Evaluation of Low Pressure Pneumoperitoneum in Bariatric Surgery (ELOPES Study)
Condition: Surgical View; Shoulder Tip Pain; Abdominal Pain
MeSH terms: Pneumoperitoneum; Abdominal Pain
Study type: Interventional

Summary: 
      This is a prospective study whereby it involves patients who are planned for bariatric
      surgery. In the bariatric surgery procedure, pneumoperitoneum pressure will be the
      experimental aspect in this study. The pneumoperitoneum pressure will be adjusted to either
      8-10 mmHg of low pressure or to 12-15mmHg of standard pressure.
    

Detailed description: 
      This will be a prospective study in patients aged between 18 and 70 years old who have
      already been screened and planned for elective bariatric surgery. In bariatric surgery, a
      large portion of the stomach will be removed. Pneumoperitoneum is also known as the abdominal
      pressure which will be the experimental aspect in this study. Laparoscopy surgery will be
      performed by introducing the camera (optical trocar) after making an incision at the belly
      button (umbilicus), and carbon dioxide which will be given at a rate of 5 L/min until the
      intra-abdominal pressure of either 8-10 mmHg (low-pressure group) or 12-15 mmHg (standard
      pressure group) is achieved. The remaining three standard ports will be placed and the
      laparoscopic sleeve gastrectomy will be performed at an insufflation rate of 15 L/min. The
      greater omentum will be divided at the greater curvature of the stomach using an ultrasonic
      dissector, beginning from the proximal antrum until the fundus. The omentum will be divided
      close to the stomach wall hence preserving the gastro-epiploic vessels. Short gastric vessels
      will be divided entirely from the stomach and this dissection will continue until the left
      crus of the diaphragm are exposed. Endoscopic staplers will then be used to staple and divide
      the stomach until the angle of His. A 39Fr gastric calibration tube will be placed along the
      lesser curvature of the stomach, acts as a guide during the division of the stomach. Finally,
      the divided stomach will be removed through a 12mm port site and the incision will be closed
      with sutures.

      Towards the end of the surgery, all residual pneumoperitoneum will be evacuated by keeping
      the trocar valves open under direct telescopic vision. The duration of surgery or any
      intraoperative complications will be recorded. The starting of surgery will be regarded after
      the induction of anaesthesia and the end of surgery is regarded when the end of skin closure.
      Operating field or also known as surgical view is defined as the view of the intra-abdomen. A
      clear operating field allows a good working space for the surgeon. Numeric rating score will
      be used to access the operating field during the surgery. Post-operative pain will be rated
      on a Visual Analog Scale at rest and with movement.
    

Intervention name(s): Pneumoperitoneum Pressure
Intervention type(s): Procedure
Intervention description(s): There will be two arms in this study. The participants recruited for this study are those who have been screened and planned for elective bariatric surgery.The pneumoperitoneum pressure will be adjusted to either 8-10mmHg or 12-15mmHg until a clear operating field is obtained by the surgeon. Low pneumoperitoneum pressure has been expected to give a clearer and better surgical view than standard pneumoperitoneum pressure. Participants under the low pressure group are expected to have lesser pain score on abdominal pain and shoulder tip pain as compared to participants in the standard pressure group.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There will be two arms in this study. One arm will be the low pressure pneumoperitoneum group (8-10mmHg) where else the other arm will be the standard pressure pneumoperitoneum group (12-15mmHg).
Masking: Double (Participant, Investigator)
Primary purpose: Treatment