Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension
Por:
Párraga Ros E., Correa-Martín L., Sánchez-Margallo F.M., Candanosa-Aranda I.E., Malbrain M.L.N.G., Wise R., Latorre R., López Albors O., Castellanos G.
Publicada:
1 sep 2018
Ahead of Print:
1 ene 2018
Categoría:
Surgery
Resumen:
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 (pH(i)) and lactic acid (Lc)] has not
been previously studied. This study aimed to monitorize intestinal
pathogenesis through sequential ileal biopsies and to measure APP,
pH(i), 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, pH(i), 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 pH(i) 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 pH(i), and increases in Lc.
Filiaciones:
Párraga Ros E.:
Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
Correa-Martín L.:
Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre (JUMISC), Cáceres, Spain
Sánchez-Margallo F.M.:
Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre (JUMISC), Cáceres, Spain
Candanosa-Aranda I.E.:
Highlands Teaching and Research Farm (CEIEPAA), Faculty of Veterinary Medicine, National Autonomous University of Mexico, Queretaro, Mexico
Malbrain M.L.N.G.:
Medical and Surgical ICU and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg/St-Erasmus, Lange Beeldekensstraat 267, Antwerp, Belgium
Wise R.:
Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, South Africa
Clinical Unit, Critical Care, Edendale Hospital, Pietermaritzburg, South Africa
Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
Latorre R.:
Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
López Albors O.:
Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
Castellanos G.:
Department of General Surgery, Virgen de la Arrixaca General University Hospital, Murcia, Spain
|