Sung G Lee, MD, Rachel Lewis, MD, Miles Landry, MBBS, Thomas Kennedy, MD, Sujata Datta, MD, Michael Lew, MD, Brandie Forman, Hernia Clinician, Bruce Ramshaw, MD, FACS. University of Tennessee at Knoxville
INTRODUCTION: Most laparoscopic procedures utilize high flow insufflators at an intra-abdominal pressure setting of 15 mmHg. This standard pressure insufflation may alter physiology intraoperatively by reducing femoral venous flow, respiratory compliance, cardiac output, and portal venous flow. Also, low pressure pneumoperitoneum may help to decrease shoulder and abdominal wall visceral pain that can occur in patients who undergo laparoscopy at standard insufflation pressures.
METHODS AND PROCEDURES: This project is a part of Clinical Quality Improvement (CQI) effort for patients with ventral/incisional hernias implemented by a multi-disciplinary hernia team. This patient group underwent a LVHR between April 2012 and July 2018. The initial 79 patients had standard laparoscopy at a pressure setting of 15 mmHg. A low pressure pneumoperitoneum system was introduced as a potential process improvement after a literature search was completed. This attempted process improvement was initiated, in part, after a patient experienced a CO2 embolus with standard insufflation. Since introduction of the low pressure system, 34 patients have undergone LVHR. A variety of patient factors, treatment factors and outcome measures are collected and analyzed by the hernia team in an attempt to improve outcomes.
RESULTS:
No major difference in demographics between two groups. Other than follow up for low pressure group was shorter compare to standard pressure group.
Both groups had similar prior surgery experience and opioid usage.
The average intraperitoneal pressure setting utilized during LVHR was 8.7 mmHg for the low pressure group and 15 mmHg for the standard pressure group. There was a decrease in length of stay by 2.1 days, a decrease of PACU Morphine Milligram Equivalents (MME) of 6.2 MME and a decrease of total hospital stay MME of 89.9 MME for the low pressure group compared with the standard pressure group.
CONCLUSIONS: This attempt at process improvement demonstrated beneficial effects for patients who underwent LVHR with a low pressure pneumoperitoneum system. As with any CQI analysis, other factors may have contributed to these outcomes and these results may be different in another local environment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94594
Program Number: P583
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster