Physiologic Changes with Pneumoperitoneum in the Obese Patient

INTRODUCTION Initial studies of physiologic changes during laparoscopy addressed normal females undergoing gynecologic surgery, while subsequent studies investigated laparoscopic cholecystectomy. Such studies are not directly comparable because of body position differences (Trendelenburg vs. reverse Trendelenburg). Other differences included patient age, medical comorbidities, and factors such as preoperative hydration. More recently, the ability to insuffl ate gas outside the peritoneal cavity has extended such techniques to other operations. Most studies of physiologic changes during pneumoperitoneum in obese subjects are recent. This chapter will address changes during laparoscopy while emphasizing specifi c impacts on obese subjects. Most of these data relate to weight loss operations.