4 - Pathophysiology of the pneumoperitoneum

Summary

Pneumoperitoneum with CO2 gas begins the process of systemic acidification by altering the ultrastructural, metabolic, and immune functions of the peritoneum. Both direct and indirect effects of CO2 can be seen in numerous aspects of the cardiovascular system. Both obese and non-obese patients undergo laparoscopy at 15 mm Hg of CO2 gas in order to provide adequate visualization while minimizing the detrimental effects of increased intra-abdominal pressure (IAP). An overall decrease in renal perfusion and a resultant increase in hormonal activity occur with pneumoperitoneum. Patients with chronic obstructive pulmonary disease (COPD) often require lower IAP during laparoscopy. Effective preventions or control of detrimental effects of CO2 pneumoperitoneum are key to maintaining the safety profile of laparoscopy. Nevertheless, with the numerous benefits that stem from sequential compression devices (SCDs), their routine use has become widely recommended for all laparoscopic surgery.