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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2008

01-01-2008

Signs of reperfusion injury following CO2 pneumoperitoneum: an in vivo microscopy study

Authors: Arash Nickkholgh, Miriam Barro-Bejarano, Rui Liang, Markus Zorn, Arianeb Mehrabi, Martha-Maria Gebhard, Markus W. Büchler, Carsten N. Gutt, Peter Schemmer

Published in: Surgical Endoscopy | Issue 1/2008

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Abstract

Background

During laparoscopic surgery, pneumoperitoneum is generally established by means of carbon dioxide (CO2) insufflation which may disturb hepatic microperfusion. It has been suggested that the desufflation at the end of the procedure creates a model of reperfusion in a previously ischemic liver, thus predisposing it to reperfusion injury.

Methods

To study the effects of pneumoperitoneum on hepatic microcirculation, Sprague-Dawley rats underwent pneumoperitoneum with an intraabdominal pressure of 8 or 12 mmHg for 90 min. Subsequently, in vivo microscopy was performed to assess intrahepatic microcirculation and transaminases were measured to index liver injury.

Results

A CO2 pneumoperitoneum of 8 mmHg did not change serum transaminases; however, further increase of intraperitoneal pressure to 12 mmHg significantly increased AST, ALT, and LDH measured after desufflation to almost 1.5 times as much as control values of 49 ± 5 U/L, 31 ± 3 U/L, and 114 ± 12 U/L. In parallel, in all subacinar zones the permanent adherence of both leukocytes and platelets to the endothelium increased by about sixfold and threefold, respectively. Furthermore, Kupffer cells labeled with latex beads as an index for their activation were significantly increased compared to controls.

Conclusion

This in vivo observation demonstrated traces of reperfusion injury in liver induced by the insufflation and desufflation of CO2 pneumoperitoneum. The clinical relevance of this finding and the issue of using hepatoprotective substances to prevent this injury should be further investigated.
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Metadata
Title
Signs of reperfusion injury following CO2 pneumoperitoneum: an in vivo microscopy study
Authors
Arash Nickkholgh
Miriam Barro-Bejarano
Rui Liang
Markus Zorn
Arianeb Mehrabi
Martha-Maria Gebhard
Markus W. Büchler
Carsten N. Gutt
Peter Schemmer
Publication date
01-01-2008
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 1/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-007-9386-6

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