Prevention of postoperative distention

Abstract

P OSTOPERATIVE distention is a troublesome symptom that often disturbs the surgeon and patient during the first few days after celiotomy. The purpose of this report is to suggest a simple procedure which has been found to prevent its occurrence in most instances of lower abdominal surgery. This procedure is to express manually, as nearly as possible, all the air from the abdominal cavity immediately prior to closing the parietal peritoneum. The rationale of this supposition is t.hat the abdominal cavity is ordinarily nonexistent or empty except for a few ounces of thin fluid and that air is forced into it by atmospheric pressure. This air must cause discomfort as is demon&rated when air is forced into the abdominal cavity in testing the patency of the Fallopian tubes (Rubin test). The amount of discomfort seems to be in proportion to the amount of gas used. Also, it was observed that patients who were delivered by extraperitoneal cesarean section often had no distention or gas pains. This is in contrast to the not uncommon occurrence of distention following the ordinary transperitoneal section. No air gets into the abdominal cavity when the extraperitonea.1 operation is successfully performed, as the peritoneal cavity is not entered. In studying the general subject of pneumoperitoneum, it was found that several years ago it was used as an aid in t,he diagnosis of intra.uterine conditions with x-ray.le3 [t was very soon observed that, by substituting carbon dioxide for oxygen or air, the untoward symptoms were diminished. Also, the patient, experienced much less discomfort when a small amount of gas was used in comparison to a larger quant,itv. Massive inflation of the abdomen sometimes resulted in marked d&tress or collapse of the paCent.’ No attempt is made to control the air t,hat gets into the abdominal cavity during peritoneoscopic examination, however, before withdrawing t,he instrument the air is encouraged to escape and sometimes pressure is made upon the abdomen to assist the evacuation.” Deflation, by expressing the air from the abdominal cavity immediately prior to closing the peritoneum, was therefore tried clinically and gave almost uniformly good results which prompted this communication. It should be emphasized that this procedure is not advocated as a preventive of ileus due t,o mechanical obstruction or infection. Also, it, c.annot be expected to have any effect on distention within the bowel 01 1.0 overcome the unt,oward aftermath of rough handling or traumatisru.