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Chirurgie 9. Dezember 2014

Effects of different intra-abdominal pressure values on different organs: what should be the ideal pressure?

Background and purpose: The control of intra-abdominal pressure (IAP) values clinically has gained considerable importance, as they affect organ functions and organ damage. Hence, the discussions on secure IAP values to be used in laparoscopic interventions still continue. In this study, the effects of low IAP values simultaneously on intrathoracic, intra-abdominal, and extra-abdominal organ damage are presented.

Methods: This study was conducted on 40 male Sprague Dawley rats in total, with an average weight of 300 ± 20 g. A saline infusion of 10 ml/kg/h was administered to all the rats from the tail vein. Mechanical ventilator support was maintained for 1 h after the tracheotomy was opened. The rats in the study were separated into four equal groups. No pneumoperitoneum, 6-mmHg pneumoperitoneum, 9-mmHg pneumoperitoneum, and 12-mmHg pneumoperitoneum was applied to Group A (control), Group B, Group C, and Group D, respectively. A total of 30 min after completion of the procedure, lung, terminal ileum, and testicle tissues taken from the rats were examined histopathologically. The results obtained were evaluated, and a statistical package was used for statistical analysis.

Results: A statistically significant difference was not detected between groups in the evaluation of presence of organ damage with respect to intestinal damage (p > 0.05). However, statistically significant difference was detected between groups with respect to lung damage (χ2 = 16.684; p = 0.001 < 0.05) and testicle damage (χ2 = 15.508; p = 0.001 < 0.05). With respect to group variable, although a statistically significant difference was not determined between mean intestinal damage scores in the groups (p > 0.05), a statistically significant difference was determined between mean lung damage scores (Kruskal–Wallis H (KW) = 16.743; p = 0.001 < 0.05) and mean testicle damage scores (KW = 15.088; p = 0.002 < 0.05).

Conclusion: In line with the data obtained from the study, when organs in different compartments of the body are evaluated as a whole, we predict that secure IAP values are between 6 and 9 mmHg.

H. R. Aydin, Assist. Prof. S. Kesici, Assist. Prof. U. Kesici, Assist. Prof. I. Saygin, Assoc. Prof. H. Ulusoy, Prof. M. Imamoglu, Prof. O. Deger, European Surgery 5/2014

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