Cardiac function during laparoscopic vs open gastric bypass: A randomized comparison

N. T. Nguyen, Hung S Ho, Neal Fleming, Peter G Moore, S. J. Lee, C. D. Goldman, C. J. Cole, B. M. Wolfe

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Hypercarbia and increased intraabdominal pressure during prolonged pneumoperitoneum can adversely affect cardiac function. This study compared the intraoperative hemodynamics of morbidly obese patients during laparoscopic and open gastric bypass (GBP). Methods: Fifty-one patients with a body mass index (BMI) of 40-60 kg/m2 were randomly allocated to undergo laparoscopic (n = 25) or open (n = 26) GBP. Cardiac output (CO), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), heart rate (HR), and mean arterial pressure (MAP) were recorded at baseline, intraoperatively at 30-min intervals, and in the recovery room. Systemic vascular resistance (SVR) and stroke volume (SV) were also calculated. Results: The two groups were similar in terms of age, weight, and BMI. Operative time was longer in the laparoscopic than in the open group (p < 0.05). The HR and MAP increased significantly from baseline intraoperatively, but there was no significant difference between the two groups. In the laparoscopic group, CO was unchanged after insufflation, but it increased by 5.3% at 2.5 h compared to baseline and by 43% compared to baseline in the recovery room. In contrast, during open GBP, CO increased significantly by 25% after surgical incision and remained elevated throughout the operation. CO was higher during open GBP than during laparoscopic GBP at 0.5 h and at 1 h after surgical incision (p < 0.05). During laparoscopic GBP, CVP, MPAP, and SVR increased transiently and PAWP remained unchanged. During open GBP, CVP, MPAP, and PAWP decreased transiently and SVR remained unchanged. There was no significant difference in the amount of intraoperative fluid administered during laparoscopic (5.5 ± 1.6 L) and open (5.6 ± 1.7 L) GBP. Conclusion: Prolonged pneumoperitoneum during laparoscopic gastric bypass does not impair cardiac function and is well tolerated by morbidly obese patients.

Original languageEnglish (US)
Pages (from-to)78-83
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume16
Issue number1
DOIs
StatePublished - 2002

Fingerprint

Gastric Bypass
Central Venous Pressure
Pulmonary Wedge Pressure
Cardiac Output
Vascular Resistance
Pulmonary Artery
Recovery Room
Pressure
Pneumoperitoneum
Arterial Pressure
Body Mass Index
Heart Rate
High Cardiac Output
Insufflation
Hypercapnia
Operative Time
Stroke Volume
Hemodynamics
Weights and Measures

Keywords

  • Cardiac function
  • Gastric bypass
  • Hemodynamics
  • Laparoscopy
  • Obesity

ASJC Scopus subject areas

  • Surgery

Cite this

Cardiac function during laparoscopic vs open gastric bypass : A randomized comparison. / Nguyen, N. T.; Ho, Hung S; Fleming, Neal; Moore, Peter G; Lee, S. J.; Goldman, C. D.; Cole, C. J.; Wolfe, B. M.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 16, No. 1, 2002, p. 78-83.

Research output: Contribution to journalArticle

Nguyen, N. T. ; Ho, Hung S ; Fleming, Neal ; Moore, Peter G ; Lee, S. J. ; Goldman, C. D. ; Cole, C. J. ; Wolfe, B. M. / Cardiac function during laparoscopic vs open gastric bypass : A randomized comparison. In: Surgical Endoscopy and Other Interventional Techniques. 2002 ; Vol. 16, No. 1. pp. 78-83.
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T1 - Cardiac function during laparoscopic vs open gastric bypass

T2 - A randomized comparison

AU - Nguyen, N. T.

AU - Ho, Hung S

AU - Fleming, Neal

AU - Moore, Peter G

AU - Lee, S. J.

AU - Goldman, C. D.

AU - Cole, C. J.

AU - Wolfe, B. M.

PY - 2002

Y1 - 2002

N2 - Background: Hypercarbia and increased intraabdominal pressure during prolonged pneumoperitoneum can adversely affect cardiac function. This study compared the intraoperative hemodynamics of morbidly obese patients during laparoscopic and open gastric bypass (GBP). Methods: Fifty-one patients with a body mass index (BMI) of 40-60 kg/m2 were randomly allocated to undergo laparoscopic (n = 25) or open (n = 26) GBP. Cardiac output (CO), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), heart rate (HR), and mean arterial pressure (MAP) were recorded at baseline, intraoperatively at 30-min intervals, and in the recovery room. Systemic vascular resistance (SVR) and stroke volume (SV) were also calculated. Results: The two groups were similar in terms of age, weight, and BMI. Operative time was longer in the laparoscopic than in the open group (p < 0.05). The HR and MAP increased significantly from baseline intraoperatively, but there was no significant difference between the two groups. In the laparoscopic group, CO was unchanged after insufflation, but it increased by 5.3% at 2.5 h compared to baseline and by 43% compared to baseline in the recovery room. In contrast, during open GBP, CO increased significantly by 25% after surgical incision and remained elevated throughout the operation. CO was higher during open GBP than during laparoscopic GBP at 0.5 h and at 1 h after surgical incision (p < 0.05). During laparoscopic GBP, CVP, MPAP, and SVR increased transiently and PAWP remained unchanged. During open GBP, CVP, MPAP, and PAWP decreased transiently and SVR remained unchanged. There was no significant difference in the amount of intraoperative fluid administered during laparoscopic (5.5 ± 1.6 L) and open (5.6 ± 1.7 L) GBP. Conclusion: Prolonged pneumoperitoneum during laparoscopic gastric bypass does not impair cardiac function and is well tolerated by morbidly obese patients.

AB - Background: Hypercarbia and increased intraabdominal pressure during prolonged pneumoperitoneum can adversely affect cardiac function. This study compared the intraoperative hemodynamics of morbidly obese patients during laparoscopic and open gastric bypass (GBP). Methods: Fifty-one patients with a body mass index (BMI) of 40-60 kg/m2 were randomly allocated to undergo laparoscopic (n = 25) or open (n = 26) GBP. Cardiac output (CO), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), heart rate (HR), and mean arterial pressure (MAP) were recorded at baseline, intraoperatively at 30-min intervals, and in the recovery room. Systemic vascular resistance (SVR) and stroke volume (SV) were also calculated. Results: The two groups were similar in terms of age, weight, and BMI. Operative time was longer in the laparoscopic than in the open group (p < 0.05). The HR and MAP increased significantly from baseline intraoperatively, but there was no significant difference between the two groups. In the laparoscopic group, CO was unchanged after insufflation, but it increased by 5.3% at 2.5 h compared to baseline and by 43% compared to baseline in the recovery room. In contrast, during open GBP, CO increased significantly by 25% after surgical incision and remained elevated throughout the operation. CO was higher during open GBP than during laparoscopic GBP at 0.5 h and at 1 h after surgical incision (p < 0.05). During laparoscopic GBP, CVP, MPAP, and SVR increased transiently and PAWP remained unchanged. During open GBP, CVP, MPAP, and PAWP decreased transiently and SVR remained unchanged. There was no significant difference in the amount of intraoperative fluid administered during laparoscopic (5.5 ± 1.6 L) and open (5.6 ± 1.7 L) GBP. Conclusion: Prolonged pneumoperitoneum during laparoscopic gastric bypass does not impair cardiac function and is well tolerated by morbidly obese patients.

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KW - Laparoscopy

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