Laparoscopic intragastric surgery under carbon dioxide pneumostomach.
BACKGROUND
Laparoscopic intragastric surgery (LIGS) requires a "pneumostomach," which is created by air insufflation via gastroscopy. If the procedure is done without duodenal clamping, migrated air from the stomach causes excessive, prolonged bowel distention, which may lead to drawbacks during and after the operation. Carbon dioxide (CO(2)), with its faster absorption than air, can attenuate bowel distention when used to establish the pneumostomach. The aims of this study were to evaluate feasibility, safety, and effectiveness of the CO(2) pneumostomach in LIGS.


METHODS
We have performed 15 LIGSs under the CO(2) pneumostomach (January 1997 to August 2004). The stomach was insufflated with CO(2) through an automatic surgical insufflator up to 8 mm Hg of intraluminal pressure. Neither a duodenal clamp nor an occlusion was employed prior to insufflation. Cardiopulmonary parameters were prospectively registered and retrospectively analyzed. The degree and extent of bowel distention was assessed by a concluding laparoscopy, and the amount of intestinal gas was evaluated by a postoperative plain abdominal radiograph.


RESULTS
LIGS was completed in all 15 cases, with a mean intragastric insufflation time of 100 minutes. The CO(2) pneumostomach provided good, constant surgical exposure with sufficient working space. No adverse impact of intragastric CO(2) insufflation was observed on the cardiopulmonary function. Even without duodenal clamping, the insufflated small bowel loops already shrank at the time of the concluding laparoscopy. Fair residual gas was documented radiologically in 2 cases, whereas it was only faint in the remaining 13 cases. No patients showed abdominal pain or bloating postoperatively.


CONCLUSIONS
The CO(2) pneumostomach is a feasible, safe alternative and is potentially effective for LIGS by eliminating the need for prior duodenal clamping and by minimizing bowel distention.
Omori
Takeshi
T
Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Nakajima
Kiyokazu
K
Ohashi
Shuichi
S
Takahashi
Tsuyoshi
T
Nishimura
Junichi
J
Sawa
Yoshiki
Y
Nishida
Toshirou
T
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007327:Insufflation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D013270:Stomach / Q000601:surgery*; D013997:Time Factors
D002245:Carbon Dioxide