gms | German Medical Science

Background: The amount of intraoperative fluid administration is a known risk factor for postoperative complications in large viscerooncological surgery. It remains unclear if this correlates even in standardized conditions as in laparoscopic bariatric surgery.

Materials and methods: In a retrospective study, 181 patients who had received a laparoscopic Roux-en-Y gastric bypass operation in one institution were included. Data analysed included perioperative data, the amount of parental fluid administration up to day 4, drain and urine output as well as postoperative complications such as wound infection, anastomotic insufficiency and pneumonia.

Results: Overall complication rate after RYGB was 17.1 %. Median amount of fluid administered intraoperatively was 2000 ml. The amount of intraoperative fluid infused significantly correlated with the cumulative incidence of postoperative complications (anastomotic insufficiency, wound infection and pneumonia) (Mann-Whitney P=0.025. This correlation continued to be significant for daily infusion amount up to day 4 (Mann-Whitney POD 1 P= 0.001; POD 2 P=0.056; POD 3 P= 0.010; POD 4 P< 0.0001). The intraoperative amount of fluid administered showed a strong correlation with fluid associated complications also in multivariate analysis (P= 0.003). As possible confounders, duration of surgery (P= 0.989) and preoperative BMI (P= 0.986) could be excluded as risk factors for postoperative complication.

Conclusion: In standardized laparoscopic bariatric surgery, the amount of intraoperative fluid administered shows a clear correlation with known fluid associated complications in a retrospective analysis. Therefore, fluid restrictive regimes need to be evaluated in prospective studies also in the field of bariatric surgery.