title: Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac: A randomized controlled study.
abstract: BACKGROUND
  We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair.
  
  
  METHODS
  In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO2 (PetCO2) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively.
  
  
  RESULTS
  After establishing capnoperitoneum, HR, blood pressure, and PetCO2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups.
  
  
  CONCLUSIONS
  Laparoscopic surgery under LP capnoperitoneum or open operation may reduce stress responses and are superior to HP capnoperitoneum.
authors.affiliation: Department of Pediatric Surgery, Department of Pharmacy, Taian City Central Hospital, Department of Surgery, Taishan Hospital of Shandong Province, Department of Reproductive Genetics Center, Taian City Central Hospital, Taian, China.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Niu
authors.forename: Xubin
authors.initials: X
authors.lastname: Song
authors.forename: Aiping
authors.initials: A
authors.lastname: Su
authors.forename: Shanshan
authors.initials: S
authors.lastname: Zhao
authors.forename: Qinghao
authors.initials: Q
authors.lastname: Li
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D001794:Blood Pressure; D002245:Carbon Dioxide; D002648:Child; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D011028:Pneumoperitoneum, Artificial; D011312:Pressure; D013312:Stress, Physiological
chemical_list: D002245:Carbon Dioxide; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone