Systemic and Peritoneal Effects of Pneumoperitoneum in Pediatric Laparoscopy

Background: Laparoscopy is a standard procedure for both children and adults. However, the potential effects of CO2 insufflation on the peritoneum remain unclear. This multicenter study aimed to assess the plasma levels of inflammatory markers and examine tissue changes in children who underwent pneumoperitoneum (PN) and laparoscopic surgery. Methods: From 2021 to 2023, patients who were candidates for elective laparoscopic surgery were divided into two groups based on their duration of PN: +/- 1 h. Serum samples were collected preoperatively (T0) and 24 h postoperatively (T1). Tumor necrosis factor-a, interleukin (IL)-6, IL-8, and regulated on activation, normal T cell expressed and secreted cytokine levels were quantified. Additionally, samples of the peritoneal serosa were obtained for double-blind histological evaluation at the beginning (T0) and end of the procedure (T1). The results are expressed as means +/- standard deviations, and significance was set at P < 0.05. Results: The study included 47 children with a median age of 12 (group A, n = 30; B, n = 17). The chemokine values at T0 and T1 did not show significant variations in either group, except for IL-8, which significantly decreased from T0 to T1, especially in group B. A peritoneal histological study showed moderate focal hyperplasia of the mesothelium and the presence of a light inflammatory infiltrate in T1 versus T0. These peritoneal changes were more present in group B than in group A. Conclusion: PN significantly reduced IL-8 levels and induced minor histological changes in the peritoneum, primarily in group B. Laparoscopic surgery minimally affected the integrity and biology of the peritoneum, resulting in beneficial effects on the immune system. (c) 2025 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).