Peritoneal Morphological Changes due to Pneumoperitoneum: The Effect of Intra-abdominal Pressure

Papparella, Alfonso; Nino, Fabiano; Coppola, S.; Noviello, C.; Paciello, Orlando; Papparella, Serenella

doi:10.1055/s-0033-1349057

Cited by 17 publications

(7 citation statements)

References 15 publications

(27 reference statements)

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“…it destroys the microvilli, causes the mesothelial cells to retract and bulge and exposes the basal lamina [ 27 , 64 , 65 , 103 – 106 ]. Interestingly, these alterations depend on the duration of gas insufflation [ 107 ] and the insufflation pressure and type of gas [ 108 ]. When humidified and heated CO 2 is used, fewer changes to the peritoneal layer were observed in comparison to using dry and cold gas in rats [ 64 , 103 ] and in pigs [ 65 ].…”

Section: General Impact Of the Standard Co 2 -Indumentioning

confidence: 99%

“…Moreover, the degree of inflammation will also depend on the type of gas and the insufflation pressure used during laparoscopy. Paparella et al [ 108 , 119 ] demonstrated that air-induced pneumoperitoneum produces more inflammation than CO 2 -induced pneumoperitoneum by evaluating the following features of the peritoneal surface: congestion, haemorrhage, oedema, and inflammatory cells and their location of the lamina propria and submucosal, and mesothelial cells looking for hyperplasia, metaplasia and hypertrophy. They also demonstrated that at higher insufflation pressure the inflammation is greater [ 108 ].…”

Section: General Impact Of the Standard Co 2 -Indumentioning

confidence: 99%

“…Paparella et al [ 108 , 119 ] demonstrated that air-induced pneumoperitoneum produces more inflammation than CO 2 -induced pneumoperitoneum by evaluating the following features of the peritoneal surface: congestion, haemorrhage, oedema, and inflammatory cells and their location of the lamina propria and submucosal, and mesothelial cells looking for hyperplasia, metaplasia and hypertrophy. They also demonstrated that at higher insufflation pressure the inflammation is greater [ 108 ]. The trauma associated with the higher insufflation pressure was also demonstrated by the group of Matsuzaki et al [ 120 , 121 ] that showed that a low intra-peritoneal pressure (8 mmHg) would be better than the standard intra-peritoneal pressure (12 mmHg) to minimise the adverse impact on the surgical peritoneal environment, and on the peritoneal fibrinolytic system during a CO 2 pneumoperitoneum [ 122 ].…”

Section: General Impact Of the Standard Co 2 -Indumentioning

confidence: 99%

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Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery

Binda

2015

Arch Gynecol Obstet

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PurposeThe peritoneum is the serous membrane that covers the abdominal cavity and most of the intra-abdominal organs. It is a very delicate layer highly susceptible to damage and it is not designed to cope with variable conditions such as the dry and cold carbon dioxide (CO2) during laparoscopic surgery. The aim of this review was to evaluate the effects caused by insufflating dry and cold gas into the abdominal cavity after laparoscopic surgery.MethodsA literature search using the Pubmed was carried out. Articles identified focused on the key issues of laparoscopy, peritoneum, morphology, pneumoperitoneum, humidity, body temperature, pain, recovery time, post-operative adhesions and lens fogging.ResultsInsufflating dry and cold CO2 into the abdomen causes peritoneal damage, post-operative pain, hypothermia and post-operative adhesions. Using humidified and warm gas prevents pain after surgery. With regard to hypothermia due to desiccation, it can be fully prevented using humidified and warm gas. Results relating to the patient recovery are still controversial.ConclusionsThe use of humidified and warm insufflation gas offers a significant clinical benefit to the patient, creating a more physiologic peritoneal environment and reducing the post-operative pain and hypothermia. In animal models, although humidified and warm gas reduces post-operative adhesions, humidified gas at 32 °C reduced them even more. It is clear that humidified gas should be used during laparoscopic surgery; however, a question remains unanswered: to achieve even greater clinical benefit to the patient, at what temperature should the humidified gas be when insufflated into the abdomen? More clinical trials should be performed to resolve this query.

