Objectives:

Laparoscopic approaches are preferred for colorectal surgeries because they have proven advantages in the literature. However, increased intra-abdominal pressure and hypo/hypervolemia adversely affect tissue perfusion. In this study, we aimed to improve postoperative outcomes with targeted fluid therapy using Pleth variability index (PVI) and to demonstrate its effect on kidneys using neutrophil gelatinase associated lipocalin (NGAL).

Materials and Methods:

This study was a prospective randomized control, single-centred study. Twenty-nine patients who underwent elective laparoscopic colorectal surgery were included. Patients were randomized into 2 groups, as Group-1 receiving targeted fluid therapy with PVI (n=15) and Group 2 receiving conventional fluid therapy (n=14). 500 mL of crystalloid bolus and 2 mL/kg/hour of maintenance fluid were applied to the PVI group. When the PVI>14%, a 250 mL of crystalloid bolus was administered. In the group receiving, conventional fluid therapy “4-2-1 rule” was used. Plasma NGAL samples were received at pre-insufflation (T0), post-insufflation 6^th (T1) and 12^th (T2) hours.

Results:

When the given fluids were compared between the groups, we detected significantly diminished results for Group 1 (p<0.001). The increase between basal NGAL and 6^th hour, 12^th hour NGAL were statistically significant in both groups (p<0.05). While there were no postoperative complications in Group 1, respiratory complications were seen in 2 patients and wound infection in 1 patient in Group 2.

Conclusion:

Targeted fluid therapy with PVI had no significant effect on NGAL associated acute kidney injury. Nevertheless, there were no postoperative complications in these patients. We think that fluid therapy with PVI can be used in laparoscopic colorectal surgeries to avoid complications caused by fluid load.

Keywords: Laparoscopic Colorectal Surgery, Acute Kidney Injury, PVI, NGAL