Evaluation of intra-abdominal pressure after laparoscopic and open gastric bypass.
BACKGROUND
Increased intra-abdominal pressure (IAP) postoperatively can adversely affect cardiovascular, pulmonary, and renal function. In this prospective, randomized trial, we compared the IAP in morbidly obese patients after laparoscopic and open gastric bypass (GBP) surgery.


METHODS
64 patients with a body mass index of 40 to 60 kg/m2 were randomized to undergo laparoscopic or open GBP. IAPs were obtained at baseline (after induction of anesthesia), immediately after the operation, and on post-operative day (POD) 1, 2, and 3. Intraoperative and postoperative fluid requirements, urine output, and creatinine clearance were recorded.


RESULTS
Demographics of the two groups were similar. IAP increased from baseline immediately after laparoscopic and open GBP (p < 0.05). IAP returned to baseline by POD 2 after laparoscopic GBP but remained elevated through POD 3 after open GBP. In fact, IAP was lower after laparoscopic GBP than after open GBP on POD 1, 2 and 3 (p < 0.05). The amount of intraoperative IV fluid was similar between groups, but laparoscopic GBP required less IV fluid and facilitated higher urine output postoperatively than open GBP. There was no significant difference in creatinine clearance between groups.


CONCLUSIONS
Laparoscopic GBP resulted in significantly lower IAP, less postoperative fluid required, and greater postoperative urine output than open GBP.
Nguyen
N T
NT
Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817-1418, USA. ninh.nguyen@ucdmc.ucdavis.edu
Lee
S L
SL
Anderson
J T
JT
Palmer
L S
LS
Canet
F
F
Wolfe
B M
BM
D000005:Abdomen / Q000503:physiopathology*; D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D005773:Gastroscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009767:Obesity, Morbid / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011312:Pressure; D011446:Prospective Studies; D016896:Treatment Outcome
D003404:Creatinine