Study of the Effects of Routine Intraoperative Intra-abdominal Pressure Monitoring on Postoperative Hemodynamic, Respiratory and Renal Parameters in Morbid Obese Patients Undergoing Abdominoplasty

Background: Abdominoplasty with tight surgical repair carries a high risk of development of postoperative abdominal compartmental syndrome. It carries the risk of postoperative respiratory, cardiovascular and renal complications. Surgical repair guided by monitoring of the intra-abdominal pressure helps to reduce postoperative respiratory, cardiovascular and renal complications in morbid obese patients. Methods: 24 morbid obese patients, who were scheduled for abdominoplasty, were classified into 2 groups: Group 1, 12 patients whom abdominoplasty is guided by measurement of the intra-abdominal pressure not to exceed 15 mmHg. Group II, (control group) abdominoplasty is not guided by intra-abdominal pressure monitoring. Pulmonary function tests, urine output, arterial blood gases, central venous pressure and cardiac index and intra-abdominal pressure were measured preoperatively, one hour, 12-hour and 24 hour postoperatively and compared in both groups. Results: Group I showed significant higher postoperative forced vital capacity, (40%±2, 48%±3, 52%±2) than group II (32%±3, 36%±3, 42%±2) respectively. Pa02 was higher in group I (180±8, 95±4, 82±4), than in group II (140±6, 95±4, 82±4) respectively. Cardiac index was significantly higher in group I (3.5±0.1, 3.5±0.3, 3.5±0.3) than in group II (2.9±0.2, 2.9±0.4, 3±0.2) respectively. Urine output was significantly higher in group I (110±8, 100±7, 105±3) than group II (50±6, 73±4, 70±4) respectively. Central venous pressure was significantly lower in group I (11±2, 9±2, 10±2) than in group II (14±2, 13±2, 12±2) respectively. Intraabdominal pressure was significantly lower in group I postoperative (14±2, 15±2, 15±2) than in group II (18±2, 19±2, 19±2) respectively. Conclusion: Routine intra-abdominal pressure monitoring during abdominoplasty in the morbid obese patients is essential to prevent postoperative abdominal compartmental syndrome and reduce postoperative pulmonary, hemodynamic and renal dysfunction.