Does elevated intra-abdominal pressure during laparoscopic colorectal surgery cause acute gastrointestinal injury?

Cai, Zhenghao; Malbrain, Manu L N G; Sun, Jing; Pan, Ruijun; Ma, Junjun; Feng, Bo; Dong, Feng

doi:10.5114/wiitm.2015.52210

Cited by 6 publications

(5 citation statements)

References 34 publications

(38 reference statements)

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“…We also investigated the ratio between IL-6, a pro-inflammatory mediator which regulates systemic inflammatory responses, and IL-10, an anti-inflammatory cytokine involved in the negative feedback loops of other cytokine production pathways. [ 12 ] Plasma levels of IL-6 were raised in both groups but in the higher pressure group these levels were reduced at a much slower rate. The IL-10 concentration decreased in the 15 mm Hg group, potentially indicating a prolonged injury and larger inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Serum cytokine levels as markers of paralytic ileus following robotic radical prostatectomy at different pneumoperitoneum pressures

Hampson¹,

Raj²,

Lingamanaicker³

et al. 2021

Current Urology

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Background: To evaluate intraoperative and postoperative cytokines in patients who underwent robotic prostatectomy (RP) at a pressure of 12 or 15 mm Hg, and the risk of postoperative ileus. Materials and methods: We presented the first series evaluating intraoperative and postoperative cytokines in patients undergoing RP at a pressure of 12 or 15 mm Hg by a single surgeon. Changes in cytokine concentrations were shown to correlate with surgical outcomes and pathological states. The study investigated the changes in cytokine concentrations (interferon-γ, tumor necrosis factor-α, interleukin-1β [IL-1β], IL-2, IL-4, IL-6, IL-12, and IL-17) at different pneumoperitoneum pressures and their potential role in the development of postoperative ileus. Results: The data on 10 consecutive patients confirmed that a lower pneumoperitoneum pressure was associated with lower cytokine levels and a lower risk of ileus. There were increased levels of postoperative interferon-γ, tumor necrosis factor-α, IL-12p70, IL-1β, IL-2, IL-4, and IL-17a at 15 mm Hg when compared to 12 mm Hg. Conclusions: The data indicated that lower pressure RP reduced intra-/postoperative cytokine levels confirming our hypothesis. Larger patient numbers are required to further validate this but the implications of this data will benefit not only urological patients but also other speciality patients undergoing minimally invasive surgery.

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Section: Discussionmentioning

confidence: 99%

Serum cytokine levels as markers of paralytic ileus following robotic radical prostatectomy at different pneumoperitoneum pressures

Hampson¹,

Raj²,

Lingamanaicker³

et al. 2021

Current Urology

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“…[23] The method of AHFI applied may partly account for the lower levels of lactic acid, hemodynamic fluctuations, and incidence of AGI-related symptoms observed in the present study, in comparison to those reported in a previous study. [24]…”

Section: Discussionmentioning

confidence: 99%

“…The times to first bowel movement, first flatus/defecation, and tolerance of semiliquid food in the WH group were consistent with the results of a previous study. [24]…”

Section: Discussionmentioning

confidence: 99%

Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery

Liu

Hou

2019

Medicine

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Background: Laparoscopic colorectal surgery may adversely affect respiration, circulation, and acid-base balance in elderly patients, owing to the relatively long duration of CO 2 absorption. We conducted this retrospective study to determine the safety and efficacy of warmed, humidified CO 2 pneumoperitoneum in elderly patients undergoing laparoscopic colorectal surgery. Methods: We enrolled 245 patients between January 2016 and August 2018. The experimental group (warming and humidification group [WH]) received warmed (37°C), humidified (98%) insufflation of CO 2 , and the control group (cold, dry CO 2 /control group [CD]) received standard CO 2 (19°C, 0%). All other aspects of patient care were standardized. Intraoperative hemodynamic data, arterial blood pH, and lactic acid levels were recorded. We also recorded intra-abdominal pressure, incidence of shivering 1 hour after surgery, satisfaction scores of patients and surgeons 24 hours after surgery, times to first flatus/defecation, first bowel movement, and tolerance of semiliquid food, discharge time, and incidence of vomiting, diarrhea, and surgical site infections. Results: Compared with the WH group, heart rate and mean arterial pressure were significantly higher from T3 to T8 ( P < .05), lactic acid levels were significantly higher from T4 to T9 ( P < .05), and recovery time in the post-anesthesia care unit (PACU) was significantly longer in the CD group ( P < .05). Patient and surgeon satisfaction scores were significantly higher in the WH group than the CD group ( P < .05). In addition, the times to first flatus/defecation and bowel movement were significantly longer in the CD group ( P < .05). No significant differences were noted between the groups in the time to tolerance of semiliquid food and time of discharge ( P > .05). The incidence of vomiting, diarrhea, and shivering was significantly lower in the WH group ( P < .05). The number of patients with a shivering grade of 0 was significantly higher in the WH group, whereas the number with a shivering grade of 3 was significantly higher in the CD group ( P < .05). Conclusion: Warmed, humidified insufflation of CO 2 in elderly patients undergoing laparoscopic colorectal surgery could stabilize hemodynamics, and reduce lactic acid levels, recovery time in the PACU, and the incidence of acute gastrointestinal injury-related symptoms.

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“…But it might result in some IAP-dependent side effects, along with its surgical complications. Cases of severe oliguria following laparoscopic surgery were reported and are thought to be due to increased intra-abdominal pressure which results in increased pressure on the renal parenchyma, renal artery, and ureters, leading to decreased cardiac output and increased renin-angiotensin-aldosterone system hormonal activity, though no adverse effect of PP on gastrointestinal system function was found in a study conducted by Cai et al [ 1 , 8 , 22 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

The effects of prolonged CO insufflation on kidney function in a rat pneumoperitoneum model.

Dogan

Dönmez²,

Sunamak

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionPneumoperitoneum (PP) is known to cause ischemia in kidneys and other intra-abdominal organs because of decreased splanchnic blood flow.AimWe aimed to determine the degree of renal injury that occurs due to a PP and prolonged PP. We measured renal injury biomarkers and made a histopathological evaluation to estimate the degree of injury and assessed the correlation of biomarkers with histopathological findings.Material and methodsTwenty-one female Sprague Dawley rats were separated randomly into three groups. Group 1 was the control group and was given anesthesia for 3 h. In group 2, a PP was administered under anesthesia for 1 h. A pneumoperitoneum was administered under anesthesia to animals in group 3 for 3 h.ResultsPathological analysis showed a significant statistical difference between the 3 groups. In particular, neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels at the 24th h and preoperative mean urea levels showed a significant difference between the groups. The 24th-hour NGAL level in group 3 was significantly higher than that of group 1. The preoperative Cys C level was higher in group 1 than in either group 2 or 3. Cys C was decreased significantly in group 1 and increased significantly in both groups 2 and 3.ConclusionsThe increase in NGAL and Cys C levels directly correlated with the duration of PP and intra-abdominal pressure, and they are therefore good biomarkers in diagnosing acute renal injury in the early phase. Serum creatinine level is not a good biomarker in the early phase of renal injury.

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Does elevated intra-abdominal pressure during laparoscopic colorectal surgery cause acute gastrointestinal injury?

Cited by 6 publications

References 34 publications

Serum cytokine levels as markers of paralytic ileus following robotic radical prostatectomy at different pneumoperitoneum pressures

Serum cytokine levels as markers of paralytic ileus following robotic radical prostatectomy at different pneumoperitoneum pressures

Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery

The effects of prolonged CO insufflation on kidney function in a rat pneumoperitoneum model.

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