title: [Effect of pneumoperitoneum on venous hemodynamics during laparoscopic cholecystectomy. Influence of patients' age and time of surgery].
abstract: OBJECTIVE
  Abdominal hyperpressure developed during laparoscopic cholecystectomy by the effect of pneumoperitoneum represents an obstacle to the venous return that may facilitate thromboembolic complications. The aim of this study was to establish the effect of pneumoperitoneum in venous hemodynamics during laparoscopy.
  
  
  METHODS
  Prospective study of 31 consecutive patients who underwent laparoscopic cholecystectomy. Venous occlusion plethysmography was performed preoperatively, after anaesthetic induction, after insufflation, before pneumoperitoneum release and at the end of surgery. Changes of plethysmography were compared with preoperative values and according to age, obesity, presence of varicose veins and pneumoperitoneum time. Bilateral lower limb venous Duplex scanning was performed at days 1, 7 and 30 to detect deep venous thrombosis (DVT).
  
  
  RESULTS
  Average age was 56 years, 66.6% females, 40% obese, 16% with varicose veins and the pneumoperitoneum time was < 45 min in 22.5% patients. Capacitance decreased progressively during surgery and was significantly reduced with pneumoperitoneum. The maximum venous outflow in the first second was reduced significantly at the end of pneumoperitoneum. These reductions were more evident in older patients.
  
  
  CONCLUSIONS
  Pneumoperitoneum produces plethysmographic changes on venous hemodynamics with a diminished venous return in lower limbs. Older patients have higher risk of thromboembolic complications, while obesity can also increase this risk. However, no DVT was demonstrated in this study.
authors.affiliation: Servicio Cirugía General y Digestivo, Hospital Universitario de Getafe, Madrid, Spain. cmaillo@oninet.pt
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Maíllo
authors.forename: Ester
authors.initials: E
authors.lastname: Martín
authors.forename: Julio
authors.initials: J
authors.lastname: López
authors.forename: José M
authors.initials: JM
authors.lastname: Jover
authors.forename: Javier
authors.initials: J
authors.lastname: Martínez
authors.forename: Inés
authors.initials: I
authors.lastname: Margalet
authors.forename: Alberto
authors.initials: A
authors.lastname: Hernández
authors.forename: José L
authors.initials: JL
authors.lastname: Ramos
authors.forename: Mariano
authors.initials: M
authors.lastname: Moreno
mesh_terms: D000367:Age Factors; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D010991:Plethysmography; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology*; D013997:Time Factors; D020246:Venous Thrombosis / Q000453:epidemiology