SPLANCHNIC ISCHEMIA DURING LAPAROSCOPIC CHOLECYSTECTOMY

Background: Experimental studies have shown that elevation of intraabd ominal pressure by means of gas insufflation produces hemodynamic dist urbances in the peritoneal viscera, leading to splanchnic ischemia. Th e purpose of this clinical investigation is to reproduce the experimen tal data in humans undergoing laparoscopic cholecystectomy. Methods: S ixteen females participated in this study. Eight of them (the control group) were subjected to open laparotomy for biliary surgery, while on the remaining eight laparoscopic cholecystectomy was performed. In al l patients hepatic microcirculation was registered during the time of operation using the laser-Doppler technique. A single-fiber laser-Dopp ler microprobe was introduced transcutaneously within the hepatic pare nchyma, through a Chiba needle, under direct or laparoscopic vision. A dditionally, gastric intramucosal/intramural pH, a low level of which indicates tissue ischemia, was assessed by means of a tonometric nasog astric catheter. Hepatic microcirculation and gastric intramucosal/int ramural pH were assessed between controls and pneumoperitoneum-subject ed patients, and within the laparoscopic surgery group, i.e., during p neumoperitoneum and after abdominal deflation. Results: Hepatic microc irculation was found to be significantly decreased in laparoscopic sur gery patients in relation to controls (22.21 +/- 5.48 vs 57.52 +/- 18. 06 perfusion units of flow, P = 0.0001) as was gastric intramural pH ( 7.15 +/- 0.16 vs 7.37 +/- 0.02, P = 0.003). Similarly, immediately aft er abdominal deflation, hepatic microcirculation exhibited a sudden el evation (22.21 +/- 5.48 vs 67.49 +/- 7.93 perfusion units of flow, P = 0.0001), while gastric intramural pH return to its normal values (7.1 5 +/- 0.16 vs 7.43 +/- 0.07, P = 0.0001). Conclusions: It is concluded that during laparoscopic cholecystectomy abdominal organs are hypoper fused, leading to a splanchnic ischemia environment. The clinical sign ificance of these events remains to be clarified.