Physiological changes of pneumoperitoneum during laproscopic cholecystectomy

Abstract

Background: Recently, the frequency and indication for laparoscopic surgery have increased, and laparoscopic cholecystectomy has been widely accepted as an alternative to laparotomy.To carry out the laparoscopic procedure, a pressure gas, most commonly co2 is used. It is important to know the pathophysiological changes that are caused by an increase in intra-abdominal pressure and by the absorption of co2 from an co2 pneumoperitoneum. Aim this study; aims to estimate some physiological changes that caused by pneumoperitoneum during laparoscopic cholecystectomy. Patients and methods: one hundred patients were included in this study randomly selected and consisted of (80 females) and (20 males) their ages were between 19-65 years. Those patients were underwent elective aparoscopic cholecystectomy. we measured some clinical and biochamical parameters (pulmonary function tests, liver function tests, serum urea and creatinine) 24hr before operation as control and 24hr after operation , also we measured end tidal co2(ETCO2),serum aldosterone, potassium and sodium before insufflation of CO2(as control)and at the end of insufflation ,blood pressure and heart rate recorded at different time throughout the operation. Results: there is a statistically significant changes in haemodynamic responses (systolic, diastolic and heart rate) after pneumoperitoneum and changes in position; Pulmonary function tests (VC, FVC, FEV1, FEV1/FVC) show highly significant decrease (p<0.01) ,highly significant increase (p<0.01) in serum level of ALT and AST enzymes 24hrs post-operative . There was highly significant increase (p<0.01) in ETCO2, serum aldosterone and serum potassium level . Serum sodium, urea and creatinine show no significant changes.
Conclusion: we concluded that laparoscopic cholecystectomy causes notable physiological alteration intraoperatively and postoperatively, caused mainly by pneumoperitoneum and change in position.