TY - JOUR
T1 - Effects of CPAP on gastric pouch pressure after bariatric surgery
AU - Weingarten, Toby N.
AU - Kendrick, Michael L.
AU - Swain, James M.
AU - Liedl, Lavonne M.
AU - Johnson, Christopher P.
AU - Schroeder, Darrell R.
AU - Johnson, Bruce D.
AU - Sprung, Juraj
PY - 2011/12
Y1 - 2011/12
N2 - 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.
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.
KW - Anastomotic leak
KW - Bariatric surgery
KW - Continuous positive airway pressure
KW - Transmural gastric pouch pressure
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U2 - 10.1007/s11695-011-0419-9
DO - 10.1007/s11695-011-0419-9
M3 - Article
C2 - 21512817
AN - SCOPUS:84155167444
SN - 0960-8923
VL - 21
SP - 1900
EP - 1905
JO - Obesity Surgery
JF - Obesity Surgery
IS - 12
ER -