Does peritoneal mobilization increase laparoscopic acidosis?
OBJECTIVE
It was hypothesized that laparoscopic colon surgery may be associated with increased absorption of CO2 resulting from mobilization of lateral peritoneal reflections.


METHODS
Six pigs underwent laparotomy with removal of a measured quadrant of peritoneum before insufflation to 15 mmHg with CO2. Six paired control animals also underwent insufflation with CO2 to 15 mmHg. Measurements of the end-tidal CO2 (PetCO2), arterial blood gas analysis for CO2 (PaCO2), and pH were performed before insufflation, at 5 and 10 minutes following insufflation, then at successive 15-minute intervals for a total of two hours, and 15 minutes following desufflation. No attempt was made to correct the hypercarbia by increasing minute ventilation.


RESULTS
PaCO2 reached its maximum level at two hours with values of 70.77 +/- 5.54 mmHg and 64.62 +/- 5.18 mmHg in the peritonectomized and control groups, respectively. PetCO2 also peaked at two hours to 60 +/- 13 mmHg for the study group and 54 +/- 11 mmHg for controls. pH reached its nadir at two hours, falling from a baseline of 7.45 +/- 0.08 to 7.23 +/- 0.09 in the study group, and from 7.42 +/- 0.04 to 7.24 +/- 0.04 in the control group. There were no statistically significant differences between the two groups for any of the parameters measured at each time interval.


CONCLUSIONS
The hypothesis that peritonectomy produces greater CO2 absorption during CO2 pneumoperitoneum was disproved under these experimental conditions.
D000042:Absorption; D000138:Acidosis / Q000209:etiology*; D000818:Animals; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism / Q000493:pharmacokinetics; D003082:Colectomy / Q000009:adverse effects; D006863:Hydrogen-Ion Concentration; D006935:Hypercapnia / Q000097:blood / Q000209:etiology; D007327:Insufflation / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects; D010537:Peritoneum / Q000378:metabolism / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D013552:Swine; D013990:Tidal Volume; D013997:Time Factors
D002245:Carbon Dioxide