Hemodynamic changes during laparoscopic gastric bypass procedures.
HYPOTHESIS: Significant detrimental intra-operative hemodynamic and respiratory changes occur in the morbidly obese during laparoscopic gastric bypass. DESIGN: Case series. SETTING: Tertiary care university hospital. PATIENTS: Thirteen patients, 10 women and 3 men, undergoing uncomplicated laparoscopic gastric bypass for morbid obesity. INTERVENTIONS: Using a pulmonary artery catheter and an arterial line, we intraoperatively monitored hemodynamic and respiratory parameters. Parameter values were recorded at set points of the procedure, and the changes were statistically analyzed. RESULTS: Significant hemodynamic and respiratory changes, mostly unfavorable, occur in the morbidly obese when creating the pneumoperitoneum in preparation for laparoscopic gastric bypass. The hemodynamic changes are attenuated when the patient is placed in the reverse Trendelenburg position and almost completely corrected when the abdomen is deflated at the completion of the procedure. The respiratory changes are more persistent. CONCLUSIONS: Laparoscopic gastric bypass surgery for morbid obesity leads to a number of predominantly detrimental, if temporary, respiratory and hemodynamic changes, which are most pronounced at the time of creation of the pneumoperitoneum. In the presence of significant cardiopulmonary comorbidities, the use of invasive intra-operative hemodynamic monitoring of the morbidly obese undergoing laparoscopic gastric bypass appears therefore justified.