Laparosc Endosc Surg Sci . 2017; 24(2): 31-37 | DOI: 10.14744/less.2017.25744

The effects of pneumoperitoneum pressure on blood gases, respiratory and venous systems during laparoscopic cholecystectomy: A prospective randomized trial

Nihat Aksakal¹, Korhan Taviloðlu¹, Hakan Teoman Yanar¹, Simru Tuðrul², Adem Uçar³, Mustafa Tükenmez¹, Ali Fuat Kaan Gök¹, Fatih Yanar^1
1Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
²Department of Anesthesiology and Intensive Care, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
³Department of Radiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey

INTRODUCTION: Increased abdominal pressure during pneumoperitoneum may distress respiratory functions and venous systems. The aim of this study was to evaluate the effect of low and high pneumoperitoneum pressure during laparoscopic cholecystectomy.
METHODS: Total of 40 patients were randomized for use of either low (8 mmHg) or high (14 mmHg) pneumoperitoneum pressure. Respiratory mechanics were monitored continuously, arterial blood gases were analyzed via radial artery catheter, and duplex scan of left common femoral vein was performed. Ten days after surgery, venous duplex scan of lower limbs was used to detect signs of deep vein thrombosis.
RESULTS: While peak inspiratory pressure significantly increased with low and high pneumoperitoneum pressure, dynamic compliance significantly decreased. Although carbon dioxide insufflation caused decrease in blood pH in both groups, it was only significant at high pneumoperitoneum pressure. Duplex scan of femoral vein revealed significant increase in diameter and decrease in peak blood velocity at high pneumoperitoneum pressure.
DISCUSSION AND CONCLUSION: Respiratory acidosis may occur due to decreased compliance, and pneumoperitoneum causes reversible venous stasis, especially during use of high pressure. Results indicated that performing laparoscopy with lower pneumoperitoneum pressure decreased these adverse effects, especially in patients with cardiopulmonary comorbid diseases. Prophylaxis for venous thromboembolism in high-risk patients undergoing laparoscopic cholecystectomy is recommended.

Keywords: Acid-base balance, deep vein thrombosis, laparoscopy, pneumoperitoneum, pulmonary mechanics, venous stasis.

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