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Pereira N, Sciaraffia C, Danilla S, Parada F, Asfora C, Moral C. Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function. Aesthet Surg J 2016; 36:697-702. [PMID: 26895955 DOI: 10.1093/asj/sjv273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Abdominal wall weakness is a consequence of rectus abdominis diastasis and flaccidity of the myofascial component. A degree of plicature of the rectus abdominis generates an increase of intra-abdominal pressure (IAP), which may result in an increase of intrathoracic pressure, thus affecting thoracic hemodynamics and leading to inadequate ventilation. OBJECTIVES To assess changes generated by plicature of the rectus abdominis on IAP and pulmonary function in patients undergoing abdominoplasty. METHODS A total of 10 female patients with abdominal ptosis were included. Chronic smokers and patients with respiratory co-morbidities were excluded. The IAP was measured using a modified Kron's trans-bladder technique. Pulmonary function was assessed by pulmonary compliance (P-Comp) and was calculated with parameters provided by the mechanical ventilator. Both were calculated before and after plicature. RESULTS The mean values for IAP before and after plicature were 6.6 and 9.3 mmHg respectively. Before plicature, the mean P-Comp value was 38.97 mL/cm of water, and after it was 36.54 mL/cm. Both differences were statistically significant. CONCLUSIONS Based on the results obtained, it is possible to conclude that plicature of the rectus abdominis generates significant physiological changes, such as an increase in IAP and a decrease of P-Comp, which do not have a clinically relevant impact on healthy individuals. Measuring IAP with the modified technique and the assessment of pulmonary function using P-Comp are both reliable and provide a more accurate correlation with such physiologic changes. LEVEL OF EVIDENCE 3: Therapeutic.
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Affiliation(s)
- Nicolas Pereira
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carlos Sciaraffia
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Stefan Danilla
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Francisco Parada
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Constanza Asfora
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - César Moral
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
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Huang GJ, Bajaj AK, Gupta S, Petersen F, Miles DAG. Increased Intraabdominal Pressure in Abdominoplasty: Delineation of Risk Factors. Plast Reconstr Surg 2007; 119:1319-1325. [PMID: 17496607 DOI: 10.1097/01.prs.0000254529.51696.43] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Abdominoplasty is associated with a 1.1 percent risk of deep venous thrombosis. This has been attributed to rectus plication causing intraabdominal hypertension, known to effect decreased venous return, venous stasis, and thus thrombosis. The authors conducted a pilot study to determine which components of the abdominoplasty procedure (i.e., general anesthesia, flexion of the bed, plication, and/or binder placement) may elevate intraabdominal pressures and whether this was clinically relevant. METHODS Twelve abdominoplasty and 10 breast reduction (control) patients were enrolled prospectively. Intraabdominal pressure was transduced through the bladder before plication in the supine and flexed positions, after plication in both positions, after skin closure in the flexed position, and on postoperative day 1 with and without a binder in the flexed position. RESULTS All intraabdominal pressures measured were clinically insignificant (<20 mm Hg). A statistically significant increase was found from flexion of the bed (mean difference, 3.80 +/- 2.0, p < 0.001, in the control group; and 4.39 +/- 1.68, p < 0.001, in the study group); rectus plication (mean difference, 2.78 +/- 2.11, p = 0.001, in the supine position; and 2.03 +/- 2.48, p = 0.016, in the flexed position); and binder placement (2.63 mm Hg for no binder versus 4.5 mm Hg with binder, p = 0.004). Both groups also showed an increase from preoperative to skin closure (mean difference, 2.03 +/- 6.7, p = 0.035, for the control group; and 2.83 +/- 3.97, p = 0.031, for the study group), suggesting general anesthesia as a risk factor. CONCLUSIONS This study confirms the effect of rectus plication on increasing intraabdominal pressures but also implicates bed position, binder placement, and general anesthetic as risk factors. A larger study is needed to clarify the role of these variables in elevating intraabdominal pressure during abdominoplasty.
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Affiliation(s)
- Georgeanna J Huang
- Loma Linda, Calif.; and Cincinnati, Ohio From the Department of Surgery, Division of Plastic Surgery, Loma Linda University; Department of Surgery, Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati; and the Health Research Consulting Group, Loma Linda University School of Public Health
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