EVIDENCE OF VENOUS STASIS AFTER ABDOMINAL INSUFFLATION FOR LAPAROSCOPIC CHOLECYSTECTOMY

Intraoperative venous stasis may increase the risk for perioperative d eep vein thrombosis and pulmonary embolism. To determine if abdominal insufflation during laparoscopic cholecystectomy causes venous stasis, eight patients undergoing this procedure had their left common femora l veins examined by a duplex scanner before and after abdominal insuff lation; the veins then were examined again before and after deflation. The right femoral veins were catheterized to measure femoral venous p ressures. Abdominal insufflation to 14 millimeters of mercury pressure increased femoral venous pressures (10.2 +/- 4.1 millimeters of mercu ry to 18.2 +/- 5.1 millimeters of mercury, p<0.001) and slowed peak bl ood velocities (24.9 +/- 8.5 centimeters per second to 18.5 +/- 4.5 ce ntimeters per second; p<0.05) without changing the cross-sectional are as (1.1 +/- 0.4 centimeter squared to 1.2 +/- 1.5 centimeter squared; p=NS) of the common femoral veins. Insufflation also reduced or elimin ated pulsatility in the common femoral veins in 75 percent of the pati ents, indicating that insufflation was causing partial proximal venous obstruction. After 80 +/- 21 minutes of surgery, these changes. remai ned significant. Deflation of the abdomen restored normal venous pulsa tility in all patients, reduced femoral venous pressures (18.5 +/- 5.2 millimeters of mercury to 12.2 +/- 9.8 millimeters of mercury; p<0.00 1), increased the peak blood velocities (14.2 +/- 6.8 centimeters per second to 28.1 +/- 16 centimeters per second; p<0.05) and decreased th e cross-sectional areas (1.4 +/- 0.6 centimeters squared to 0.9 +/- 0. 4 centimeters squared; p<0.05) of the common femoral veins, indicating venous decompression had occurred. The results suggest abdominal insu fflation causes venous stasis during laparoscopic cholecystectomies. M easures shown to reduce intraoperative venous stasis, such as pneumati c compressive stockings, may benefit patients undergoing these procedu res.