Intraabdominal Pressure and Postoperative Discomfort in Laparoscopic Roux-en-Y Gastric Bypass (RYGB) Surgery: a Randomized Study

High intraabdominal pressure (IAP) during laparoscopic surgery has been associated with postoperative discomfort. Effects on nausea and access have not been subjected to randomized studies. In cholecystectomy, lower IAP may cause less pain, but nausea and surgical access in RYGB surgery have not been investigated. We studied the influence of two IAP levels on surgical access, operation time, postoperative pain, and nausea. Fifty consecutive female gastric bypass patients were randomized to intraabdominal pressure of 12 (IAP(12)) or 18 (IAP(18)) mm Hg. Surgeons and personnel were blinded to randomization; study groups were well matched for age and BMI. Operative time was noted in minutes. Visual analogue scales were used for assessing access and for patients assessing pain (abdomen-shoulder) and nausea (supine-standing) at six time points during the first 16 postoperative hours. Rescue medication was recorded. In 3/25 patients in the IAP(12) group, the code was broken due to access problems vs. 0/25 in the IAP(18) group (p = 0.1398). Operative time did not differ. Access was significantly better for IAP(18) (92.2 +/- 2.3 vs. 69.3 +/- 4.2; p = 0.0001). Postoperative shoulder pain was maximal after 6 h but throughout less than in the abdomen (p < 0.0001); there were no differences in pain between IAP(18) and IAP(12) (p = 0.7408). Postoperative nausea was significantly greater standing than supine but without differences between groups. Higher IAP gives better surgical access in laparoscopic Roux-en-Y gastric bypass with no negative effect on pain or nausea.