Assessment of a method to expel intraperitoneal gas after gynecologic laparoscopy.
OBJECTIVE
To assess a method using instillation of saline to expel all residual intraperitoneal CO2 after laparoscopy. If successful, this would enable clinicians to use radiography as a simple diagnostic test to detect bowel perforation following laparoscopic surgery.


METHODS
Cohort study (Canadian Task Force classification II-2).


METHODS
Department of Endo-Gynecology, Royal Hospital for Women, Sydney, Australia.


METHODS
Thirty women undergoing elective gynecologic laparoscopic surgery.


METHODS
At completion of surgery, the patient remained in maximum head- down position as the abdomen was filled with up to 1 L of normal saline. The suprapubic port remained open to allow the CO2 to escape as it was displaced by the saline. Closure of abdominal ports was completed in routine manner. Erect upper abdominal radiographs were taken 24 hours after surgery, and measurements of any subdiaphragmatic gas were recorded. If gas was evident at 24 hours, a repeat radiograph was performed at 48 hours.


RESULTS
Of the 30 patients recruited, four did not complete the study protocol. There was evidence of subdiaphragmatic gas in 25 (96%) of 26 patients on the radiograph taken 24 hours postsurgery. The median volume of gas was 12.9 mL (range 0-2003 mL; IQ range 2.0-144 mL). Of the patients that had a second radiograph, 76% still had subdiaphragmatic gas present.


CONCLUSIONS
This method for displacement of residual intraperitoneal gas at the end of laparoscopy does not appear to be effective.
Thomson
Angus J M
AJ
Department of Endo-Gynecology, Royal Hospital for Women, University of New South Wales, Sydney, Australia. gus@doctors.org.uk
Abbott
Jason A
JA
Lenart
Meegan
M
Willison
Fariba
F
Vancaillie
Thierry G
TG
Bennett
Michael J
MJ
D000328:Adult; D001315:Australia; D002245:Carbon Dioxide / Q000009:adverse effects; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007274:Injections, Intraperitoneal; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012965:Sodium Chloride / Q000627:therapeutic use*; D016896:Treatment Outcome
D002245:Carbon Dioxide; D012965:Sodium Chloride