Effects of CPAP on gastric pouch pressure after bariatric surgery

Toby N. Weingarten, Michael L. Kendrick, James M. Swain, Lavonne M. Liedl, Christopher P. Johnson, Darrell R. Schroeder, Bruce David Johnson, Juraj Sprung

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: The purpose of this study was to determine if the routine use of postoperative continuous positive airway pressure (CPAP) in patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with an increase in transmural gastric pouch pressure, which may create the risk for anastomotic leak. Methods: Transmural gastric pressures (difference between gastric pouch and bladder pressures) were measured postoperatively [post-anesthesia recovery care unit (PACU) arrival (prior to initiation of CPAP), 5 min, 30 min, and PACU discharge] in 28 patients (19 patients used CPAP, 9 patients did not) following laparoscopic RYGB. Changes in pressure over time were assessed using a generalized estimating equation, taking into account the repeated measurements obtained for each subject. In all cases, two-tailed P values ≤0.05 were considered statistically significant. Results: Among patients that used CPAP, there were no changes in transmural pouch pressure from baseline at any point in time (P=0.628). However, in patients that did not use CPAP, there was a trend towards increased transmural gastric/pouch pressure (P=0.053), which could be attributed to a transient decrease in bladder pressure at the 5-min measurement interval. Conclusions: Application of CPAP did not increase transmural gastric pouch pressure in our bariatric patients; therefore, its use in the post-RYGB patients does not pose a risk for pouch distension, which could lead to the disruption of anastomotic integrity.

Original languageEnglish (US)
Pages (from-to)1900-1905
Number of pages6
JournalObesity Surgery
Volume21
Issue number12
DOIs
StatePublished - Dec 2011

Fingerprint

Continuous Positive Airway Pressure
Bariatric Surgery
Stomach
Pressure
Gastric Bypass
Urinary Bladder
Anesthesia
Bariatrics
Anastomotic Leak

Keywords

  • Anastomotic leak
  • Bariatric surgery
  • Continuous positive airway pressure
  • Transmural gastric pouch pressure

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Weingarten, T. N., Kendrick, M. L., Swain, J. M., Liedl, L. M., Johnson, C. P., Schroeder, D. R., ... Sprung, J. (2011). Effects of CPAP on gastric pouch pressure after bariatric surgery. Obesity Surgery, 21(12), 1900-1905. https://doi.org/10.1007/s11695-011-0419-9

Effects of CPAP on gastric pouch pressure after bariatric surgery. / Weingarten, Toby N.; Kendrick, Michael L.; Swain, James M.; Liedl, Lavonne M.; Johnson, Christopher P.; Schroeder, Darrell R.; Johnson, Bruce David; Sprung, Juraj.

In: Obesity Surgery, Vol. 21, No. 12, 12.2011, p. 1900-1905.

Research output: Contribution to journalArticle

Weingarten, TN, Kendrick, ML, Swain, JM, Liedl, LM, Johnson, CP, Schroeder, DR, Johnson, BD & Sprung, J 2011, 'Effects of CPAP on gastric pouch pressure after bariatric surgery', Obesity Surgery, vol. 21, no. 12, pp. 1900-1905. https://doi.org/10.1007/s11695-011-0419-9
Weingarten TN, Kendrick ML, Swain JM, Liedl LM, Johnson CP, Schroeder DR et al. Effects of CPAP on gastric pouch pressure after bariatric surgery. Obesity Surgery. 2011 Dec;21(12):1900-1905. https://doi.org/10.1007/s11695-011-0419-9
Weingarten, Toby N. ; Kendrick, Michael L. ; Swain, James M. ; Liedl, Lavonne M. ; Johnson, Christopher P. ; Schroeder, Darrell R. ; Johnson, Bruce David ; Sprung, Juraj. / Effects of CPAP on gastric pouch pressure after bariatric surgery. In: Obesity Surgery. 2011 ; Vol. 21, No. 12. pp. 1900-1905.
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AB - Background: The purpose of this study was to determine if the routine use of postoperative continuous positive airway pressure (CPAP) in patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with an increase in transmural gastric pouch pressure, which may create the risk for anastomotic leak. Methods: Transmural gastric pressures (difference between gastric pouch and bladder pressures) were measured postoperatively [post-anesthesia recovery care unit (PACU) arrival (prior to initiation of CPAP), 5 min, 30 min, and PACU discharge] in 28 patients (19 patients used CPAP, 9 patients did not) following laparoscopic RYGB. Changes in pressure over time were assessed using a generalized estimating equation, taking into account the repeated measurements obtained for each subject. In all cases, two-tailed P values ≤0.05 were considered statistically significant. Results: Among patients that used CPAP, there were no changes in transmural pouch pressure from baseline at any point in time (P=0.628). However, in patients that did not use CPAP, there was a trend towards increased transmural gastric/pouch pressure (P=0.053), which could be attributed to a transient decrease in bladder pressure at the 5-min measurement interval. Conclusions: Application of CPAP did not increase transmural gastric pouch pressure in our bariatric patients; therefore, its use in the post-RYGB patients does not pose a risk for pouch distension, which could lead to the disruption of anastomotic integrity.

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