Analysis of gas embolism in pediatric laparoscopy: incidence, risk factors, and preventive strategies.

BACKGROUND

Gas embolism during pediatric laparoscopic surgery is often subclinical but can have serious consequences. Identifying patient and procedure-related risk factors is essential to improve perioperative safety and outcomes.

PURPOSE: This study aimed to determine risk factors associated with gas embolism in pediatric laparoscopy and to propose preventive strategies.

STUDY

DESIGN

Single-center, prospective observational study including 57 pediatric patients undergoing minimally invasive surgery (MIS) from January 2021 to June 2025. Intraoperative gas embolism was monitored by transthoracic echocardiography. Patient demographics, laparoscopic preset, CO₂ volume used, and intra-abdominal pressure (IAP) variations were analyzed as potential risk factors.

RESULTS

Gas embolism was detected in 25 patients (43.9%; 95% CI 31.0-56.7%). Patient characteristics and laparoscopic setting parameters were not associated with gas embolism. Repetitive intra-abdominal volume variations were strongly associated with the occurrence of gas embolism (OR 49.8, 95% CI 9.14-271.65; p < 0.0001). The median CO₂ volume was higher in the embolism group (28 vs. 20 L, p = 0.002).

CONCLUSIONS

Gas embolism is common in pediatric laparoscopy, although most episodes are subclinical. Repetitive intra-abdominal pressure variations, which lead to higher CO₂ consumption, significantly increase gas embolism risk. Awareness and careful intraoperative management are essential, particularly in high-risk procedures, to minimize potential complications. These findings support future multi-center studies to validate preventive strategies.