SAN FRANCISCO -- Chronic abdominal compartment syndrome may account for many of the comorbidities that resolve after weight loss in the extremely obese, according to the results of a small study.
Obesity hypoventilation syndrome, urinary stress incontinence, venous stasis disease, hypertension, and other common complicating health conditions that occur in patients with morbid obesity may all be explained by chronic, markedly elevated intraabdominal pressure. This pressure squeezes the lungs and vasculature and inhibits normal functioning of many organ systems, Dr. Harvey Sugarman reported at the annual meeting of the American College of Surgeons.
This would explain why obese patients often have severe pulmonary hypertension and high cardiac filling pressures without evidence of congestive heart failure, Dr. Sugarman said. The pressure elevation also could account for the chronic headaches that obese patients often have, which could be the result of pseudotumor cerebrii, a known sequela of abdominal compartment syndrome.
To test this theory intraabdominal pressure was determined by measuring urinary bladder pressures in 79 obese patients with comorbid conditions before and after scheduled weight loss surgery.
Urinary bladder pressures, which ranged from 12 to 42 cm of water pressure preoperatively fell from a mean of 17 cm to a mean of 10 cm after 1 year according to Dr. Sugarman of the Medical College of Virginia, Richmond.
In this time frame, mean weight dropped from 140 to 87 kg and mean body mass index (BMI) decreased from 52 to 33, he reported.
Importantly the average number of comorbid conditions also plummeted from 2.9 per patient preoperatively to 0.4 postoperatively.
The suggestion that chronic abdominal compartment syndrome might cause many of the complications of obesity was first published 40 years ago, but there has been no discussion of this theory in the literature since then, Dr. Sugarman said in an interview with this newspaper.
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