Karbondioksit ile Oluşturulan Pnömoperitoneumun Periton Yapısı Üzerine Etkileri

Sdü Sağlık Bilimleri Enstitüsü Dergisi / Cilt 8 Sayı 2 / 2017 The Effects of Carbon Dioxide Pneumoperitoneum on Peritoneal Structure Karbondioksit ile Oluşturulan Pnömoperitoneumun Periton Yapısı Üzerine Etkileri Bekir Sarıcık1, Y. Savaş Koca1, Ö. Rıdvan Tarhan1 1Süleyman Demirel University, Medical Faculty, Department of General Surgery, Isparta, Turkey. Abstract Özet To create pneumoperitoneum at the beginning of laparoscopic surgery, several gases have been trialled. The most commonly used of these gases is carbon dioxide. Although pneumoperitoneum created with carbon dioxide provides an appropriate area for surgeons to perform laparoscopic operations, it can also cause several unwanted changes to the peritoneal structure. Some of these side-effects are inevitable but some exhibit changes depending on the method of application. This review was prepared taking into consideration the previous experimental and clinical studies in literature related to the effects on the peritoneal structure of pneumoperitoneum created with carbon dioxide. The creation of pneumoperitoneum affects the peritoneal environment and thereby the organism. This effect is caused by increased intra-abdominal pressure, the local peritoneal destructive effect, carbon dioxide absorption and chemical metabolic changes. It is important to be aware of the effects created by pneumoperitoneum, especially in obese patients or those with concomitant diseases. With this awareness, it will be possible to reduce the effects of the undesired changes wrought by pneumoperitoneum. Keywords: Carbon Dioxide Pneumoperitoneum, Laparoscopy, Carbon Dioxide Insufflation Laparoskopik ameliyatların uygulanmaya başlamasıyla beraber pnömoperiton oluşturmak için birçok gaz denenmiştir. Bunlar arasında halen en yaygın kullanımda olan karbondioksit gazıdır. Karbondioksit ile oluşturulan pnömoperiton laparoskopik ameliyatlarda cerrahlara uygun alan oluşturmasına rağmen peritoneal yapı üzerinde birtakım istenmeyen değişikliklere de sebep olmaktadır. Bu yan etkilerden bazıları kaçınılmaz olmasına rağmen bazı yan etkilerde uygulama şekline bağlı değişiklik gösterebilmektedir. Karbondioksit ile oluşturulan pnömoperitonun peritoneal yapı üzerine etkilerine ilişkin literatürdeki yapılan deneysel ve klinik çalışmalar dikkate alınarak bu derleme hazırlandı. Pnomöperiton oluşumu peritoneal çevreyi ve dolayısıyla organizmayı etkiler. Bu etkilenim intraabdominal basınç artışı, karbondioksitin lokal peritoneal destrüktif etkileri, karbondioksit emilimi ve kimyasal metabolik değişimler gibi sebeplerle olmaktadır. Özellikle ek hastalığı olan ya da obez hastalarda pnömoperitonun yaptığı etkiler hakkında farkındalığa sahip olunması önemlidir. Bu farkındalık hastaların pnömoperitonun yaptığı istenmeyen değişikliklerden etkilenimini azaltacağı kanısındayız Anahtar kelimeler: Karbondioksit Pnömoperiton, Laparoskopi, Karbondioksit İnsuflasyonu Introduction consists of 3 layers, the mesothelium, the basal membrane and connective tissue. Mesothelial cells are arranged over the basal membrane in the form of a single row and there are connectors and desmosomes at intervals. In addition, there are microvilli on the apical surface of mesothelial cells (1).The mesothelium has a similar structure in all areas of the peritoneum, but there are changes in thickness in the underlying connective tissue and cells. The thinnest mesothelium is in the anterior wall (2). The mesothelial cells may be cubic, smooth or intermittent in form. Cubic cells are often parenchymal over organs and the smooth cells are to be found more on the intestine, omentum and parietal peritoneum (3). The Effects of Carbon Dioxide Pneumoperitoneum on the Peritoneal Structure There have been experimental and clinical studies related to damage to the peritoneal structure in laparoscopic surgery (4, Pneumoperitoneum created with carbon dioxide insufflation is still a widely used method throughout the world in laparoscopic surgery. During the development of laparoscopic techniques, several gases have been used for this purpose. However, none have become as widely used as carbon dioxide. While providing an appropriate area to be worked on by the surgeon, it is also however, the reason for a series of unwanted side-effects. To date there have been many experimental and clinical studies in literature on the effects of carbon dioxide gas on the peritoneal structure. In this paper, literature was reviewed and a compilation was formed of the effects on the peritoneal structure of pneumoperitoneum created with carbon dioxide. Peritoneal Cavity Morphology The peritoneum is the largest serous membrane in the body and DOI: 10.22312/sdusbed.297916 Müracaat tarihi: 14.03.2017 Kabul tarihi: 12.04.2017 Yazışma Adresi / Corresponding: Bekir Sarıcık, Süleyman Demirel Üniversitesi Araştırma ve Uygulama Hastanesi, Genel Cerrahi Kliniği, Isparta, Türkiye. Tel: 0246 211 92 80/0537 063 80 26 E-mail: 45 Carbon Dioxide Effects On Peritoneum Bekir Sarıcık ve ark. 5). In addition to impairment of the morphological structure of the peritoneum, it may also cause a series of metabolic changes. For reasons such as gas insufflation, hypothermia, pressure, dryness or light, the creation of pneumoperitoneum may cause events such as peritoneal spillage, reduced fibrinolysis, changes in immune response, reductions in growth factor production, metabolic acidosis and focal tissue oxygen pressure (6). Several gases have been used in laparoscopic surgery such as carbon dioxide, helium, xenon and air and studies have been conducted on this subject. However, carbon dioxide, which is colourless, non-combustible and easily available, is the most widely used gas. As absorption and elimination are simple, there is no risk of gas embolism (7, 8). Although carbon dioxide is the most widely used gas, it also has several or basal membrane peeling was observed. The mesothelial cells exposed to carbon dioxide were seen to be a more dense structure in electron microscopy and apoptosis was also seen. There was an increase in the intracytoplasmic vacuoles and there were intermittent spaces between the epithelial cells. Oedema was observed in the subepithelial area (10). Wildbrett et al investigated the effects of helium and carbon dioxide on the peritoneum in rats. There was seen to be a significant level of reduction in the tissue oxygen pressure of both helium and the carbon dioxide. When a mixture of 80% carbon dioxide and 20% oxygen was used, there was no significant change in the tissue oxygen pressure. In addition, while the Ph value was reduced with carbon dioxide, it was increased with helium (11). In another study, air was compared with carbon dioxide. There was less clouding of the lens with the use of carbon dioxide, as there was a frequent need to clean the lens with the use of air. The return to daily activities was determined to be earlier with the use of carbon dioxide. As the air was not sterile, peritonitis was (...truncated)