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Invited Critique
February 1, 2007

Overcoming Reduced Hepatic and Renal Perfusion Caused by Positive-Pressure Pneumoperitoneum—Invited Critique

Arch Surg. 2007;142(2):125. doi:10.1001/archsurg.142.2.125

Bickel et al have demonstrated improved renal and hepatic perfusion by using intermittent compression stockings in patients undergoing laparoscopic surgery. Therefore, it seems that the use of this device overcomes some of the detrimental effects of PPP. The authors recognize the fact that in most patients the effects of pneumoperitoneum are transient and result in no adverse sequelae. They properly suggest that the best application of their findings may be “in elderly patients with preexisting cardiovascular diseases.” The study, however, was performed in patients in class I and class II of the American Society of Anesthesiologists system. Therefore, we do not really know if use of the device would result in the same improvements in patients with significant preexisting atherosclerosis.

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