Schwenk W, Bohm B, Junghans T, Hofmann H, Muller JM.
Intermittent sequential compression of the lower limbs prevents venous stasis in
laparoscopic and conventional colorectal surgery.
Dis Colon Rectum 1997 Sep;40(9):1056-62

Department of General Surgery, Charite, Medical Faculty of the
Humboldt-University, Berlin, Germany.

PURPOSE: This study was designed to evaluate the influence of intraoperative
intermittent sequential compression (ISC) on venous blood return from the lower
limbs during laparoscopic and conventional colorectal colectomy. METHODS: Fifty
patients undergoing laparoscopic (n = 25) or conventional (n = 25) colorectal
surgery were included in a prospective study. Peak venous flow (PFV) and the
cross-sectional area (CSA) of the femoral vein were assessed by Doppler
ultrasound examination intraoperatively. RESULTS: Age, gender, and body mass
index were comparable between both groups. Baseline PFV was 21 +/- 6.6 cm/s in
the conventional and 18.4 +/- 6.4 cm/s in the laparoscopic group (P = 0.2). ISC
increased PFV to 156 +/- 29 percent of the baseline value in the conventional
group and to 161 +/- 29 percent in the laparoscopic group. PFV decreased after
abdominal insufflation to 127 +/- 19 percent of the baseline value in the
laparoscopic group and after laparotomy to 134 +/- 27 percent in the conventional
group (P = 0.3). PFV decreased slightly in both groups during surgery but
remained well above the baseline value. Baseline CSA was 1.02 +/- 0.17 cm2 in the
conventional group and 1 +/- 0.23 cm2 in the laparoscopic group. ISC decreased
CSA to 0.91 +/- 0.18 cm2 (conventional) and 0.85 +/- 0.18 cm2 (laparoscopic)
after initiation of ISC. CSA was 0.92 +/- 0.18 cm2 after abdominal insufflation
in the laparoscopic group, and it was 0.93 +/- 0.18 cm2 after laparotomy in the
conventional group (P = 0.4). During surgery, there were no differences in
absolute CSA or CSA changes compared with the baseline value in both groups.
Postoperative circumference of the calf and thigh were not different between both
groups. Postoperative thromboembolic complications did not occur. CONCLUSION: ISC
effectively increases venous blood flow from the lower limbs during conventional
and laparoscopic colorectal resections and may decrease the risk of postoperative
deep vein thrombosis. Therefore, ISC is strongly recommended in every prolonged
laparoscopic procedure.