title: Effects of CPAP on gastric pouch pressure after bariatric surgery.
abstract: BACKGROUND
  The purpose of this study was to determine if the routine use of postoperative continuous positive airway pressure (CPAP) in patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with an increase in transmural gastric pouch pressure, which may create the risk for anastomotic leak.
  
  
  METHODS
  Transmural gastric pressures (difference between gastric pouch and bladder pressures) were measured postoperatively [post-anesthesia recovery care unit (PACU) arrival (prior to initiation of CPAP), 5 min, 30 min, and PACU discharge] in 28 patients (19 patients used CPAP, 9 patients did not) following laparoscopic RYGB. Changes in pressure over time were assessed using a generalized estimating equation, taking into account the repeated measurements obtained for each subject. In all cases, two-tailed P values ≤0.05 were considered statistically significant.
  
  
  RESULTS
  Among patients that used CPAP, there were no changes in transmural pouch pressure from baseline at any point in time (P = 0.628). However, in patients that did not use CPAP, there was a trend towards increased transmural gastric/pouch pressure (P = 0.053), which could be attributed to a transient decrease in bladder pressure at the 5-min measurement interval.
  
  
  CONCLUSIONS
  Application of CPAP did not increase transmural gastric pouch pressure in our bariatric patients; therefore, its use in the post-RYGB patients does not pose a risk for pouch distension, which could lead to the disruption of anastomotic integrity.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. weingarten.toby@mayo.edu
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: James M
authors.initials: JM
authors.lastname: Swain
authors.forename: Lavonne M
authors.initials: LM
authors.lastname: Liedl
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Johnson
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Johnson
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies