Abstract
Laparoscopy has become the procedure of choice for routine gallbladder removal. A
serious complication of this technique is the occurrence of gas emboli due to insufflation.
It is associated with a high mortality rate of around 28%. The present systematic
review intends to provide more insight into causes, symptoms and risk factors for
this specific complication and to explore which measures should be taken to treat
and prevent it. The Cochrane library and Pubmed were used as sources. Articles and
their references were selected when they were related to the subject in sufficient
detail.
The course of this complication can vary from asymptomatic up to impairment of normal
flow through the right ventricle (RV) or pulmonary artery, potentially leading to
acute heart failure. The severity depends on the amount of gas, the rate of accumulation
and the ability to remove the gas bubbles. It is difficult to estimate the true incidence
of venous gas embolism during laparoscopic cholecystectomy as there are various diagnostic
tools, each with different sensitivity. Precautions that need to be taken are: correct
positioning of the needle, low insufflation pressure, low insufflation speed, screening
for hypovolemia, Trendelenburg positioning, availability of intervention equipment
at operation table, no placement of venous catheters during inspiration and catheter
removing during expiration.
Physicians need to be more aware of this harmful complication and the preventative
measurements that need to be taken. As there are virtually no prospective data, future
studies are needed to gain more knowledge on gas emboli during laparoscopic cholecystectomy.
Keywords
Abbreviations:
CVP (Central Venous Pressure), ETCO2 (End Tidal Carbon Dioxide), ETN2 (End Tidal Nitrogen), HBOT (Hyperbaric oxygen therapy), mPAP (mean Pulmonary Artery Pressure), PEEP (Positive End Expiratory Pressure), SvO2 (Mixed Venous Oxygen Saturation), TEE (Trans Esophageal Echocardiography), TTE (Trans Thoracic Echocardiography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 20, 2018
Accepted:
October 14,
2018
Received:
August 11,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
