INFLUENCE OF PNEUMOPERITONEUM DURING BARIATRIC INTERVENTION BY LAPAROSCOPIC SLEEVE RESECTION OF THE STOMACH ON THE HEMOCOAGULATION SYSTEM IN PATIENTS WITH MORBID OBESITY
DOI:
https://doi.org/10.31379/2411.2616.15.1.7Keywords:
bariatrics, pneumoperitoneum, hemostasis.Abstract
Background. Bariatric surgery is well known for obese patients treatment due to it benefits. Postoperative venous thromboembolism (VTE) is less common in this cohort. The aim of this study is to compare LPTEG data received in intraoperative settings from bariatric surgery patients with different pneumoperitoneum sets. Materials and methods. Patients aged 25-75 y.o. with BMI ≥35, who underwent laparoscopic bariatric surgery (n=68) were divided on two groups: group 1 (n=43) underwent bariatric surgery with standard pneumoperitoneum pressure presets (12-15mmHg); group 2 (n=25) underwent bariatric surgery with higher than standard pneumoperitoneum pressure presets (≥16mmHg) due to visualization problems. Mean duration of surgical intervention was 60-80 min; duration of pneumoperitoneum was 45-60 min. LPTEG data were collected on 30 minute of surgical procedure. Results. Blood coagulation constants checked by LPTEG were: Intensity of contact coagulation (ICC), Intensity of coagulation drive (ICD), clot maximum density (MA) and fibrinolytic activity – Index of retraction and clot lysis (IRCL). We received slight increase of all measurements in group 1: ICC by 23,57 %, ICD by 34.57 %, MA by 74,52%, IRCL by 91,18 % above the norm; in group 2 – significant increase in all the measurements: ICC by 38.71 %, ICD by 69.03 %, MA by 98.93 %, IRCL by 118.73 % above the norm. Conclusion. Higher pneumoperitoneum pressure presets significantly affecting LPTEG data in comparison to standard in intraoperative setting; this may increase intra- and postoperative VTE risk. Further studies are needed to create a VTE prevention roadmap for cases, when high intraperitoneal pressure required.
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