Skip to main content

Pneumoperitoneum in the Obese: Practical Concerns

  • Chapter
Book cover Minimally Invasive Bariatric Surgery

Abstract

The laparoscopic approach to bariatric surgery was first reported in the early 1990s (1). With refinement of the laparoscopic approach to bariatric surgery, particularly laparoscopic gastric bypass, there has been a tremendous growth in the field of bariatric surgery. Patients view laparoscopic bariatric surgery as a less invasive approach and are more likely to seek laparoscopic surgical therapy for the treatment of morbid obesity. With an increase in the demand for bariatric surgery, there is also an increase in the number of surgeons interested in learning laparoscopic bariatric surgery. There has also been an increase in the number of institutions providing laparoscopic bariatric surgery workshops and growth in membership of the American Society for Bariatric Surgery. Therefore, it is important for surgeons performing laparoscopic bariatric surgery to understand the fundamental differences between laparoscopic and open surgery and possible intraoperative adverse consequences of pneumoperitoneum in the morbidly obese.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 249.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 1994;4:353–357.

    Article  PubMed  Google Scholar 

  2. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001;234:279–289.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Jakimowics J, Stultiens G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 1998;12:129–132.

    Article  Google Scholar 

  4. Beebe DS, McNevin MP, Crain JM, et al. Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy. Surg Gynecol Obstet 1993;176:443–447.

    CAS  PubMed  Google Scholar 

  5. Chiu AW, Chang LS, Birkett DH, Babayan RK. The impact of pneumoperitoneum, pneumoretroperitoneum, and gasless laparoscopy on the systemic and renal hemodynamics. J Am Coll Surg 1995;181:397–406.

    CAS  PubMed  Google Scholar 

  6. Hirvonen EA, Poikolainen EO, Paakkonen ME, Nuutinen LS. The adverse hemodynamic effects of anesthesia, headup tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. Surg Endosc 2000;14:272–277.

    Article  CAS  PubMed  Google Scholar 

  7. Nguyen NT, Anderson J, Fleming NW, Ho HS, Jahr J, Wolfe BM. Effects of pneumoperitoneum on intraoperative respiratory mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc 2004;18:64–71.

    Article  CAS  PubMed  Google Scholar 

  8. Dumont L, Mattys M, Mardirosoff C, et al. Changes in pulmonary mechanics during laparoscopic gastroplasty in the morbidly obese patient. Acta Scand Anesth 1997;41: 408–413.

    Article  CAS  Google Scholar 

  9. Tan PL, Lee TL, Tweed WA. Carbon dioxide absorption and gas exchange during pelvic laparoscopy. Can J Anaesth 1992;39:677–681.

    Article  CAS  PubMed  Google Scholar 

  10. Sanchez NC, Tenofsky PL, Dort JM, Shen LY, Helmer SD, Smith RS. What is normal intra-abdominal pressure? Am Surg 2001:67:243–248.

    CAS  PubMed  Google Scholar 

  11. Nguyen NT, Lee SL, Anderson JT, et al. Evaluation of intraabdominal pressure after open and laparoscopic gastric bypass. Obes Surg 2001;11:40–45.

    Article  CAS  PubMed  Google Scholar 

  12. Dexter SP, Vucevic M, Gibson J, McMahon MJ. Hemodynamic consequences of high-and low-pressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc 1999;13:376–381.

    Article  CAS  PubMed  Google Scholar 

  13. Meininger D, Byhahn C, Bueck M, et al. Effects of pro-longed pneumoperitoneum on hemodynamics and acidbase balance during totally endoscopic robot-assisted radical prostatectomies. World J Surg 2002;26:1423–1427.

    Article  PubMed  Google Scholar 

  14. Fried M, Krska Z, Danzig V. Does the laparoscopic approach significantly affect cardiac functions in laparoscopic surgery? Pilot study in non-obese and morbidly obese patients. Obes Surg 2001;11:293–296.

    Article  CAS  PubMed  Google Scholar 

  15. Nguyen NT, Ho HS, Fleming NW, et al. Cardiac function during laparoscopic vs open gastric bypass: a randomized comparison. Surg Endosc 2002;16:78–83.

    Article  CAS  PubMed  Google Scholar 

  16. Halevy A, Gold-Deutch R, Negri M, et al. Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Ann Surg 1994;219:362–364.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Saber AA, Laraja RD, Nalbandian HI, Pablos-Mendez A, Hanna K. Changes in liver function tests after laparoscopic cholecystectomy: not so rare, not always ominous. Am Surg 2000;66:699–702.

    CAS  PubMed  Google Scholar 

  18. Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg 2002;12:49–51.

    Article  PubMed  Google Scholar 

  19. Spaulding L, Trainer T, Janiec D. Prevalence of nonalcoholic steatohepatitis in morbidly obese subjects undergoing gastric bypass. Obes Surg 2003;13:347–349.

