Effect of intraoperative humidified CO2 insufflation in open laparotomy for colorectal resection: a randomized controlled trial.

Abstract

Bowel adhesion formation is a relatively common long-term complication of open abdominal surgery that can lead to small bowel obstruction. It is the byproduct of peritoneal inflammation that occurs during or after the surgical procedure. Studies suggest that peritoneal desiccation is an important contributing factor that promotes peritoneal inflammation and injury after laparotomy. Replacement of the operative atmosphere in the peritoneal cavity with humidified, warmed carbon dioxide (CO2) may prevent bowel desiccation and thereby mitigate peritoneal inflammation. Evidence from animal and human laparoscopic studies suggest that a humidified, warmed CO2 atmosphere prevents peritoneal inflammation and exerts other beneficial effects including stabilizing core body temperature and respiratory function and reducing perioperative pain, tumour cell migration and wound infection. There are as yet no human randomized controlled trials that have examined whether peritoneal inflammation occurs during laparotomy, and whether intervention with CO2 can mitigate this. Thus, the specific goals of this study are to determine the extent of peritoneal inflammation during open human abdominal colorectal surgery and the beneficial effects of CO2.