Evaluation of Low Pressure Pneumoperitoneum in Bariatric Surgery (ELOPES Study)
Evaluation of Low Pressure Pneumoperitoneum in Bariatric Surgery (ELOPES Study)
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.
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.
Inclusion Criteria:

 -  Age 18-70 years

 -  Ability to give informed consent

 -  Patients who are approved by the anaesthetics to undergo bariatric surgery.

 Exclusion Criteria:

 -  Age below 18 and above 70

 -  Inability to give informed consent

 -  Patient unfit for bariatric surgery including who has poor respiratory, cardiac, renal
 and liver function.

 -  Patient with Body Mass Index (BMI) >50

 -  Patient with American Society of Anesthesiologists (ASA) >3