Endoscopy during laparoscopy: Reduced postprocedural bowel distention with intraluminal CO₂ insufflation

Background: Intraluminal endoscopy during laparoscopy can substitute for manual palpation in defining anatomy and pathology, but a potential problem is the persistent bowel distention associated with intraluminal air insufflation. Methods: To compare the rates of intraluminal absorption, a 30- cm segment of small bowel with an intact vascular supply was insufflated with either air or CO₂ during CO₂ pneumoperitoneum. Intraluminal pressures and bowel circumferences were monitored after the insufflation was stopped. To study the metabolic and hemodynamic effects of CO₂ endoscopy during laparoscopy, the small bowel was insufflated to an intraluminal pressure of 15 mmHg during CO₂ pneumoperitoneum. Nitrogen pneumoperitoneum was used to differentiate the effects from intraluminal and peritoneal CO₂ insufflation. Results: The intraluminal pressures remained elevated and the bowel distended for the entire 3 h following bowel insufflation with air. Following intraluminal CO₂ insufflation, both the intraluminal pressures and the bowel circumferences returned to preinsufflation values within 15 min. Intraluminal CO₂ insufflation also led to systemic absorption of CO₂ with significant metabolic and hemodynamic changes. These changes were effectively corrected by doubling minute ventilation. Conclusions: Intraluminal CO₂ was absorbed faster than intraluminal air. Although decreased bowel distention is certainly of practical value, endotracheal intubation needs to be done to effectively ventilate the absorbed CO₂.