Lactate Metabolism during Laparoscopic Cholecystectomy: Comparison between CO2 Pneumoperitoneum and Abdominal Wall Retraction

Abstract

Recent reports have implicated CO2 pneumoperitoneum for laparoscopic surgery in the occurrence of postoperative mesenteric ischemia. With this kind of surgery, the increase in blood lactate levels has been attributed to anaerobic metabolism, probably due to tissue ischemia induced by high intraabdominal pressure (IAP). The aim of this study was to evaluate the metabolic repercussion 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 either a CO2 pneumoperitoneum (IAP of 12 mmHg) or abdominal wall retraction (abdominal wall pressure 6-10 kp). Intraoperative and postoperative blood samples were collected and lactate levels determined by enzymatic analysis. Repeated measures analysis of variance (MANOVA) was used for statistical analysis. Significance was evaluated at p < 0.05. The groups were shown to be homogeneous. Lactate concentration, expressed as mean (SD), went from 25.4 (14.4) 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 AWR group. No significant differences were found between groups intraoperatively (p = 0.116) or postoperatively (p = 0.99). Our study did not show significant differences in blood lactate levels during LC with CO2 pneumoperitoneum compared to the same procedure with abdominal wall retraction.

Evaluation of Oxidative Stress in Laparoscopic Cholecystectomy

“…Ortiz-Oshiro et al recently concluded that minimizing the operation time and limiting CO 2 pneumoperitoneum with 12 mmHg are important factors that protect patients undergoing laparoscopic surgery from possible perioperative ischemic phenomena. 22 Patients with cardiac and/or pulmonary diseases may respond differently to peritoneal CO 2 insufflation, even if the LC is performed under routine intra-abdominal pressure, within a short time, and adequate ventilation and oxygenation is provided. Because acidosis may develop in these patients, recurrent blood gas analysis should be done during the procedure.…”

Effects of different intraabdominal pressure levels on oxidative stress markers in laparoscopic cholecystectomy

“…In another study, an increase in lipid peroxidation products and a decrease in endogenous antioxidants were reported in the early postoperative period in laparoscopic surgery when compared to open cholecystectomy (20). It was reported that the oxidative stress contributed to the pulmonary functions impairment in laparoscopic procedures with CO 2 insufflation (19,20).…”

“…It is known that oxidative stress plays a role in the etiopathogenesis of many diseases, such as atherosclerosis, diabetes, cancer, and aging (18). Ortiz-Oshiro et al (19) suggested that the restriction of pressure by 12 mmHg and a short surgery duration are the key points to prevent potential oxidative injury in laparoscopic surgery.…”

Evidence for Negative Effects of Elevated Intra‐Abdominal Pressure on Pulmonary Mechanics and Oxidative Stress

“…Ortiz-Oshiro et al suggested that restriction of pressure by 12 mmHg and short surgery time are the most important factors to prevent potential oxidative injury in laparoscopic surgery [ 19 ].…”