E. Ortiz-oshiro et al., Lactate metabolism during laparoscopic cholecystectomy: Comparison betweenCO2 pneumoperitoneum and abdominal wall retraction, WORLD J SUR, 25(8), 2001, pp. 980-984
Recent reports have implicated CO2 pneumoperitoneum for laparoscopic surger
y in the occurrence of postoperative mesenteric ischemia. With this kind of
surgery, the increase in blood lactate levels has been attributed to anaer
obic metabolism, probably due to tissue ischemia induced by high intraabdom
inal pressure (LAP). The aim of this study was to evaluate the metabolic re
percussion of CO2 pneumoperitoneum during laparoscopic cholecystectomy (LC)
. This was a prospective randomized study of CO2 pneumoperitoneum (PP group
, n = 19) versus abdominal wall retraction (AWR group, n = 15). Demographic
data were collected preoperatively. Four-trocar LC was performed with eith
er a CO2 pneumoperitoneum (IAP of 12 mmHg) or abdominal wall retraction (ab
dominal wall pressure 6-10 kp). Intraoperative and postoperative blood samp
les were collected and lactate levels determined by enzymatic analysis. Rep
eated measures analysis of variance (MANOVA) was used for statistical analy
sis. Significance was evaluated at p < 0.05. The groups were shown to be ho
mogeneous. Lactate concentration, expressed as mean (SD), went from 25.4 (1
4.4) mg/dl at baseline to 18.9 (13.6) mg/dl 4 hours after surgery in the PP
group and from 19.4 (6.1) mg/dl at baseline to 17.8 (14.7) mg/dl in the AW
R group. No significant differences were found between groups intraoperativ
ely (p = 0.116) or postoperatively (P = 0.99). Our study did not show signi
ficant differences in blood lactate levels during LC with CO2 pneumoperiton
eum compared to the same procedure with abdominal wall retraction.