SPLANCHNIC MICROCIRCULATORY CHANGES DURING CO2 LAPAROSCOPY

BACKGROUND: Splanchnic macrocirculatory changes during high-pressure C O2 pneumoperitoneum include a decrease in mesenteric arterial blood fl ow, and decreased gastric perfusion with a drop in gastric pH in exper imental studies. Microcirculatory changes in abdominal organs under cl inical conditions with a low pressure CO2 pneumoperitoneum are unknown . STUDY DESIGN: In 18 patients undergoing routine laparoscopy with a C O2 pneumoperitoneum (7 symptomatic cholecystolithiasis, 3 acute cholec ystitis, and 8 acute appendicitis), gastric, duodenal,jejunal, colonic , hepatic, and peritoneal blood flow was measured with a custom-made l aser Doppler flow probe at an intra-abdominal pressure of 0, 10, and 1 5 mm Hg. RESULTS: Intra-abdominal pressure elevation from 10 mm Hg to 15 mm Hg significantly decreased the blood flow in the stomach by 40 p ercent to 54 percent, the jejunum by 32 percent, the colon by 44 perce nt, the liver by 39 percent, the parietal peritoneum by 60 percent, an d the duodenum by 11 percent. Splanchnic blood flow decreased with ope rative time at a constant intra-arterial pressure (r=0.88, p<0.0001). CONCLUSIONS: From our study, we concluded that laparoscopic procedures with a CO2 pneumoperitoneum should be performed at a pressure of 10 m m Hg or lower to avoid splanchnic microcirculatory disturbances.