Splanchnic microcirculatory changes during CO2 laparoscopy.
BACKGROUND
Splanchnic macrocirculatory changes during high-pressure CO2 pneumoperitoneum include a decrease in mesenteric arterial blood flow, and decreased gastric perfusion with a drop in gastric pH in experimental studies. Microcirculatory changes in abdominal organs under clinical conditions with a low pressure CO2 pneumoperitoneum are unknown.


METHODS
In 18 patients undergoing routine laparoscopy with a CO2 pneumoperitoneum (7 symptomatic cholecystolithiasis, 3 acute cholecystitis, and 8 acute appendicitis) gastric, duodenal, jejunal, colonic, hepatic, and peritoneal blood flow was measured with a custom-made laser Doppler flow probe at an intra-abdominal pressure of 0, 10, and 15 mm Hg.


RESULTS
Intra-abdominal pressure elevation from 10 mm Hg to 15 mm Hg significantly decreased the blood flow in the stomach by 40 percent to 54 percent, the jejunum by 32 percent, the colon by 44 percent, the liver by 39 percent, the parietal peritoneum by 60 percent, and the duodenum by 11 percent. Splanchnic blood flow decreased with operative time at a constant intra-arterial pressure (r = 0.88, p < 0.0001).


CONCLUSIONS
From our study, we concluded that laparoscopic procedures with a CO2 pneumoperitoneum should be performed at a pressure of 10 mm Hg or lower to avoid splanchnic microcirculatory disturbances.
Schilling
M K
MK
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital Bern, Switzerland.
Redaelli
C
C
Krähenbühl
L
L
Signer
C
C
Büchler
M W
MW
D000293:Adolescent; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D003106:Colon / Q000098:blood supply; D004386:Duodenum / Q000098:blood supply; D005260:Female; D006801:Humans; D007583:Jejunum / Q000098:blood supply; D008099:Liver / Q000098:blood supply; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010537:Peritoneum / Q000098:blood supply; D011028:Pneumoperitoneum, Artificial; D011312:Pressure; D012039:Regional Blood Flow; D013152:Splanchnic Circulation; D013270:Stomach / Q000098:blood supply
D002245:Carbon Dioxide