CO2 pneumoperitoneum: What we know and what we need to know

The development of the laparoscopic technique in surgery was so overwhelmin g that scientific evaluation could not keep in step. While investigators we re still discussing the effects of the pneumoperitoneum on the healthy orga nism, laparoscopy was already performed in patients with an acute abdomen d ue to trauma or disease. Therefore, there is an urgent need of further expe rimental and clinical studies with relevant endpoints to gain external evid ence concerning the benefits of diagnostic or therapeutic laparoscopy for c ritically ill patients. In experiments with pigs we have shown that even in a healthy organism perfusion and energy metabolism of the small bowel is i mpaired by a pneumoperitoneum with carbon dioxide. Under the conditions of a systemic inflammatory response syndrome induced by infusion of endotoxin, the negative effects of the pneumoperitoneum were significantly amplified. Furthermore, we found that the increased intracranial pressure as caused b y a head injury was further enhanced during a pneumoperitoneum but not by t he alternative method of mechanical wall retraction. The current literature dealing with the effects of a pneumoperitoneum in critically ill patients is still controversial. Our data support the results of those authors who h old the opinion that creating a pneumoperitoneum in patients with acute abd ominal problems means an additional serious burden that in single cases may lead to a disaster. As evidence is lacking, the current extension of lapar oscopy into the field of intensive cafe medicine is still a human experimen t that must be performed with high responsibility, extensive monitoring, an d according to the rules of a clinical study.