WOMENS-HEALTH Messages for October, 2002: Re: Gas pains after abdominal surgery ???

Re: Gas pains after abdominal surgery ???

From: William McIntosh, MD (anonymous@obgyn.net)
Tue, 1 Oct 2002 14:06:45 -0500 (CDT)

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At Tue, 1 Oct 2002, Curious wrote: >
>Gas pains post op ???
>
>I keep reading about the gas pains post surgery. It certainly makes me
>uneasy. I had open abdominal surgery in 1978 for a small bowel
>resection. Incision began above my belly button, ran along the right
>side of it and down to just an inch or two above the pubic bone. I
>didn't have ANY gas pains after surgery. I don't know how long the
>surgery took but it couldn't have been too short given the work that
>needed to be done. I didn't have a nasogastro tube before or after
>surgery, instead I had a tube emptying my bowel coming out of the upper
>left quadrant.
>
>I thought at first that those experiencing the gas pains were those who
>had laparoscopic surgery. But the more I read I see that many had open
>abdominal surgery and still experienced gas pain. WHY? How long does
>this gas pain last? How many days?
>
>What did Mayo Clinic know 24 years ago that local surgeons today don't
>know about today??? What surgical procedure "improvement" has been the
>cause of these gas pains?

There are two types of "gas pain". The first is the classic pain from a buildup of flatus inside the bowel. Anytime the bowel is touched, it stops moving for some period of time that is usually proportionate to the amount of touching. It then returns over time from the top down, ie, stomach first, the small bowel, then large bowel, and finally rectum. There are all sorts of things done for this, from early mobilization to graduated feeding to NG tubes and on and on. These have gone largely unchanged for 30 years.

The second type of gas pain is unique to laparoscopy. The abdomen is pumped full of carbon dioxide gas in order to create a work space. It is a safe, cheap, nontoxic in any amount, nonflammable gas, and generally perfect for the task. Try as you might however, there is no way to get all of it out at the end of a case, and the remnants combine with the water in the abdomen to produce a dilute carbonic acid. This is not harmful, but it irritates the diaphragm, which in turn refers its pain, typically to the right shoulder and arm, but other places as well sometimes.

-- William D. McIntosh, MD, FACOG

This is for educational purposes only, and is not a substitute for consultation and examination by a licensed medical professional.

Next message: William McIntosh, MD: "Re: ***temperature and thyroid? ***"
Previous message: Elise: "Re: prolapsed"
In reply to: Curious: "Gas pains after abdominal surgery ???"
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Reply: Curious: "Thank you, Dr McIntosh Re: Gas pains after abdominal surgery ???"

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