Bleed or not to bleed in Bariatric surgery- Intraoperative measures can prevent post op bleeding

A recent study conducted by Giovanna Pavone and team found that bleeding cases decreased by increasing mean arterial pressure (MAP) by 30% lowering the pneumoperitoneum pressure of CO2 to 8 mmHg in the final 15 minutes of the operation. Most importantly, all bleedings were easily controlled with medical therapy and/or transfusions.

The best and most effective treatment for morbid obesity is bariatric surgery. A potentially fatal side effect of 1.3–1.7% of bariatric procedures is hemorrhage. The purpose of this study is to determine whether decreasing pneumoperitoneal pressure of CO2 to 8 mmHg in the final 15 minutes of the procedure and raising mean arterial pressure (MAP) by 30% compared to preoperatively could lessen postoperative bleeding following laparoscopic sleeve gastrectomy (LSG).

Researchers looked at patients who underwent bariatric surgery in our Department between July 2017 and June 2020 (Group A) and July 2020 and June 2022 (Group B). Beginning in July 2020, intraoperative measures have been put in place to stop postoperative bleeding. These measures include raising mean arterial pressure (MAP) by 30% compared to preoperative levels and lowering the pneumoperitoneal pressure of CO2 to 8 mmHg during the final 15 minutes of surgery.

The key findings of this study were:

1. 200 patients were included in the study, split into the two categories above. Group A's average ages are 44.49 +/- 8.49 and 43.73 +/- 9.28.

2. For Group A, the mean preoperative BMI is 45.6 kg/m2 6.71 and for Group B, it is 48.9 7.15 kg/m2.

3. Group A measured a mean MAP of 83.06 18.58 mmHg, while group B measured 111.88 12.46 mmHg (p 0.05, z-score: 4.15226, and U: 13,900).

4. In group A, there were 9 cases of bleeding that were noted; the majority of them received medical care and blood transfusions; only one hemodynamically unstable patient underwent a second laparoscopy.

5. Only two incidences of bleeding in group B were documented by the researchers, one of which necessitated blood transfusions.

In conclusion, researchers were able to lessen postoperative hemorrhage thanks to these efforts. This approach can be a fantastic place to start, but additional prospective trials will be needed to determine whether lowering pneumoperitoneum pressure of CO2 and normalizing intraoperative blood pressures are safe and whether they can reduce the risk of postoperative hemorrhage.

Reference: 

Pavone, G., Gerundo, A., Pacilli, M., Fersini, A., Ambrosi, A., & Tartaglia, N. (2022). Bariatric surgery: to bleed or not to bleed? This is the question. In BMC Surgery (Vol. 22, Issue 1). Springer Science and Business Media LLC.https://doi.org/10.1186/s12893-022-01783-w