Femoral venous flow dynamics during intraperitoneal and preperitoneal laparoscopic insufflation

C. A. Morrison, Martin Schreiber, S. B. Olsen, S. P. Hetz, M. M. Acosta

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Laparoscopic herniorrhaphy may be performed using an intraperitoneal or a preperitoneal approach. Anecdotal and experimental evidence indicates that alterations in lower extremity venous flow, which occur during intraperitoneal laparoscopic insufflation, may be associated with an increased risk of deep vein thrombosis. However, no study has directly compared femoral venous flow during intraperitoneal insufflation with that during preperitoneal insufflation. Method: In eight consecutive patients undergoing laparoscopic herniorrhaphy under general anesthesia, flow through the common femoral vein was evaluated with B-mode and color flow duplex. Pre- and intraperitoneal pressures were standardized to 10 mm Hg, and respiratory tidal volumes were standardized to 10 cc/kg. Flow measurements were taken at end expiration. Flow through the common femoral vein was measured after induction of anesthesia, during intraperitoneal insufflation, during preperitoneal insufflation, and between insufflations to ensure return to baseline. Results: All patients in the study were males. Their mean age was 59 years. Mean flow in the common femoral vein was essentially identical at baseline (138 ml/min) and during preperitoneal insufflation (135 ml/min). Alternatively, mean flow in the common femoral vein was significantly reduced during intraperitoneal insufflation (65 ml/min, p = 0.02). Conclusions: Flow in the common femoral vein is significantly reduced during intraperitoneal insufflation. However, flow in the common femoral vein is not affected by preperitoneal insufflation. These data suggest that laparoscopic preperitoneal inguinal hernia repair may pose as less a risk of thromboembolic complications than laparoscopic intra-peritoneal inguinal hernia repair.

Original languageEnglish (US)
Pages (from-to)1213-1216
Number of pages4
JournalSurgical Endoscopy and Other Interventional Techniques
Volume12
Issue number10
StatePublished - Oct 1998
Externally publishedYes

Fingerprint

Insufflation
Thigh
Femoral Vein
Herniorrhaphy
Inguinal Hernia
Tidal Volume
Venous Thrombosis
General Anesthesia
Lower Extremity
Anesthesia
Color
Pressure

Keywords

  • Deep vein thrombosis
  • Femoral vein
  • Inguinal hernia repair
  • Laparoscopy
  • Preperitoneal

ASJC Scopus subject areas

  • Surgery

Cite this

Femoral venous flow dynamics during intraperitoneal and preperitoneal laparoscopic insufflation. / Morrison, C. A.; Schreiber, Martin; Olsen, S. B.; Hetz, S. P.; Acosta, M. M.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 12, No. 10, 10.1998, p. 1213-1216.

Research output: Contribution to journalArticle

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AU - Schreiber, Martin

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AU - Acosta, M. M.

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N2 - Background: Laparoscopic herniorrhaphy may be performed using an intraperitoneal or a preperitoneal approach. Anecdotal and experimental evidence indicates that alterations in lower extremity venous flow, which occur during intraperitoneal laparoscopic insufflation, may be associated with an increased risk of deep vein thrombosis. However, no study has directly compared femoral venous flow during intraperitoneal insufflation with that during preperitoneal insufflation. Method: In eight consecutive patients undergoing laparoscopic herniorrhaphy under general anesthesia, flow through the common femoral vein was evaluated with B-mode and color flow duplex. Pre- and intraperitoneal pressures were standardized to 10 mm Hg, and respiratory tidal volumes were standardized to 10 cc/kg. Flow measurements were taken at end expiration. Flow through the common femoral vein was measured after induction of anesthesia, during intraperitoneal insufflation, during preperitoneal insufflation, and between insufflations to ensure return to baseline. Results: All patients in the study were males. Their mean age was 59 years. Mean flow in the common femoral vein was essentially identical at baseline (138 ml/min) and during preperitoneal insufflation (135 ml/min). Alternatively, mean flow in the common femoral vein was significantly reduced during intraperitoneal insufflation (65 ml/min, p = 0.02). Conclusions: Flow in the common femoral vein is significantly reduced during intraperitoneal insufflation. However, flow in the common femoral vein is not affected by preperitoneal insufflation. These data suggest that laparoscopic preperitoneal inguinal hernia repair may pose as less a risk of thromboembolic complications than laparoscopic intra-peritoneal inguinal hernia repair.

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