Influence of pneumoperitoneum on the deep venous system during laparoscopy.
BACKGROUND
There is widespread concern that laparoscopic procedures that are usually performed under general anesthesia, using muscle relaxation, in a reverse Trendelenberg position and with pneumoperitoneum, may lead to venous stasis in lower limbs.


OBJECTIVE
To evaluate perioperative changes in the venous system and determine the frequency of deep venous thrombosis associated with minimally invasive surgery.


METHODS
Prospective consecutive series.


METHODS
Sixty-five patients undergoing elective minimally invasive surgery.


METHODS
Laparoscopic procedures with no thromboprophylaxis.


RESULTS
Sixty-one patients completed the investigations (coagulation profile and lower limb venous duplex scan) on admission and on the first postoperative day. The median duration of pneumoperitoneum was 45 minutes (range: 18-90 minutes). None of postoperative scans revealed thrombosis. No significant changes in the postoperative coagulation profile were identified. Perioperative scans of the left femoral vein revealed an increase in cross-sectional area (P<0.05) and a decrease in peak blood velocity (P<0.05).


CONCLUSIONS
In this study of low-risk patients for thromboembolism, laparoscopy with pneumoperitoneum at pressures below 12 mm Hg per se did not increase the prevalence of deep venous thrombosis. This implies that venous hemodynamic changes observed during pneumoperitoneum did not cause deleterious venous stasis. Still, caution needs to exercised with regard to the view that no special precautions to prevent deep venous thrombosis are warranted in patients undergoing laparoscopy.
Wazz
G
G
Department of Surgery, Tawam Hospital, Al-Ain, United Arab Emirates. gabiw@yahoo.com
Branicki
F
F
Taji
H
H
Chishty
I
I
D000328:Adult; D001780:Blood Coagulation Tests; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007327:Insufflation / Q000009:adverse effects; D010535:Laparoscopy; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011152:Popliteal Vein / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000453:epidemiology / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*