Kiudelis M, Endzinas Z, Mickevicius A, Pundzius J.
[Venous stasis and deep vein thrombosis prophylaxis during lapaoscopic
fundoplication]
[Article in German]
Zentralbl Chir 2002 Nov;127(11):944-9

Department of Surgery, Hospital of Kaunas University of Medicine, Germany.

AIMS OF THE STUDY: first, to study the effect of a pneumoperitoneum (12 mm Hg) on
femoral venous outflow, second, to evaluate the efficacy of mechanical antistasis
devices: intermittent pneumatic compression (IPC), intermittent electric calf
muscle stimulation (IECS) and graded compression leg bandages (LB) in reducing
venous stasis, third, to determinate the incidence of deep venous thrombosis
(DVT) after laparoscopic fundoplications using venous occlusion plethysmography
method. PATIENTS AND METHODS: 54 patients undergoing elective laparoscopic
fundoplications were studied. They were randomized into three groups - 18
patients in each group. The first group received LB, the second group received
IECS and the third group IPC during operations. Lower extremity venous blood
velocity was evaluated using Doppler ultrasonography during operation. In all 54
patients leg venous outflow was measured 1 day before and 1 day after operation
using venous occlusion plethysmography method, in order to detect possible DVT
after operation. The blood velocity in the femoral vein without pneumoperitoneum
was 20.1 +/- 2.4 cm/s in the IPC group, 20.3 +/- 1.4 cm/s in the IECS group, and
23.9 +/- 1.2 cm/s in the LB group. With the introduction of a pneumoperitoneum
(12 mm Hg) and the reverse Trendelenburg position the femoral venous blood
velocity was significantly reduced in all groups: 9.3 +/- 0.9 cm/s in IPC group,
9.4 +/- 0.9 cm/s in IECS group, and 9.2 +/- 1.1 cm/s in LB group (p < 0.05). The
maximum blood velocity generated by the IPC when a pneumoperitoneum (12 mm Hg)
was present was 17.4 +/- 1.9 cm/s, and in the IECS group 14.0 +/- 1.1 cm/s,
whereas in the LB group the blood velocity remained the same (9.2 +/- 1.1 cm/s).
Calf DVT and pulmonary artery microembolization developed in one patient of the
LB group, detected by venous occlusion plethysmography and lung perfusion
scintigraphy methods one day after operation. CONCLUSIONS: The femoral vein
stasis which appears in laparoscopic fundoplications can be minimized by reducing
the intraabdominal pressure during operation, and avoiding reverse Trendelenburg
position as much as possible. IPC is more effective than IECS in reducing venous
stasis induced by the pneumoperitoneum and the reverse Trendelenburg position.
Graded compression by leg bandages is ineffective in patients undergoing
laparoscopic gastrofundoplication. With a pneumoperitoneum in place, neither
device was able to return the depressed blood flow velocity to the values
recorded without a pneumoperitoneum. The incidence of DVT and pulmonary embolism
after laparoscopic fundoplications was 1.8 % in our study.