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. 1975 Jun;181(6):829–835. doi: 10.1097/00000658-197506000-00012

Choice of abdominal operative incision in the obese patient: a study using blood gas measurements.

R W Vaughan, L Wise
PMCID: PMC1343903  PMID: 1094970

Abstract

Although many factors may influence the choice of the operative incision, physiologic safety in terms of the degree of postoperative hypoxemia should be considered. No data currently exist to delineate in markedly obese patients the effect of the operative incision on the extent or duration of this hypoxemia. Fifty-four consecutive patients of both sexes, scheduled for elective jejunoileal bypass for morbid exogenous obesity, were studied. In 23 patients the operation was performed through a transverse incision and in 25 patients through a vertical incision. In 6 patients, cholecystectomy was also performed in addition to the jejunoileal bypass. Postoperatively there was a significant fall in PAO2 both in the transverse and vertical incision groups and this continued through day 4. On day 5 statistically significant hypoxemia was present only in the vertical incision group. In addition, the decrease in PaO2 was significantly greater on days 4 and 5 in the vertical group than in the transverse group. On days 2 and 3 again the mean decrease in PaO2 was greater in the vertical group but this was not statistically significant. The effect of added cholecystectomy on PaO2 was studied in 6 women with midline incisions. The results were compared with 6 subjects who had small bowel bypass without cholecystectomy and who were matched for incision, age weight, girth/height ratio, weight/height ratio, smoking habit, and percentage of predicted ERV. In both groups there was a significant fall of PAO2 from day 1 through day 4, but there was no significant difference between the two groups. Although the numbers studied were small, these limited results would suggest that the type of incesion rather than the intraoperative procedure is the important factor in determining postoperative PAO2 changes. These studies also suggest that in patients with an increased potential for postoperative hypoxemia (i.e., markedly obese), the transverse abdominal approach shoudl always be seriously considered.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J. I., Horton P. W., Millar W. T., Parikh R. K., Spence A. A. The effect of upper abdominal surgery on the relationship of airway closing point to end tidal position. Clin Sci. 1972 Aug;43(2):137–141. doi: 10.1042/cs0430137. [DOI] [PubMed] [Google Scholar]
  2. Beecher H. K. THE MEASURED EFFECT OF LAPAROTOMY ON THE RESPIRATION. J Clin Invest. 1933 Jul;12(4):639–650. doi: 10.1172/JCI100525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cahill J. M. Respiratory problems in surgical patients. Am J Surg. 1968 Sep;116(3):362–368. doi: 10.1016/0002-9610(68)90223-7. [DOI] [PubMed] [Google Scholar]
  4. Diament M. L., Palmer K. N. Venous/arterial pulmonary shunting as the principal cause of postoperative hypoxaemia. Lancet. 1967 Jan 7;1(7480):15–17. doi: 10.1016/s0140-6736(67)92421-x. [DOI] [PubMed] [Google Scholar]
  5. EFRON G. ABDOMINAL WOUND DISRUPTION. Lancet. 1965 Jun 19;1(7399):1287–1290. doi: 10.1016/s0140-6736(65)92777-7. [DOI] [PubMed] [Google Scholar]
  6. EGBERT L. D., BENDIXEN H. H. EFFECT OF MORPHINE ON BREATHING PATTERN. A POSSIBLE FACTOR IN ATELECTASIS. JAMA. 1964 May 11;188:485–488. doi: 10.1001/jama.1964.03060320007001. [DOI] [PubMed] [Google Scholar]
  7. EGBERT L. D., LAVER M. B. The effect of site of operation and type of anesthesia upon the ability to cough in the postoperative period. Surg Gynecol Obstet. 1962 Sep;115:295–298. [PubMed] [Google Scholar]
  8. EGBERT L. D., TAMERSOY K., DEAS T. C. Pulmonary function during spinal anesthesia: the mechanism of cough depression. Anesthesiology. 1961 Nov-Dec;22:882–885. doi: 10.1097/00000542-196111000-00002. [DOI] [PubMed] [Google Scholar]
  9. GORDH T., LINDERHOLM H., NORLANDER O. Pulmonary function in relation to anesthesia and surgery evaluated by analysis of oxygen tension of arterial blood. Acta Anaesthesiol Scand. 1958;2(1):15–26. doi: 10.1111/j.1399-6576.1958.tb05247.x. [DOI] [PubMed] [Google Scholar]
  10. HALASZ N. A. VERTICAL VS HORIZONTAL LAPAROTOMIES. I. EARLY POSTOPERATIVE COMPARISONS. Arch Surg. 1964 Jun;88:911–914. doi: 10.1001/archsurg.1964.01310240007003. [DOI] [PubMed] [Google Scholar]
  11. KRAISSL C. J. The selection of appropriate lines for elective surgical incisions. Plast Reconstr Surg (1946) 1951 Jul;8(1):1–28. doi: 10.1097/00006534-195107000-00001. [DOI] [PubMed] [Google Scholar]
  12. Keill R. H., Keitzer W. F., Nichols W. K., Henzel J., DeWeese M. S. Abdominal wound dehiscence. Arch Surg. 1973 Apr;106(4):573–577. doi: 10.1001/archsurg.1973.01350160185032. [DOI] [PubMed] [Google Scholar]
  13. Reitamo J., Möller C. Abdominal wound dehiscence. Acta Chir Scand. 1972;138(2):170–175. [PubMed] [Google Scholar]
  14. Spence A. A., Alexander J. I. Mechanisms of postoperative hypoxaemia. Proc R Soc Med. 1972 Jan;65(1):12–14. doi: 10.1177/003591577206500105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Spence A. A., Alexander J. I. Pulmonary consequences of abdominal and thoracic surgery. Int Anesthesiol Clin. 1972 Winter;10(4):41–59. doi: 10.1097/00004311-197201040-00005. [DOI] [PubMed] [Google Scholar]
  16. TROELL L. Post-operative changes in circulation and the effects of oxygen therapy. Acta Chir Scand. 1951;102(3):203–214. [PubMed] [Google Scholar]
  17. TWEEDIE F. J., LONG R. C. Abdominal wound disruption. Surg Gynecol Obstet. 1954 Jul;99(1):41–47. [PubMed] [Google Scholar]
  18. Vaughan R. W., Engelhardt R. C., Wise L. Postoperative hypoxemia in obese patients. Ann Surg. 1974 Dec;180(6):877–882. doi: 10.1097/00000658-197412000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Zollinger R. M., Passi R. Observations on pre- and postoperative care. Am J Surg. 1966 Nov;112(5):716–720. doi: 10.1016/0002-9610(66)90111-5. [DOI] [PubMed] [Google Scholar]

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