Disappearance of intraperitoneal gas following gynaecological laparoscopy

We investigated 25 day case gynaecological laparoscopy patients to determine the duration of the pneumoperitoneum, the rate at which residual gas disappeared and the relative contribution of this gas to pain in the early postoperative period. The volume of gas was calculated from measurements of the subdiaphragmatic gas bubble obtained from an erect chest X-ray. Each patient was X-rayed twice, either immediately prior to discharge and at 24 h post laparoscopy, or at 24 h and 48 h post surgery. Patients were contacted by telephone at 24 and 48 h to confirm fitness to return for the X-ray and at the same time verbal pain and activity scores were recorded. We found that residual gas was almost entirely gone by 48 h following surgery and that it appeared to reduce in an exponential manner. The contribution of this gas to postoperative pain was significant in the first 24 h, but by 48 h it was considerably reduced. We conclude that in day case gynaecological laparoscopy patients, postoperative pneumoperitoneum is short-lived, and that by 48 h its volume and contribution to postoperative pain should be minimal.