Gastrointestinal Effects of Pneumoperitoneum

Halevy et al., in a series comparing open and laparoscopic cholecystectomy, have demonstrated that laparoscopic surgery results in significantly less disruption of normal gastrointestinal motility when compared to open surgery (18).

The mechanism(s) of decreased ileus with laparoscopic surgery remain(s) unclear. Another concern with abdominal laparoscopy has been gastroesophageal reflux. Despite the increased intra-abdominal pressures associated with insufflation, there has been no increased incidence of gastroesophageal reflux and regurgitation in patients undergoing laparoscopic procedures (19). However, the combination of elevated intra-abdominal pressures from the pneumoperitoneum, morbid obesity, and the application of the Trendelenburg position can increase the likelihood of regurgitation and aspiration of gastric contents. To avoid reflux, high-risk patients may be premedicated with 10 mg of intravenous metoclopramide. Also, administration of H2 blockers can reduce gastric acidity and the associated morbidity if aspiration of gastric contents should occur. Finally, a cuffed endotracheal tube should prevent aspiration of stomach contents.

The authors observed that the postoperative signs and symptoms of laparoscopic bowel perforation were different from the classic postoperative symptoms of bowel perforation that occur with open surgery.

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