One Hour Laparoscopy at 15 mmHg Elongates the Abdominal Wall

1
One Hour Laparoscopy at 15 mmHg Elongates the
Abdominal Wall

• Mulier J.P. 1, Dillemans B.2, Mulier K. 3 ,
  Lambert S 2., Lesaffer J. 2 Van Cauwenberge S.2,
  Crombach M4
• 1. Dep of Anaesthesiology, Sint JAN
  Brugge-Oostende, Bruges, Belgium.
• 2. Dep of general Surgery Sint JAN
  Brugge-Oostende, Bruges, Belgium, Belgium
• 3. Dep of general Surgery H Hart ZH, Louvain,
  Belgium
• 4. Dep of Anaesthesiology, KULeuven, Louvain,
  Belgium
• Contact Email jan.mulier_at_azbrugge.be
• More info www.publicationslist.com/jan.mulier

• Introduction
• Patients complain after a laparoscopy from a
  change in the abdominal wall strength.
• Due to weight loss after bariatric surgery?
• Due to damage of the abdominal wall?
• Is the abdominal wall compliance changed
  immediately after laparoscopy?
• Results
• Two patients were excluded as the leakage during
  the second measurement was too high.
• No difference in depth of muscle relaxation or
  anesthesia.
• The mean time of laparoscopy was 59 /- 19
  minutes
• the mean inflation pressure was 15,4 /- 1,5 mmHg
  
• The mean BMI was 42,2
• IAV and E changed significant after one hour
  laparoscopy.
• Discussion
• Laparoscopy changes the abdominal E.
• It is not clear if a lower pressure and a shorter
  time could lower this effect.
• Is it usefull to pre insufflate in case of
  insufficient workspace?
• How long last this effect last.

• Method
• 10 lap gastric bypass operation. BMIgt40
• Exclusion prev. laparoscopy , laparotomy or G gt0
• Inflated through one trocar to 15 mmHg.
• Measurement of Elastance (E), PV0, inflated
  abdominal volume (IAV) and pressure (IAP) at
  start laparoscopy. (1)
• Same measurements at end laparoscopy.
• Inflation stop and pressure recording to verify
  no leak.
• Depth of anesthesia and muscle relaxation,
• Time between both inflations and pressure used
  for pneumoperitoneum are recorded.

IFSO 26-29 aug 2009 Paris