Comparison of Perioperative Metabolic, Hemodynamic, and Respiratory Effects of Intraperitoneal Versus Preperitoneal CO 2 Insufflation.

PURPOSE: Since laparoscopic surgery is performed with carbon dioxide (CO 2 ) insufflation, it is known to have some metabolic consequences. Due to these metabolic changes, some clinicians may prefer open surgery for inguinal hernia in patients with pulmonary comorbidities. Our study aimed to compare the metabolic and systemic perioperative effects of preperitoneal insufflation with those of intraperitoneal insufflation.

METHODS

This prospective controlled study included 20 patients who underwent totally extraperitoneal (TEP) inguinal hernia repair and 20 patients who underwent laparoscopic cholecystectomy. End-tidal carbon dioxide (ETCO 2 ), peak inspiratory pressure (PIP), vital parameters, and arterial blood gas analysis results [pH, bicarbonate (HCO 3- ), partial pressure of carbon dioxide (PCO 2 ), and lactate] were recorded before insufflation and at 10 and 20 minutes after insufflation. These parameters were compared between the 2 groups.

RESULTS

In comparison between groups, no statistically significant differences were found in terms of age, gender, ASA score, or BMI ( P >0.05). In both groups, within-group analyses of HCO 3 , ETCO 2 , and PCO 2 showed that 10-minute measurements were significantly higher than preinsufflation and 20-minute measurements ( P <0.05), whereas lactate levels did not show significant variation. When vital parameters were evaluated within-group analysis, diastolic blood pressure and pulse were observed to be lower in both groups at preinsufflation compared with the 10- and 20-minute measurements ( P >0.05). No statistically significant difference was observed between the groups when preinsufflation 10-minute and 20-minute analyses were evaluated for all parameters ( P <0.05).

CONCLUSION

On the basis of the standardized intergroup analyses of pulmonary and metabolic parameters, preperitoneal and intraperitoneal CO 2 insufflation demonstrated similar perioperative respiratory and metabolic effects. Laparoscopic inguinal hernia repair, which offers rapid postoperative recovery, does not appear to impose a greater metabolic burden than laparoscopic cholecystectomy. Therefore, laparoscopy may be considered a primary surgical approach for inguinal hernia repair, similar to cholecystectomy.