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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2018

01-09-2018

Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension

Authors: Ester Párraga Ros, Laura Correa-Martín, Francisco M. Sánchez-Margallo, Irma Eugenia Candanosa-Aranda, Manu L. N. G. Malbrain, Robert Wise, Rafael Latorre, Octavio López Albors, Gregorio Castellanos

Published in: Surgical Endoscopy | Issue 9/2018

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Abstract

Background

Low splanchnic perfusion is an immediate effect of pneumoperitoneum-induced intra-abdominal hypertension (IAH). Anatomical structure results in the intestinal mucosa being the area most sensitive to hypoperfusion. The relationship between intestinal injury and clinical parameters of tissue perfusion [abdominal perfusion pressure (APP), gastric intramucosal pH (pHi) and lactic acid (Lc)] has not been previously studied. This study aimed to monitorize intestinal pathogenesis through sequential ileal biopsies and to measure APP, pHi, and Lc levels at different pneumoperitoneum-induced intra-abdominal pressures (20, 30, and 40 mmHg) to evaluate the potential relationships between them.

Materials and methods

Fifty pigs were divided into four groups; a control group (C) and three experimental groups with different pneumoperitoneum-induced levels [20 mmHg (G20), 30 mmHg (G30), and 40 mmHg (G40)], that were maintained for 3 and 5 h. APP, pHi, and Lc were measured and ileal biopsies taken laparoscopically every 30 min. The mucosal damage was graded using the standardized Park’s Score and animals were classified as injured (I+) or uninjured (I−).

Results

Different histopathological lesions were observed in groups G20, G30, and G40 but no damage observed in group C. A 33.3% of animals in G20 and G30 were I+ after 3 h, while 93.3% were injured in G40. After 5 h, histopathological lesions were no longer seen in some animals in G20 and only 10% were I+. Conversely, in G30 I+ pigs increased to 80% while those in G40 remained at 93.3% I+. The I+ animals had significantly lower APP and pHi than those I−. Lc was the clinical parameter that showed the earliest differences, with significantly higher figures in I+ animals.

Conclusions

The evolution of intestinal injuries from pneumoperitoneum-induced IAH depends on the degree of IAP. These damages may be associated with decreases in APP and pHi, and increases in Lc.
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Metadata
Title
Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension
Authors
Ester Párraga Ros
Laura Correa-Martín
Francisco M. Sánchez-Margallo
Irma Eugenia Candanosa-Aranda
Manu L. N. G. Malbrain
Robert Wise
Rafael Latorre
Octavio López Albors
Gregorio Castellanos
Publication date
01-09-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6142-z

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