Improved Outcomes for Lap-banding Using the Insuflow Device Compared with Heated-only Gas

Overview

Journal JSLS

Specialty General Surgery

Date 2009 Oct 2

PMID 19793466

Citations 9

Authors

Richard Benavides

Alvin Wong

Hoang Nguyen

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Preconditioning gas by humidification and warming the pneumoperitoneum improves laparoscopic outcomes. This prevents peritoneal desiccation and detrimental events related to traditional cold-dry gas. Few comparisons have been done comparing traditional cold-dry, heated-only, and humidified-warmed carbon dioxide.

Methods: A prospective, controlled, randomized, double-blind study of laparoscopic gastric banding included 113 patients and compared traditional dry-cold (n=35) versus dry-heated (n=40), versus humidified-warm gas (n=38). Pain medications were standardized for all groups. Endpoints were recovery room length of stay, pain location, pain intensity, and total pain medications used postoperatively for up to 10 days.

Results: The humidified-warmed group had statistically significant differences from the other 2 groups with improvement in all end points. The dry-heated group had significantly more pain medication use and increased shoulder and chest pain than the other 2 groups had.

Conclusion: Using warm-humidified gas for laparoscopic gastric banding reduces shoulder pain, shortens recovery room length of stay, and decreases pain medication requirements for up to 10 days postoperatively. Dry-heated gas may cause additional complications as is indicated by the increase in pain medication use and pain intensity.

Citing Articles

Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review.

Cheong J, Keshava A, Witting P, Young C Ann Coloproctol. 2018; 34(3):125-137.

PMID: 29991201 PMC: 6046539. DOI: 10.3393/ac.2017.09.26.

Heated insufflation with or without humidification for laparoscopic abdominal surgery.

Birch D, Dang J, Switzer N, Manouchehri N, Shi X, Hadi G Cochrane Database Syst Rev. 2016; 10:CD007821.

PMID: 27760282 PMC: 6464153. DOI: 10.1002/14651858.CD007821.pub3.

Warmed and humidified carbon dioxide for abdominal laparoscopic surgery: meta-analysis of the current literature.

Balayssac D, Pereira B, Bazin J, Le Roy B, Pezet D, Gagniere J Surg Endosc. 2016; 31(1):1-12.

PMID: 27005288 DOI: 10.1007/s00464-016-4866-1.

Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery.

Binda M Arch Gynecol Obstet. 2015; 292(5):955-71.

PMID: 25911545 PMC: 4744605. DOI: 10.1007/s00404-015-3717-y.

The effects of insufflation conditions on rat mesothelium.

Davey A, Hayward J, Marshall J, Woods A Int J Inflam. 2013; 2013:816283.

PMID: 23864985 PMC: 3707227. DOI: 10.1155/2013/816283.

References

Dixon J, Reuben Y, Halket C, OBrien P . Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg. 2005; 15(8):1111-7. DOI: 10.1381/0960892055002149. View

Ren C, Fielding G . Laparoscopic adjustable gastric banding: surgical technique. J Laparoendosc Adv Surg Tech A. 2003; 13(4):257-63. DOI: 10.1089/109264203322333584. View

Alexander J . Pain after laparoscopy. Br J Anaesth. 1997; 79(3):369-78. DOI: 10.1093/bja/79.3.369. View

Farley D, Greenlee S, Larson D, Harrington J . Double-blind, prospective, randomized study of warmed, humidified carbon dioxide insufflation vs standard carbon dioxide for patients undergoing laparoscopic cholecystectomy. Arch Surg. 2004; 139(7):739-43. DOI: 10.1001/archsurg.139.7.739. View

Hamza M, Schneider B, White P, Recart A, Villegas L, Ogunnaike B . Heated and humidified insufflation during laparoscopic gastric bypass surgery: effect on temperature, postoperative pain, and recovery outcomes. J Laparoendosc Adv Surg Tech A. 2005; 15(1):6-12. DOI: 10.1089/lap.2005.15.6. View

Wills V, Hunt D, Armstrong A . A randomized controlled trial assessing the effect of heated carbon dioxide for insufflation on pain and recovery after laparoscopic fundoplication. Surg Endosc. 2001; 15(2):166-70. DOI: 10.1007/s004640000344. View

Ott D . Desertification of the peritoneum by thin-film evaporation during laparoscopy. JSLS. 2003; 7(3):189-95. PMC: 3113197. View

Demco L . Effect of heating and humidifying gas on patients undergoing awake laparoscopy. J Am Assoc Gynecol Laparosc. 2001; 8(2):247-51. DOI: 10.1016/s1074-3804(05)60585-3. View

Mouton W, Bessell J, Otten K, Maddern G . Pain after laparoscopy. Surg Endosc. 1999; 13(5):445-8. DOI: 10.1007/s004649901011. View

10.

Ott D, Reich H, Love B, McCorvey R, Toledo A, Liu C . Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow device: a prospective randomized controlled multi-center study. JSLS. 1999; 2(4):321-9. PMC: 3015252. View

11.

Saad S, Minor I, Mohri T, Nagelschmidt M . The clinical impact of warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy. Surg Endosc. 2000; 14(9):787-90. DOI: 10.1007/s004640010060. View

12.

Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J . Effect of CO(2) gas warming on pain after laparoscopic surgery: a randomized double-blind controlled trial. Surg Endosc. 1999; 13(11):1110-4. DOI: 10.1007/s004649901184. View

13.

Li T, Saravelos H, Richmond M, Cooke I . Complications of laparoscopic pelvic surgery: recognition, management and prevention. Hum Reprod Update. 1998; 3(5):505-15. DOI: 10.1093/humupd/3.5.505. View

14.

Elenkov I, Iezzoni D, Daly A, Harris A, Chrousos G . Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation. 2005; 12(5):255-69. DOI: 10.1159/000087104. View

15.

Binda M, Molinas C, Hansen P, Koninckx P . Effect of desiccation and temperature during laparoscopy on adhesion formation in mice. Fertil Steril. 2006; 86(1):166-75. DOI: 10.1016/j.fertnstert.2005.11.079. View

16.

Almeida Jr O . Awake microlaparoscopy with the Insuflow device. JSLS. 2002; 6(3):199-201. PMC: 3043433. View

17.

Beste T, Daucher J, Holbert D . Humidified compared with dry, heated carbon dioxide at laparoscopy to reduce pain. Obstet Gynecol. 2006; 107(2 Pt 1):263-8. DOI: 10.1097/01.AOG.0000194065.59688.fa. View

18.

Mouton W, Bessell J, Millard S, Baxter P, Maddern G . A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery. Surg Endosc. 1999; 13(2):106-8. DOI: 10.1007/s004649900915. View