Publication: Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension
Authors
Párraga Ros, Ester ; Correa Martín, Laura ; Sánchez‑Margallo, Francisco M. ; Candanosa‑Aranda, Irma Eugenia ; Malbrain, Manu L. N. G. ; Wise, Robert ; López Albors, Octavio Miguel ; Latorre Reviriego, Rafael Manuel ; Castellanos, Gregorio
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Publisher
Springer
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DOI
https://doi.org/10.1007/s00464-018-6142-z
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info:eu-repo/semantics/article
Description
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 intraabdominal 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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Citation
Surgical Endoscopy (2018) 32:3989–4002
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