Hemocoagulative Modifications after Laparoscopic Surgery at Different Pneumoperitoneum Pressure Settings

Intagliata Eva; Vecchio Rosario; Saitta Cesare; Vizzini Clarissa; Lo Presti Federica; Cacciola Rossella Rosaria; Cacciola Emma; Vecchio Veronica

doi:10.29337/ijsp.173

Hemocoagulative Modifications after Laparoscopic Surgery at Different Pneumoperitoneum Pressure Settings

Int J Surg Protoc. 2022 Jun 14;26(1):41-48. doi: 10.29337/ijsp.173. eCollection 2022.

Authors

Intagliata Eva¹, Vecchio Rosario¹, Saitta Cesare², Vizzini Clarissa¹, Lo Presti Federica¹, Cacciola Rossella Rosaria³, Cacciola Emma⁴, Vecchio Veronica³

Affiliations

¹ Department of General Surgery and Medical Surgical Specialties, University of Catania, Policlinico "G. Rodolico - San Marco", Via S. Sofia 78, 95123 Catania, Italy.
² Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
³ Department of Biomedical Science, Hematologic Unit, University of Catania, Policlinico "G. Rodolico - San Marco", Via S. Sofia 78, 95123 Catania, Italy.
⁴ Department of Medical Sciences, Surgical Sciences and Advanced Technologies, Hemostasis Unit, University of Catania, Italy, Policlinico "G. Rodolico - San Marco", Via S. Sofia 78, 95123 Catania, Italy.

Abstract

Background: Many of the effects of pneumoperitoneum on cardiovascular, respiratory and metabolic systems have been discussed in Literature, but very little is known about the variations of the hemocoagulative parameters in patients undergoing laparoscopic surgery. The purpose of this study is to analyze the variations of the hemocoagulative parameters in patients undergoing elective laparoscopic cholecystectomy for symptomatic gallbladder stones. An eventual statistically significant difference linked to different pressure settings of pneumoperitoneum will allow selecting a specific intrabdominal pressure for a more adequate treatment with a lower incidence of pneumoperitoneum related complications.

Materials and methods: The clinical trial was conducted on 43 patients assigned in two groups based on the intra-abdominal pressure: group A, 27 patients, 12 mmHg, and group B, 16 patients, 8 mmHg. Hemoglobin, hematocrit, platelets count, PT ratio, aPTT, Fibrinogen, D-dimer, Von Willebrand factor, Factor II, Lupus Anticoagulant, Antithrombin III, Protein C, Protein S, Anticardiolipin IgG and IgM, anti-beta 2-Glicoprotein IgG and IgM were evaluated.

Results: For group A, patient's variations were observed for D-dimer, Factor II, von Willembrand factor and protein C reactive, while for patients belonging to group B the parameters most affected were PT ratio, anti-thrombin III and protein C reactive.D-dimer values increased significantly in group A, a statistically significant decrease in anti-thrombin III levels was detected in group B, and a statistically significant difference in PT ratio in patients belonging to group B was observed.

Conclusion: The statistical analysis showed no significant difference in the post-operative parameters when comparing the two groups of patients. Alterations of the coagulation parameters were present between pre- and post-operative data within the same group, namely a higher abdominal pressure is linked to a prothrombotic state. The question is worthy of further studies.

Highlights: - Variations of the hemocoagulative parameters in patients undergoing laparoscopy are still a matter of study;- Pneumoperitoneum seems to cause alterations in the hemocoagulative parameters, which could be influenced by the pneumoperitoneum pressure;- An eventual statistically significant difference linked to different pressure settings of pneumoperitoneum will allow selecting a specific intrabdominal pressure for a more adequate surgical treatment with a lower incidence of pneumoperitoneum related complications.

Keywords: hemocoagulation; laparoscopy; pneumoperitoneum; pneumoperitoneum pressure.

Publication types

Editorial