PATHOPHYSIOLOGIC FEATURES OF A PNEUMOPERITONEUM AT LAPAROSCOPY - A SWINE MODEL

OBJECTIVE: The aim of this study was to examine local and systemic rea ctions of the body to a pneumoperitoneum to elucidate potential danger s and risks of laparoscopic procedures. STUDY DESIGN: Laparoscopy was performed on 25 pigs. The pigs were divided into five groups by level of intraabdominal pressure (14 and 18 mm Hg) and gas used (carbon dixo ide and air). The effects of the pneumoperitoneum on cardiopulmonary c ondition and the peritoneal milieu were observed. These effects should be the result of various changes at the mechanical, ventilatory, cell ular, hormonal, and immunologic levels. RESULTS: In this animal study marked changes in the peritoneal milieu were observed, and we demonstr ated that these changes were dependent on the gas used, intraabdominal pressure, and duration of application. Locally these changes are mani fest in the development of severe peritoneal acidosis, hypercapnia, an d the release of various mediators. Systemic changes, in particular ca rdiopulmonary changes, also depend on the intraabdominal pressure and the gas used. CONCLUSION: During conventional pneumoperitoneum the per itoneum might change to a large extent so that the development of new risks are possibly encouraged. A reduction in intraabdominal pressure with the use of carbon dioxide as the insufflation gas should result i n normal acid-base balance.