Venous Stasis and Deep Vein Thrombosis Prevention in Laparoscopic Surgery; Chapter 2

Abstract

Introduction Laparoscopic surgery – is one of the most progressive minimal invasive surgery branches. About 25–40% of all abdominal operations are performed laparoscopicaly in our days and this rating is going in ascending order. Laparoscopic operations (cholecystectomy, fundoplication, appendectomy, bypass due to morbid obesity et at.) have rapidly become the operations of choice in abdominal surgery. Several authors reported that deep vein thrombosis (DVT) in the legs developed in 30% of postoperative patients and pulmonary embolism (PE) in 10% of these patients. Many studies explored the frequency of deep leg vein thrombosis after various open abdominal surgery operations. Some studies (Geerts and al.,1994) determined that deep leg vein thrombosis develops in 55% of polytrauma patients. Clagett &Reisch, 1988; found 25% rate of DVT after open abdominal surgery. Literature data on the incidence of DVT after laparoscopic operations is limited. Patel MI and al., 1996; carried out the prospective clinical study, studying the frequency of DVT after laparoscopic cholecystectomy. The rate of DVT, diagnosed by ultrasound Doppler, was 55%. The incidence of DVT and PE after laparoscopic fundoplications was 1.8% in our prospective randomized study. Lord RV and al., 1998; performed the prospective clinical study and compared the incidence of DVT after laparoscopic or microlaparotomic (open) cholecystectomy. The incidence of DVT was 1.7% after laparoscopic and 2.4% after open cholecystectomy. Nevertheless, many authors states, that the incidence of DVT should be less after laparoscopic surgery when comparing with open one. Laparoscopic operations, in comparison with open ones, have few basic differences: 1. Laparoscopic operation involves a specific manipulation called abdominal insufflation in addition to the routine procedure of general anesthesia. The increased intraabdominal pressure associated with pneumoperitoneum (12-14 mm Hg) during laparoscopic upper gastr