Endoscopy during laparoscopy - Reduced postprocedural bowel distention with intraluminal CO2 insufflation

Background: Intraluminal endoscopy during laparoscopy can substitute for ma nual palpation in defining anatomy and pathology, but a potential problem i s the persistent bowel distention associated with intraluminal air insuffla tion. Methods: To compare the rates of intraluminal absorption, a 30-cm segment o f small bowel with an intact vascular supply was insufflated with either ai r or CO2 during CO2 pneumoperitoneum. Intraluminal pressures and bowel circ umferences were monitored after the insufflation was stopped. To study the metabolic and hemodynamic effects of CO2 endoscopy during laparoscopy, the small bowel was insufflated to an intraluminal pressure of 15 mmHg during C O2 pneumoperitoneum. Nitrogen pneumoperitoneum was used to differentiate th e effects from intraluminal and peritoneal CO2 insufflation. Results: The intraluminal pressures remained elevated and the bowel distend ed for the entire 3 h following bowel insufflation with air. Following intr aluminal CO2 insufflation, both the intraluminal pressures and the bowel ci rcumferences returned to preinsufflation values within 15 min. Intraluminal CO2 insufflation also led to systemic absorption of CO2 with significant m etabolic and hemodynamic changes. These changes were effectively corrected by doubling minute ventilation. Conclusions: Intraluminal CO2 was absorbed faster than intraluminal air. Al though decreased bowel distention is certainly of practical value, endotrac heal intubation needs to be done to effectively ventilate the absorbed CO2.