The Influence of Carbon Dioxide Pneumoperitoneum on Portal Blood Flow in Patients with Liver Cirrhosis

Sumito Takagi, Hironori Kaneko, Akira Tamura, Naoki Joubara, Toshio Katagiri, Masaru Tsuchiya, Takashi Ishii and Tadaaki Shiba

2nd. Department of Surgery, Toho University, School of Medicine

The aim of this study was to investigate the influence of carbon dioxide pneumoperitoneum on cholelithiasis patients with liver cirrhosis. A total of 24 patients with symptomatic gallstones were scheduled for laparoscopic cholecystectomy. The patients were divided into two groups : an LC group (with liver cirrhosis, n=12) and a Control group (without liver cirrhosis, n=12). The cross sectional area of the portal vein trunk (S), the velocity of portal blood (V), and the mean portal blood flow (F) were measured and calculated by using a laparoscopic pulsed Doppler ultrasonic probe after insufflating the abdomen to an intra-abdominal pressure (IAP) of 4 to 15 mmHg. Subsequent laparoscopic cholecystectomy was performed successfully. Total bilirubin (T-Bil), AST, and ALT were measured on postoperative day 1 (POD 1). No significant differences were found in the background factors or postoperative course between the LC group and the Control group, except for the preoperative serum platelet level. The serum levels of T-Bil, AST, and ALT on POD 1 in the LC group were significantly higher than in the Control group (p<0.05). As IAP increased, the S, V and F values in the LC group significantly decreased (p<0.01). The F value at an IAP of 15 mmHg was significantly correlated with the ALT level on POD 1 in the LC group (R=-0.888, p=0.0002). In conclusion, the F values were shown to be a good parameter for intraoperative evaluation of liver function after laparoscopic surgery in patients with liver cirrhosis.

Key words
laparoscopic cholecystectomy, liver cirrhosis, CO₂ pneumoperitoneum, laparoscopic Doppler ultrasonography, portal blood flow

Reprint requests
Sumito Takagi 2nd. Department of Surgery, Toho University, School of Medicine 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JAPAN

Accepted
October 31, 2000

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