kusminsky ER. Complications of Central Venous Catheterization. Jamcollsurg 2007;204(4):681-696.
Pınar HU, Doğan R, Konuk ÜM, Çifci E, Duman E, Karagülle E et al. The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation. BMC Anesthesiology 2016;16:62.
Descriptive Statistics