title: Physiological impact of pneumoperitoneum on gastric mucosal CO2 pressure during laparoscopic versus open appendectomy in children.
abstract: BACKGROUND
  Funded knowledge about the physiological impact of laparoscopic surgery in children is sparse. Although there are data on hemodynamic compromise after creation of a pneumoperitoneum in children, little is known about microcirculatory changes at the mucosa level. Therefore, the aim of this study was to assess gastric microcirculation by continuous gastric air tonometry in the setting of laparoscopic versus open appendectomy.
  
  
  METHODS
  Twenty children 5-17 years old undergoing laparoscopic and 7 children undergoing open appendectomy were included in the study. Gastric intramucosal CO(2) pressure (pCO(2)i) was measured under standardized flow and intraperitoneal pressure using continuous air tonometry (TONOCAP(®), Datex Ohmeda), and ΔpCO(2) (pCO(2)i - end-expiratory CO(2) pressure [pCO(2)e]) was obtained for the time course of surgery.
  
  
  RESULTS
  ΔpCO(2) increased significantly from the baseline value not only in the laparoscopic group but also in the open surgery group. Even though ΔpCO(2) was higher in the laparoscopic group at all time points, the overall increase in ΔpCO(2) for both groups was uniform. The largest differences were observed during the initial 20 minutes of the operation. The changes observed were exclusively due to an increase of pCO(2)i in relation to a constant pCO(2)e.
  
  
  CONCLUSIONS
  In the setting of a standardized, simple operation in an otherwise healthy child above the age of 5 years, our data suggest that the effect of a pneumoperitoneum on splanchnic perfusion is comparable to the compromise caused by open surgery. Further research must be obtained when evaluating the full impact of laparoscopy in children.
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Berger
authors.forename: Jan
authors.initials: J
authors.lastname: Goedeke
authors.forename: Jochen
authors.initials: J
authors.lastname: Hubertus
authors.forename: Oliver
authors.initials: O
authors.lastname: Muensterer
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ring-Mrozik
authors.forename: Dietrich
authors.initials: D
authors.lastname: von Schweinitz
authors.forename: Martin
authors.initials: M
authors.lastname: Lacher
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply* / Q000503:physiopathology*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008833:Microcirculation; D011028:Pneumoperitoneum, Artificial