Splanchnic mucosal ischemia: an unrecognized consequence of routine pneumoperitoneum.

The hemodynamic consequences of a pneumoperitoneum are well understood, but there have been no studies investigating its impact on splanchnic mucosal perfusion. By use of nasogastric tonometry, this study demonstrates that fit patients undergoing elective laparoscopic cholecystectomy at normal pneumoperitoneum pressures (12-15 mm Hg) develop significant splanchnic mucosal ischemia. This is a particular concern in patients with preexistent peripheral vascular disease undergoing prolonged laparoscopic procedures.