- Aanvrager: Mevrouw C.A.L. de Raaff
WORLD IFSO 2017 C.A.L. de Raaff, MD OLVG, Amsterdam Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery
The 22nd World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) was held in London, UK from 29 August – 2 September 2017.
This congress provided a scientific program of the highest standard covering (morbid) obesity, accompanying comorbidities, surgical procedures and its outcomes.
By attending the IFSO congress, I was able to present results of a study that was conducted during my PhD program on obstructive sleep apnea (OSA) in bariatric surgery. This posterpresentation highlighted the influence of continuous positive airway pressure (CPAP) on postoperative leakage in bariatric surgery.
OSA affects two-third of morbidly obese individuals undergoing bariatric surgery . Perioperative usage of CPAP is advised for moderately and severe OSA to avoid respiratory failure and cardiac events . CPAP increases the air pressure in the upper airway, but also may elevate the air pressure in the esophagus and stomach. Concern exists that this predisposes to mechanical stress resulting in suture line disruption. This study evaluated whether perioperative CPAP usage is associated with an increased risk of suture line disruption after bariatric surgery. All patients who underwent bariatric surgery including a suture line were eligible for inclusions. Only patients with information regarding postoperative CPAP usage were included. From November 2007 to August 2016, postoperative CPAP status was documented in 2135 patients: 497 (23.3%) used CPAP postoperatively whereas 1638 (76.7%) used no CPAP. Mean body mass index was 44.1 kg/m2 (SD 6.6). Suture line disruption occurred in 25 patients (1.2%). The leakage rate was not associated with CPAP usage (8 (1.6%) in CPAP group versus 17 (1%) in non-CPAP group, p=0.300). CPAP was no risk factor for suture line disruption in multivariable analysis as well. With these results, it can be concluded that postoperative CPAP does not appear to increase the risk of suture line disruption in bariatric surgery. CPAP is recommended in all patients with moderate or severe OSA who undergo bariatric surgery.
1. de Raaff CA, Pierik AS, Coblijn UK, de Vries N, Bonjer HJ, van Wagensveld BA. Value of routine polysomnography in bariatric surgery. Surg Endosc. 2017 Jan;31(1):245-248.
2. de Raaff CAL, Gorter-Stam MAW, de Vries N, et al. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis. 2017 Jul;13(7):1095-1109. Keywords: Obstructive Sleep Apnea; Continuous Positive Airway Pressure; Bariatric Surgery; Postoperative Leakage