Lower extremity venous changes in pneumoperitoneum during laparoscopic surgery

The effect of pneumoperitoneum on veins of the lower limbs related to the intra-abdominal working pressures during laparoscopic cholecystectomy has not been thoroughly investigated. We tested the hypothesis that working pressures do not affect the venous haemodynamics in the lower limbs.

The cross-sectional area and peak flow rates of femoral and saphenous veins in the right groin were measured in 60 patients divided into two groups according to the intra-abdominal working pressures (11 vs 14 mmHg). All measurements were carried out preoperatively and at predetermined periods during and after laparoscopic cholecystectomy by colour Doppler ultrasonography. One-way anova and chi(2) test were used for the analysis of demographic data. For the repeated measures, anova and Student's t-test were used for statistical analysis. The probabilities less than 0.05 were accepted as statistically significant.

The cross-sectional area of the veins increased, whereas the peak flow rate in veins decreased during pneumoperitoneum. Comparing the peak flow rate in the saphenous vein at the third intraoperative measurement, there is statistically significant difference between the two groups (P < 0.05).

The degree of intra-abdominal pressure affects the haemodynamics of the peripheral veins. Pneumoperitoneum during laparoscopy causes stasis in the peripheral veins. It is reasonable to use routine prophylaxis for deep vein thrombosis, in the light of these findings.