Physiologic effects of pneumoperitoneum in adults with sickle cell disease undergoing laparoscopic cholecystectomy (A case control study)

Abstract

This study proved the safety of LC in patients with SCD and cholelithiasis, and that they can tolerate the physiological effects of pneumoperitoneum as non-SCD adults.

Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?

“…Carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy is associated with persistent increases in heart rate and blood pressure until desufflation [1][2][3]. We found significantly lower arterial blood pressure values, fewer needs for supplemental doses of fentanyl and labetalol, and higher Pa-EtCO 2 gradient values with the use of hypocapnia before and throughout CO 2 insufflation during laparoscopic cholecystectomy with the patient in the reverse Trendelenburg position.…”

Experimental use of a novel single-port gasless laparoendoscopic operative field formation device

“…However, accumulating clinical data have also directed the attention of researchers and doctors to the dangers of pneumoperitoneum [9]. When pneumoperitoneum is used, CO 2 can enter the circulatory system through the peritoneum, abdominal organs, and broken vessels, resulting in adverse effects on the circulatory system [1], the respiratory system [2], blood coagulation [10], and the nervous system [11] as well as increasing the risk of maternal-foetal hypoxia [3] and the risk of seeding of free tumour cells in the abdominal cavity [4]. Therefore, although traditional surgical approaches continue to be applied and promoted in clinical practice, new gasless laparaendoscopic techniques have emerged.…”

“…However, it is associated with complications. However, accumulating clinical data reveal the danger of pneumoperitoneum and the high risks of its associated complications such as adverse effects on the circulatory system [1], the respiratory system [2], blood coagulation – especially venous thrombosis - [10], and the nervous system [11] as well as increasing the risk of maternal-foetal hypoxia [3], and the risk of seeding of free tumour cells in the abdominal cavity [4]. However, the complication rate of pneumoperitoneoum has not been prospectively studied in small animals.…”

Laparoscopic cholecystectomy: consensus conference-based guidelines

“…LC is safe in sickle cell disease patients without preoperatory transfusion and by maintaining a low insufflation pressure [43][44][45][46]. Statement 1.1 Although a systematic prophylactic LC for asymptomatic cholelithiasis is not generally indicated (GoR strong), it might be advisable in some subgroups of patients: incidental (concomitant) cholecystectomy during another laparoscopic operation; chronic hemolytic conditions; risk of malignancy (ethnicity, geographic area, gallbladder imaging); microcalculi/biliary sludge in presence of functioning gallbladder; post-cardiac transplant patient 5) (GoR weak)…”