Ideal Patient’s Body Position for Bariatric Surgery

1. Ideal Patient’s Body Position for Bariatric Surgery Mulier J.P. 1, Dillemans B.2, Van Cauwenberge S.2,Lesaffer J. 2 Casier I. 1 1. Dep of Anesthesia, Sint JAN Brugge-Oostende, Bruges, Belgium. 2. Dep of general Surgery Sint JAN Brugge-Oostende, Bruges, Belgium, Belgium Contact Email: jan.mulier@azbrugge.be More info: www.publicationslist.com/jan.mulier Background and Goal of Study • A sufficient laparoscopic workspace at a low abdominal pressure. • What is the ideal patient’s body position to optimize workspace? Results • The ideal position, the trunk horizontal and the legs flexed, increased the abdominal volume by 1000 ml at 15 mmHg in comparison with the horizontal position without leg flexion. • Reverse trendelenburg without leg flexion, the worst position, decreased the volume by 200 ml. Materials and Methods • The pneumoperitoneum inflated volume at 15 mmHg was measured in 20 morbid obese patients undergoing laparoscopic surgery (and approved by the hospital ethical committee. ) • This measurement was taken with a) table horizontal, legs flat; b) table in 20° reverse Trendelenburg, legs flat; c) table in 20° reverse Trendelenburg, legs flexed 45° upward at the hips; d) table horizontal, legs flexed 45° upward; and e) table in 20° Trendelenburg, legs flat. • Trendelenburg is never used in upper abdominal laparoscopy but was also investigated. • The inflated volume at 15 mmHg was measured for each position and an analysis of variance was performed on repeated measurements. References • 1. Dillemans B. et al. Fully-Stapled Roux-enY gastric bypass. Obes Surg 2009 • 2. Mulier J. et al. On the abdominal pressure volume relationship. ISPUB 2009;21:1 Conclusion In laparoscopic bariatric surgery the legs should be flexed as much as possible to maximize the surgical workspace in anti trendelenburg position. IFSO 26-29 aug 2009 Paris