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Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect
Xiaoguang Niu1, Xubin Song, Aiping Su
1Department of Pediatric Surgery, Department of Pharmacy, Taian City Central Hospital, Department of Surgery, Taishan Hospital of Shandong Province, Department of Reproductive Genetics Center, Taian City Central Hospital, Taian, China.
Insights
Lower capnoperitoneum pressure during pediatric laparoscopic inguinal hernia repair reduces physiological stress responses. This approach, along with open surgery, is preferable to high-pressure laparoscopy for minimizing patient stress.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Surgical Stress Response
Background:
- Pediatric laparoscopic inguinal hernia repair involves creating pneumoperitoneum.
- Different capnoperitoneum pressures may influence physiological stress responses in children.
- Evaluating these effects is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To compare the effects of high-pressure (12 mmHg) versus low-pressure (8 mmHg) capnoperitoneum during laparoscopic surgery.
- To assess the stress response in pediatric patients undergoing laparoscopic inguinal hernia repair versus open surgery.
- To determine the optimal capnoperitoneum pressure for minimizing stress in pediatric laparoscopic procedures.
Main Methods:
- Prospective randomized controlled study involving 68 children with indirect inguinal hernia.
- Three groups: high-pressure (HP) laparoscopy (12 mmHg), low-pressure (LP) laparoscopy (8 mmHg), and open operation (OP).
- Monitoring of heart rate, blood pressure, end-tidal CO2, and measurement of adrenocorticotropic hormone and cortisol levels.
Main Results:
- High-pressure capnoperitoneum significantly increased heart rate, blood pressure, and end-tidal CO2 compared to low-pressure and open surgery.
- Intraoperative adrenocorticotropic hormone and cortisol levels were higher in the high-pressure group than the low-pressure group.
- No significant differences in postoperative stress hormone levels were observed among the three groups.
Conclusions:
- Laparoscopic surgery using low-pressure capnoperitoneum or open operation effectively reduces physiological stress responses in pediatric patients.
- High-pressure capnoperitoneum is associated with a greater stress response compared to low-pressure laparoscopy.
- Low-pressure capnoperitoneum is a potentially safer and less stressful alternative for pediatric laparoscopic inguinal hernia repair.
Background:
We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair.
Methods:
In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO2 (PetCO2) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively.
Results:
After establishing capnoperitoneum, HR, blood pressure, and PetCO2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups.
Conclusions:
Laparoscopic surgery under LP capnoperitoneum or open operation may reduce stress responses and are superior to HP capnoperitoneum.
