Co2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance

Background: Knowledge of the pathophysiological basis of laparoscopic procedures, in particular the impact of CO2pneumoperitoneum (PNP) on the body, can prevent onset of complications during laparoscopy. Design and Methods: Standard intra-abdominal pressure (IAP), which is used during laparoscopic surgery, is 12 to 15 mm Hg. The direct effect of CO2-pneumoperitoneum is a consequence of the mechanical action of the gas, and increased intra-abdominal pressure. The indirect effect of CO2-pneumoperitoneum caused by the absorption of gas from the abdomen. Analysis of articles that evaluated the effects of CO2-pneumoperitoneum on the body and intra-abdominal organs contributes to an even better use of the laparoscopic method. Results: The results of numerous experimental and clinical studies have confirmed that increased IAP and CO2-pneumoperi toneum intraoperatively causing reduction the portal venous blood flow, increasing venous stasis, reduced glomerular filtration, reduced Tiffeneau-index and pulmonary compliance what it can lead to hemodynamic and cardiac disorders. Consecutive intraoperative acidosis and hipercarbia impact the function of intra-abdominal organs and heart. Conclusion: To avoid the side effects of CO2-pneumoperitoneum, which is important in patients with ASA II and more often as necessary to be operate with low pressure (IAP: 6-8 mm Hg) or use gasless laparoscopy.