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Section: General Impact Of the Standard Co 2 -Indumentioning

confidence: 99%

Section: General Impact Of the Standard Co 2 -Indumentioning

confidence: 99%

Section: General Impact Of the Standard Co 2 -Indumentioning

confidence: 99%

See 1 more Smart Citation

Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery

Binda

2015

Arch Gynecol Obstet

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“…In our study, warming and humidification of the insufflation gas significantly reduced shoulder-tip pain. Histological studies have shown that carbon dioxide pneumoperitoneum is associated with a destruction of the peritoneal layer as well as with an alteration of the peritoneal cell metabolism due to desiccation and pressure leading to peritoneal acidosis and release of inflammatory mediators with a following inflammatory response [ 23 – 25 ]. Several studies therefore suggest that destruction of the peritoneal integrity contributes to the development of shoulder-tip pain.…”

Section: Discussionmentioning

confidence: 99%

Insufflation with Humidified and Heated Carbon Dioxide in Short-Term Laparoscopy: A Double-Blinded Randomized Controlled Trial

Herrmann

Wilde

2015

BioMed Research International

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Background. We tested the hypothesis that warm-humidified carbon dioxide (CO2) insufflation would reduce postoperative pain and morphine requirement compared to cold-dry CO2 insufflation. Methods. A double-blinded, randomized, controlled trial was conducted to compare warm, humidified CO2 and cold-dry CO2. Patients with benign uterine diseases were randomized to either treatment (n = 48) or control (n = 49) group during laparoscopically assisted vaginal hysterectomy. Primary endpoints of the study were rest pain, movement pain, shoulder-tip pain, and cough pain at 2, 4, 6, 24, and 48 hours postoperatively, measured by visual analogue scale. Secondary outcomes were morphine consumption, rejected boli, temperature change, recovery room stay, and length of hospital stay. Results. There were no significant differences in all baseline characteristics. Shoulder-tip pain at 6 h postoperatively was significantly reduced in the intervention group. Pain at rest, movement pain, and cough pain did not differ. Total morphine consumption and rejected boli at 24 h postoperatively were significantly higher in the control group. Temperature change, recovery room stay, and length of hospital were similar. Conclusions. Warm, humidified insufflation gas significantly reduces postoperative shoulder-tip pain as well as morphine demand. This trial is registered with Clinical Trial Registration Number DRKS00003853 (German Clinical Trials Register (DRKS)).

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“…Carbon dioxide (CO 2 ) insufflation in laparoscopy procedures causes mesothelial morphological changes [ 1 ], structure damage [ 2 ], and the risk of intra-abdominal adhesion [ 3 ]. Tissue damage triggers the inflammatory response, mast cell infiltration, and degranulation that are believed to stimulate adhesion.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic procedures impact on mast cell mediators, extracellular matrix and adhesion scoring system in rats

Poerwosusanta

Gunadi²,

Oktaviyanti

et al. 2020

Annals of Medicine and Surgery

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Background Laparoscopic procedures under certain pressure have the potential to cause intra-abdominal adhesions. However, the pathomechanism of this disorder is unknown. Release of mast cell mediators due to mast cell degranulation is thought to be the cause. Materials and methods Thirty male Sprague-Dawley rats were grouped into five groups (n = 6 per group): one control group and four intervention groups to which 60 min insufflation was performed using carbon dioxide at 5, 8, 10 and 12 mmHg. Seven days after laparoscopy, we euthanized and evaluated the levels of histamine, tryptase, and chymase of peritoneal fluid, the thickness of ECM of peritoneal tissue, and intraabdominal adhesion scoring system. Results Histamine and tryptase levels in peritoneal fluid were significantly higher at the 10- and 12 mm Hg intervention compared to control (histamine: 0.50 ± 0.35 vs. 0.41 ± 0.41 vs. 0.04 ± 0.02 ng/mL, respectively; and tryptase: 0.69 ± 0.11 vs. 0.65 ± 0.05 vs. 0.48 ± 0.02 ng/ml respectively). The ECM was significantly thicker in the intervention groups at 10- and 12-mm Hg compared to control (71.3 [66.7–85.2] vs. 48.4 [34.5–50.3] vs. 10.25 [8.7–12.1] μm, respectively). Moreover, the intra-abdominal scoring was also significantly higher in the intervention groups at 10- and 12 mm Hg compared to control (4 [0–4] vs. 4.5 [4–5], vs. 0, respectively). Conclusions Laparoscopic procedures increase the release of mast cell mediators in peritoneal fluid, the thickness of ECM and intraabdominal adhesion scoring in rats, implying that it might increase the possibility of intrabdominal adhesion in humans.

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Peritoneal Morphological Changes due to Pneumoperitoneum: The Effect of Intra-abdominal Pressure

Abstract: Our data confirm that PN affects the peritoneal integrity. The grades of morphological peritoneal changes are related to the level of IAP. Low CO2 pressure causes minor peritoneal changes with respect to high pressure and air insufflation.

Cited by 17 publications

References 15 publications

Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery

Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery

Insufflation with Humidified and Heated Carbon Dioxide in Short-Term Laparoscopy: A Double-Blinded Randomized Controlled Trial

Laparoscopic procedures impact on mast cell mediators, extracellular matrix and adhesion scoring system in rats

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