VENOUS HEMODYNAMIC CHANGES DURING ENDOSCOPIC CHOLECYSTECTOMY
S.I. HADIYEV, P.A. ABBASOV, V.A. PASHAZADE
Azerbaijan Medical University, Baku, AZERBAIJAN
Introduction: One of the effects pneumoperitoneum formed in the laparoscopic intervention is its ability to reduce venous return in lower limbs by increasing pressure in vena cava inferior and vena iliaca communis because of the increased intraobdominal pressure. The aim of the present investigation is to study venous hemodynamic changes that caused in the veins of lower limbs by pneumoperitoneum formed in the laparoscopic cholecystectomy.
Materials and methods: The investigation included 45 patients that underwent laparoscopic cholecystectomy because of cholelithiasis in 2005-2010 in the Baku city Clinical Hospital No 5, surgical department of the II department of surgical diseases of the AMU, and “City Hospital” clinic. Results of Venous color doppler ultrasound of lower limbs carried out a day before the operation of all the patients included to the investigation were assessed. Intraoperative venous Doppler examination at 3 different times: after the anaesthesia, after the creation of pneumoperitoneum and during the anaesthesia after the completion of pneumoperitoneum. Patients included to the investigation were divided into two groups: in the 1st group patients carboxiperitoneum was created at 14 mm of mercury, in the nd group at – 11mm of mercury, and hemodynamic changes were studied. The 1st group includes total of 35 patients at the age of 21-76 of which 9 are men, and 26 are women, 2nd group includes total of 10 patients at the age of 24- 63 of which 3 are men, and 7 are women. Average diameter, area and the highest flow speed of femoral vein and vena saphena were studied in patients involved into the investigation on the 1st, 2nd, 3rd intraoperative and 1st and 7th postoperative days.
Discussions and results: While the highest flow speed of preoperative femoral vein of the 1st group patients ranged between 9,12 - 62,12 cm/sec, in the 2nd group patients it ranged between 12,1 - 35 cm/sec (p<0,05). Similarly, while the highest flow speed of femoral vein on the 7th postoperative day of the 1st group patients ranged between 10 - 65,1 cm/sec, in the 2nd group patients it ranged between 13 - 33,9 cm/sec (p<0,05). While the highest flow speed of v.saphena during the 3rd intraoperative measurement in the 1st group patients ranged between 3,5 - 15,6cm/sec, in the 2nd group patients it ranged between 6,01 - 32,1 cm/sec (p<0,05). No difference was found during separate comparison of other indicators (p>0,05). While the preoperatively measured highest flow speed of the femoral vein in the 1st group patients decreased by the average of 13,2 ± 9,58 cm/sec as compared to the highest flow speed after the creation of pneumoperitoneum (the 2nd intraoperative measurement), in the second group patients the decrease constituted average of 6,89 ± 2,14 cm/sec (p<0,05). Differences between other preoperative indicators and second intraoperative indicators of the both groups were not statistically significant (p>0,05).