24.0: Thursday, March 17, 2005

Increased Intraabdominal Pressure in Abdominoplasty: To Plicate or Not To Plicate?

Georgeanna J. Huang, MD, Anureet Bajaj, MD, Vanessa Talbot, Robert A. Hardesty, MD, Subhas Gupta, MD, PHD, FRCSC, and Duncan A.G. Miles, MD.

Grazer and Goldwyn showed that abdominoplasty has a 1.1% risk for the development of deep venous thrombosis (DVT) and 0.8% risk of pulmonary embolism. Gilliland and Sorbera hypothesized that rectus plication and the subsequent increase in intraabdominal pressure (IAP) caused their patient to develop gastroesophageal reflux and DVT requiring release of the plication and anticoagulation. The hemodynamic consequences of elevated IAP are known to include elevated peak airway pressures and decreased venous return. Such venous stasis could lead to the development of DVT. In recent literature, bilateral TRAM closure without mesh was noted to increase IAP and complications. Another study of obese patients undergoing abdominoplasty found no difference in IAP following plication. We measured IAP in 12 abdominoplasty and 10 breast reduction control patients before plication, after plication, and postoperative day one to determine if a significant increase in IAP could be attributable to plication. Using paired t-test analysis, we found a significant increase in IAP following flexion of the bed and following rectus plication. However, there were no clinical sequelae, as all IAP remained below the clinically significant value of 20 mm Hg. Our limited series confirms that IAP increases but is not clinically significant following rectus plication.