Physiological Impact of Pneumoperitoneum on Gastric Mucosal CO 2 Pressure During Laparoscopic Versus Open Appendectomy in Children

Abstract

Abstract

Introduction:

Funded knowledge about the physiological impact of laparoscopic surgery in children is sparse. Although there are data on hemodynamic compromise after creation of a pneumoperitoneum in children, little is known about microcirculatory changes at the mucosa level. Therefore, the aim of this study was to assess gastric microcirculation by continuous gastric air tonometry in the setting of laparoscopic versus open appendectomy.

Patients and Methods:

Twenty children 5–17 years old undergoing laparoscopic and 7 children undergoing open appendectomy were included in the study. Gastric intramucosal CO₂ pressure (pCO₂i) was measured under standardized flow and intraperitoneal pressure using continuous air tonometry (TONOCAP^®, Datex Ohmeda), and ΔpCO₂ (pCO₂i – end-expiratory CO₂ pressure [pCO₂e]) was obtained for the time course of surgery.

Results:

ΔpCO₂ increased significantly from the baseline value not only in the laparoscopic group but also in the open surgery group. Even though ΔpCO₂ was higher in the laparoscopic group at all time points, the overall increase in ΔpCO₂ for both groups was uniform. The largest differences were observed during the initial 20 minutes of the operation. The changes observed were exclusively due to an increase of pCO₂i in relation to a constant pCO₂e.

Discussion:

In the setting of a standardized, simple operation in an otherwise healthy child above the age of 5 years, our data suggest that the effect of a pneumoperitoneum on splanchnic perfusion is comparable to the compromise caused by open surgery. Further research must be obtained when evaluating the full impact of laparoscopy in children.