Postoperative Respiratory Complications in Obese Patients Undergoing Laparoscopic Surgery

Abstract

Introduction: Obesity and pneumoperitoneum during laparoscopy increase risk of atelectasis and hypoxemia. Optimal intraoperative ventilation strategies remain unclear. This review evaluates evidence on protective ventilation in this population.
Methods: Systematic literature search (PubMed, Embase, 2010–2023) for studies on adults with BMI ≥30 kg/m² undergoing laparoscopic surgery. Interventions: high positive end-expiratory pressure (PEEP) with recruitment maneuvers vs. conventional low PEEP. Primary outcome: postoperative pulmonary complications (PPCs).
Results: Nine RCTs (n=1,578) showed high PEEP (8–12 cmH₂O) plus recruitment reduced PPCs (OR 0.51, p=0.005) and improved intraoperative oxygenation (PaO₂/FiO₂ +65 mmHg). No difference in barotrauma. Driving pressure >15 cmH₂O independently predicted PPCs.
Discussion: High PEEP counteracts reduced functional residual capacity from obesity and pneumoperitoneum. Recruitment maneuvers may be beneficial but require hemodynamic monitoring. Driving pressure is a key modifiable risk factor.
Conclusions: Individualized PEEP with recruitment maneuvers and driving pressure limitation reduces PPCs in obese laparoscopic patients. Perioperative lung ultrasound may guide titration.