Assessment of a method to expel intraperitoneal gas after gynecologic laparoscopy

STUDY OBJECTIVE: To assess a method using instillation of saline to expel all residual intraperitoneal CO₂ after laparoscopy. If successful, this would enable clinicians to use radiography as a simple diagnostic test to detect bowel perforation following laparoscopic surgery. DESIGN: Cohort study (Canadian Task Force classification II-2). SETTING: Department of Endo-Gynecology, Royal Hospital for Women, Sydney, Australia. PATIENTS: Thirty women undergoing elective gynecologic laparoscopic surgery. INTERVENTIONS: At completion of surgery, the patient remained in maximum head- down position as the abdomen was filled with up to 1 L of normal saline. The suprapubic port remained open to allow the CO₂ to escape as it was displaced by the saline. Closure of abdominal ports was completed in routine manner. Erect upper abdominal radiographs were taken 24 hours after surgery, and measurements of any subdiaphragmatic gas were recorded. If gas was evident at 24 hours, a repeat radiograph was performed at 48 hours. MEASUREMENTS AND MAIN RESULTS: Of the 30 patients recruited, four did not complete the study protocol. There was evidence of subdiaphragmatic gas in 25 (96%) of 26 patients on the radiograph taken 24 hours postsurgery. The median volume of gas was 12.9 mL (range 0-2003 mL; IQ range 2.0-144 mL). Of the patients that had a second radiograph, 76% still had subdiaphragmatic gas present. CONCLUSION: This method for displacement of residual intraperitoneal gas at the end of laparoscopy does not appear to be effective.