Ali NAYCI, Hakan TAŞKINLAR, Dilek YÜNLÜEL, Gökhan Berktuğ BAHADIR, Caner İSBİR, İsa KILLI, Ülkü ÇÖMELEKOĞLU

Analyzing the effect of laparoscopy duration time on peroperative gastroesophageal reflux

Background/aim: Intraabdominal pressure (IAP) is one of the main reasons for gastroesophageal reflux (GER). This study investigateswhether IAP during laparoscopic surgery leads to GER in a time-dependent manner.Materials and methods: In a laparoscopy model, 15 mmHg IAP was created in 8 Wistar albino rats in the Trendelenburg position(TP). A 5 mm laparotomy was performed in the left lower abdominal region, and a 6 Fr catheter was placed intraabdominally. Air wasinsufflated into the abdominal cavity, and the pressure was kept constant at 15 mmHg. Esophageal pH alterations were measured by pHsticks for 4 h every 30 min.Results: The basal median esophageal pH value was 9 (8–10), the value after placing the catheter was 9 (7–10) (P = 0.47), and the medianpH value after placing the subjects in TP was 9 (8–10) (P = 0.70). In our experimental model, esophageal pH values were found todecrease significantly at the 150th minute in TP and at 15 mmHg IAP (P < 0.05). Two rats died: one at the 120th minute and the otherat the 240th minute (P > 0.05).Conclusion: Esophageal pH values decreased and continued to remain low following IAP increase and TP in this experimental ratmodel. Prolonged laparoscopic procedures can particularly lead to GER that requires instant recognition and rapid and appropriateintervention.

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1. Georgeson K, Tekant GT. Gastroesophageal reflux disease. In: Grosfeld JL, O’Neill JA Jr, Fonkalsrud EW, Coran AG (editors). Pediatric Surgery. 6th ed. Philadelphia, PA, USA: Mosby Inc.; 2006. pp. 1120-1140.
2. Contencin P, Adjoua P, Viala P, Erminy M, Narcy P. Longterm esophageal and oropharyngeal pH-metry in ORL manifestations of gastroesophageal reflux in children. Annales d’oto-laryngologie et de Chirurgie Cervico Faciale 1992; 109: 129-133.
3. Barak N, Ehrenpreis, ED, Harrison JR, Sitrin MD. Gastrooesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obesity Reviews 2002; 3: 9-15. doi: 10.1046/j.1467-789X.2002.00049.x
4. Min F, Tarlo SM, Bargman J, Poonai N, Richardson R et al. Prevalence and causes of cough in chronic dialysis patients: a comparison between hemodialysis and peritoneal dialysis patients. Advances in peritoneal Dialysis 2000; 16: 129-133.
5. Navarro-Rodriguez T, Hashimoto CL, Carrilho FJ, Strauss E, Laudanna AA et al. Reduction of abdominal pressure in patients with ascites reduces gastroesophageal reflux. Diseases of the Esophagus 2003; 16: 77-82.
6. Beaudoin S, Kiefler G, Sapin E, Bargy F, Hélardot PG. Gastroesophageal reflux in neonates with congenital abdominal wall defects. European Journal of Pediatric Surgery 1995; 5: 323-326. doi: 10.1055/s-2008-1066236
7. Koivusalo A, Rintala R, Lindahl H. Gastroesophageal reflux in children with congenital abdominal wall defect. Journal of Pediatric Surgery 1999; 34: 1127-1129. doi: 10.1016/S0022- 3468(99)90582-1
8. Scarlett M, Crawford-Sykes A, Nelson M. Preoperative starvation and pulmonary aspiration. New perspectives and guidelines. West Indian Medical Journal 2002; 51: 241-245.
9. Saint-Maurice D, Michaud L, Guimber D, Thurnerelle C, Deschildre A et al. Esophageal pH-metry in children with recurrent respiratory events: diagnosis value of a day time esophageal pH monitoring. Archivos de Pediatría 2002; 9: 1236- 1240. doi: 10.1016/S0929-693X(02)00111-2
10. Bortolotti M. Laryngospasm and reflex central apnea caused by aspiration of refluxed gastric content in adults. Gut 1989; 30: 233-238. doi: 10.1136/gut.30.2.233
11. Doyle MT, Twomey CF, Owens TM, McShane AJ. Gastroesophageal reflux and tracheal contamination during laparoscopic cholecystectomy and diagnostic gynecological laparoscopy. Anesthesia and Analgesia 1998; 86: 624-628. doi: 10.1213/00000539-199803000-00035
12. İmamoğlu M, Çay A, Ünsal MA, Aydın S, Özdemir O et al. The effects of increased intraabdominal pressure on testicular blood flow, oxidative stress markers, and morphology. Journal of Pediatric Surgery 2006; 41 (6): 1118-1124. doi: 10.1016/j. jpedsurg.2006.02.004
13. Dodds WJ, Hogan WJ, Miller WN, Stef JJ, Arndorfer RC et al. Effect of increased intraabdominal pressure on lower esophageal sphincter pressure. American Journal of Digestive Disease 1975; 20: 298-308.
14. Iwakiri K, Sugiura T, Kotoyori M, Yamada H, Hayashi Y et al. Effect of body position on lower esophageal sphincter pressure. Journal of Gastroenterology 1999; 34: 305-309.
15. Tournadre JP, Chassard D, Berrada KR, Bouletreau P. Effect of pneumoperitoneum and Trendelenburg position on gastrooesophageal reflux and lower oesophageal sphincter pressure. British Journal of Anaesthesia 1996; 76: 130-132.
16. Derakhshan MH, Robertson EV, Fletcher J, Jones GR, Lee YY et al. Mechanism of association between BMI and dysfunction of the gastro-oesophageal barrier in patients with normal endoscopy. Gut 2012; 61: 337-343. doi: 10.1136/gutjnl-2011-300633