Utilisation of Humidified Warm Co₂ Insufflation in Laparoscopic Hiatus Hernia Repair: A Randomised Control Trial Evaluating Perioperative and Clinical Outcomes

Background Inadvertent perioperative hypothermia (IPH) is linked to adverse postoperative outcomes. The utilisation of warm humidified carbon dioxide insufflation is associated with the reduced risk of IPH by preventing intraoperative hypothermia during laparoscopic procedures. However, there lies a paucity of evidence in determining the benefits of this intervention in laparoscopic hiatus hernia repair. Methods Fifty-nine patients were randomised into two laparoscopic groups—control group which received dry, room temperature CO2, and HumiGard group (warm, humidified CO2). Three patients were excluded as they failed to receive HumiGard appropriately. Core temperatures of patients were measured at 30-minute intervals from the start of surgery to the end. A standardised Pain Visual Analogue Score (VAS) score was awarded based on pain levels reported postoperatively. The oral morphine equivalent (OME) was measured based on total analgesic use by patients postoperatively from days one to three. Postoperative blood markers were also obtained and compared between both groups. Results A larger proportion of patients from the HumiGard group who were experiencing intraoperative hypothermic episodes achieved normothermia by the end of surgery (HumiGard 61.54% vs Control 55.56%). The OME requirement by the HumiGard patients was lower across all three days postoperatively compared to the control group despite a lower median pain score reported by the control group. The length of stay was the same between both groups, and there were no significant differences in postoperative blood makers when measured across three days in the postoperative period. Conclusion This prospective randomised control trial demonstrated positive outcomes for patients receiving warm, humidified CO2 during laparoscopic hiatus hernia repair via the restoration of core-body temperature which reduced the risk of inadvertent perioperative hypothermia. This translated into lower OME requirement postoperatively.