Introduction: Pulmonary embolism (PE) is a relatively uncommon complication following laparoscopic cholecystectomy (LC). When the abdomen is insufflated with CO2, increased intrabdominal pressure diminishes venous return causing potentially low cardiac output and venous stasis. Our study was to determine whether this phenomenon is significant enough to increase the risk of PE while performing LC.
Methods: We reviewed 750 consecutive cases of LC at our institution. No patients developed deep vein thrombosis (DVT) post-operatively requiring anticoagulation. Only one case of symptomatic PE requiring treatment occurred. There may have been additional cases of undiagnosed, minor PE that were not symptomatic. The patient was treated with anticoagulation therapy and did well.
Results: PE is a rare complication in LC. Although obesity and venous stasis due to pneumoperitoneum appear to increase the risk factors for development of PE, our impression is that it may not be clinically significant. We are pursuing a study to assess the effect of venous stasis in the early post operative period by utilizing Doppler evaluation. Length of surgery may be a factor, which only can be studied after accumulating a larger series of patients.
Conclusions: Although pneumoperitoneum decreases venous return leading to venous stasis, it does not probably increase the incidence of pulmonary embolism. We, therefore, do not recommend extra precautionary measures for prevention of PE in LC.
Program Number: P187