FEMORAL VENOUS FLOW DYNAMICS DURING INTRAPERITONEAL AND PREPERITONEALLAPAROSCOPIC INSUFFLATION

Background: Laparoscopic herniorrhaphy may be performed using an intra peritoneal or a preperitoneal approach. Anecdotal and experimental evi dence indicates that alterations in lower extremity venous flow, which occur during intraperitoneal laparoscopic insufflation, may be associ ated with an increased risk of deep vein thrombosis. However, no study has directly compared femoral Venous flow during intraperitoneal insu fflation with that during preperitoneal insufflation. Method: In eight consecutive patients undergoing laparoscopic herniorrhaphy under gene ral anesthesia, flow through the common femoral vein was evaluated wit h B-mode and color flow duplex. Pre- and intraperitoneal pressures wer e standardized to 10 mm Hg, and respiratory tidal volumes were standar dized to 10 cc/kg. Flow measurements were taken at end expiration. Flo w through the common femoral vein was measured after induction of anes thesia, during intraperitoneal insufflation, during preperitoneal insu fflation, and between insufflations to ensure return to baseline. Resu lts: All patients in the study were males. Their mean age was 59 years . Mean flow in the common femoral vein was essentially identical at ba seline (138 ml/min) and during preperitoneal insufflation (135 ml/min) . Alternatively, mean flow in the common femoral vein was significantl y reduced during intraperitoneal insufflation (65 ml/min, p = 0.02). C onclusions: Flow in the common femoral Vein is significantly reduced d uring intraperitoneal insufflation. However, flow in the common femora l vein is not affected by preperitoneal insufflation. These data sugge st that laparoscopic preperitoneal inguinal hernia repair may pose as less a risk of thromboembolic complications than laparoscopic intraper itoneal inguinal hernia repair.