The effect of different levels of peritoneal CO₂ pressure on bleeding time of spleen capsule injury

Aims: The authors, in contrast to similar injuries with open surgery, had observed spontaneous hemostasis of relatively large spleen capsule injuries during laparoscopic surgery. Methods: Standard spleen injuries were carried out in 5 anesthetized mongrel dogs at different CO₂ pressures and in open surgery. Bleeding was checked every minute by wiping around the injury but not removing the clot. Bleeding time was measured until no more oozing was detected. At every pressure level 3-3 measurements were done and analyzed. Parenchymal pressure of the spleen and systemic blood pressure were detected with direct catheter implantation. Results: In open surgery the average bleeding time was 15.2 min; at 5, 15, and 25 mmHg CO₂ pressures bleeding times were 12.3, 10.6, and 9.8 min, respectively. The parenchymal pressure of the spleen (5–6 mmHg) rose synchronously with peritoneal pressure, but no significant changes in systemic blood pressure were seen. Conclusion: Peritoneal CO₂ pressure may counterweight the parenchymal pressure of the spleen, thus helping hemostasis. There seems to be an inverse proportion between peritoneal pressure and bleeding time. In case of spleen capsule injury during laparoscopic surgery, chances for spontaneous hemostasis are much better compared to open surgery. Attention must be paid to maintain adequate peritoneal pressure.