Intra-abdominal pressure in the morbidly obese.
BACKGROUND
Recent data suggests that increased intra-abdominal pressure (IAP) is one factor associated with the morbidity of morbidly obese patients, who have a BMI>35 kg/m2. IAP has been proposed to be an abdominal compartment syndrome (ACS). This study investigated the characteristics of IAP in morbidly obese patients.


METHODS
45 morbidly obese patients (mean BMI55+/-2 kg/m2) had IAP measured using urinary bladder pressure.


RESULTS
The mean IAP for the morbidly obese group was 12+/-0.8 cmH2O, increased when compared to controls (IAP=0+/-2 cmH2O). The IAP correlated to the sagittal abdominal diameter, an index of the degree of central obesity (r=+0.83, P<0.02); however, it did not correlate to basal insulin, body weight, or BMI. The end-expiratory IAP did not change when measured after the laparotomy incision was made, but IAP measured in the last 15 patients increased during the first 2 postoperative days. The IAP for patients with pressure-related morbidity (gastroesophageal reflux disease, hernia, stress incontinence, diabetes, hypertension, and venous insufficiency) was 12+/-1 cmH2O, while those without these morbidities had an IAP of 9+/-0.8 cmH2O.


CONCLUSIONS
We conclude that IAP is increased in morbid obesity. This increased IAP is a function of central obesity and is associated with increased morbidity. The degree of IAP elevation correlates with increased co-morbidities. We also conclude that elevation in IAP in morbid obesity is not a true ACS but represents a direct mass effect of the visceral obesity.
Lambert
David M
DM
Creighton University Medical Center, Department of Surgery, Omaha, NE 68131, USA.
Marceau
Simon
S
Forse
R Armour
RA
D000005:Abdomen / Q000503:physiopathology*; D000328:Adult; D000886:Anthropometry; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000469:parasitology / Q000503:physiopathology* / Q000601:surgery; D011312:Pressure; D001743:Urinary Bladder / Q000503:physiopathology