    Article  PubMed  Google Scholar 

  20. Nguyen NT, Braley S, Fleming NW, Lambourne L, Rivers R, Wolfe BM. Comparison of postoperative hepatic function after laparoscopic versus open gastric bypass. Am J Surg 2003;186:40–44.

    Article  PubMed  Google Scholar 

  21. Jakimowics J, Stultiens G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 1998;12:129–132.

    Article  Google Scholar 

  22. Lindgren L, Koivusalo AM, Kellokumpu I. Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy. Br J Anaesth 1995;75:567–572.

    Article  CAS  PubMed  Google Scholar 

  23. Sharma KC, Brandstetter RD, Brensilver JM, Jung LD. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest 1996;110: 810–815.

    Article  CAS  PubMed  Google Scholar 

  24. Galizia G, Prizio G, Lieto E, et al. Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. Surg Endosc 2001;15:477–483.

    Article  CAS  PubMed  Google Scholar 

  25. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal reexploration. Ann Surg 1984;199:28–30.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Nishio S, Takeda H, Yokoyama M. Changes in urinary output during laparoscopic adrenalectomy. BJU Int 1999;83: 944–947.

    Article  CAS  PubMed  Google Scholar 

  27. Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg 1982;196:594–597.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. McDougall EM, Monk TG, Wolf JS, et al. The effect of prolonged pneumoperitoneum on renal function in an animal model. J Am Coll Surg 1996;182:317–328.

    CAS  PubMed  Google Scholar 

  29. Nguyen NT, Perez RV, Fleming N, Rivers R, Wolfe BM. Effect of prolonged pneumoperitoneum on intraoperative urine output during laparoscopic gastric bypass. J Am Coll Surg 2002;195:476–483.

    Article  PubMed  Google Scholar 

  30. Are C, Kutka M, Talamini M, et al. Effect of laparoscopic antireflux surgery upon renal blood flow. Am J Surg 2002;183:419–423.

    Article  PubMed  Google Scholar 

  31. Ortega AE, Peters JH, Incarbone R, et al. A prospective randomized comparison of the metabolic and stress hormonal responses of laparoscopic and open cholecystectomy. J Am Coll Surg 1996;183:249–256.

    CAS  PubMed  Google Scholar 

  32. Ido K, Suzuki T, Kimura K, et al. Lower-extremity venous stasis during laparoscopic cholecystectomy as assessed using color Doppler ultrasound. Surg Endosc 1995;9:310–313.

    Article  CAS  PubMed  Google Scholar 

  33. Millard JA, Hill BB, Cook PS, Fenoglio ME, Stahlgren LH. Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy. Arch Surg 1993;914–919.

    Google Scholar 

  34. Nguyen NT, Cronan M, Braley S, Rivers R, Wolfe BM. Duplex ultrasound assessment of femoral venous flow during laparoscopic and open gastric bypass. Surg Endosc 2001;192:469–476.

    CAS  Google Scholar 

  35. Schwenk W, Bohm B, Fugener A, Muller JM. Intermittent pneumatic sequential compression (ISC) of the lower extremities prevents venous stasis during laparoscopic cholecystectomy. A prospective randomized study. Surg Endosc 1998;12:7–11.

    Article  CAS  PubMed  Google Scholar 

  36. Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 1993;76:1067–1071.

    Article  CAS  PubMed  Google Scholar 

  37. Westerband A, Van De Water JM, Amzallag M, et al. Cardiovascular changes during laparoscopic cholecystectomy. Surg Gynecol Obstet 1992;175:535–538.

    CAS  PubMed  Google Scholar 

  38. Kraut EJ, Anderson JT, Safwat A, Barbosa R, Wolfe BM. Impairment of cardiac performance by laparoscopy in patients receiving positive end-expiratory pressure. Arch Surg 1999;134:76–80.

    Article  CAS  PubMed  Google Scholar 

  39. Dorsay DA, Greene FL, Baysinger CL. Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography. Surg Endosc 1995; 9:128–133.

    Article  CAS  PubMed  Google Scholar 

  40. Ho HS, Saunders CJ, Gunther RA, Wolfe BM. Effector of hemodynamics during laparoscopy: CO2 absorption or intra-abdominal pressure? J Surg Res 1995;59:497–503.

    Article  CAS  PubMed  Google Scholar 

  41. Declan Fleming RY, Dougherty TB, Feig BW The safety of helium for abdominal insufflation. Surg Endosc 1997;11: 230–234.

    Article  Google Scholar 

  42. Zuckerman RS, Heneghan S. The duration of hemodynamic depression during laparoscopic cholecystectomy. Surg Endosc 2002;16:1233–1236.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Nguyen, N.T., Wolfe, B.M. (2007). Pneumoperitoneum in the Obese: Practical Concerns. In: Schauer, P.R., Schirmer, B.D., Brethauer, S.A. (eds) Minimally Invasive Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68062-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-68062-0_14

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-68058-3

  • Online ISBN: 978-0-387-68062-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics