Surgical causes

Coelioscopy procedures are currently the major cause of VGE. Although CO2 is used, there is a risk of GE, which is estimated at around 1 to 2 per 100063.

Gas can enter either by direct accidental injection into a parietal vessel or into a highly vascularized organ (liver, spleen, uterus), or by venous laceration caused by the surgical dissection or the parietal distension due to the pneumoperitoneum. Although authors agree that the abdominal distension caused by the pneumoperitoneum leads to collapse of adjacent veins, resolution stops this protective effect of mechanical compression and accounts for the occurrence of post-surgical GE. Gas can also accumulate in the entrance site and migrate later with patient movement, which accounts for delayed post-surgical occurrences64.

Lastly, abdominal distension can be caused by other gases than the one causing the pneumoperitoneum: electrosurgical knives using an argon flow; gas-cooled lasers; haemostasis equipment spraying biological glue with air as a carrier gas65 may all cause GE by allowing the abdominal pressure to rise temporarily above the safety level.

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