Prolonged capnoperitoneum does not cause postoperative ileus in pigs: Safety of prolonged capnoperitoneum

Abstract

Introduction: Operative time is an accepted risk factor for the development of postoperative ileus (POI). Innovative surgical procedures such as robotic surgery and natural orifice transluminal endoscopic surgery (NOTES) will be associated with longer operative times. Although intraabdominal manipulation is a major factor for POI the impact of prolonged capnoperitoneum on postoperative gastrointestinal transit time (GIT-TT) has rarely been studied. Material and methods: IRB approved survival pilot study to assess postoperative GIT-TT using fecal collection and chromium-oxide (Cr₂O₃) labeling in pigs. Twelve female pigs were randomly assigned to three groups of four animals each. Group A received eight hours anesthesia and pressure-controlled high flow capnoperitoneum (15 mmHg), group B eight hours of anesthesia only and group C no intervention. No intraoperative manipulation. The pilot study was terminated after eight days. Results: None of the animals developed POI. In Group A one animal died after eight hours of general anesthesia. No differences in postoperative fecal output, Cr₂O₃ excretion rate or weight gain were found. Conclusion: This study is the first to investigate eight hours of capnoperitoneum in a survival model. GIT-TT is not affected by prolonged capnoperitoneum in pigs. No POI occurred with prolonged capnoperitoneum. Prolonged capnoperitoneum is safe regarding postoperative gastrointestinal function in innovative surgical procedures.

Key words::

• Capnoperitoneum
• minimally invasive surgery
• NOTES
• safety
• postoperative ileus

Acknowledgements

Animal protection and ethics approval: Lower Saxony Ministry for consumer protection and food safety, Oldenburg, Germany. File reference 33.9-42502-04-06/1151, 16.09.2010. Funding Dr. Borchert none, Funding Dr. Köhler none, Funding Dr. Jäger none, Funding Dr. Diederich none, Funding Dr. Hüther none, Funding Dr. Berk none, Funding Prof. Lamade none.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.