Effect of intra‐abdominal pressure on hepatic microcirculation: Implications of the endothelin‐1 receptor

Sánchez‐Etayo, G.; Borrat, X.; Escobar, Bibiana; Hessheimer, Amelia J.; Rodríguez-Laiz, G.; Taurà, Pilar

doi:10.1111/j.1751-2980.2012.00613.x

Cited by 11 publications

(4 citation statements)

References 33 publications

(54 reference statements)

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“…Since normal portal venous pressure is between 7 and 10 mmHg, increase in intra-abdominal pressure above this level reduces portal blood flow and may therefore cause a certain degree of hepatic ischemia [ 96 – 98 ]. Animal studies have shown a pressure-dependent decrease n hepatic blood flow, although this difference was not significant in all studies [ 93 , 99 , 100 ]. Likewise, postoperative AST and ALT were significantly increased when comparing low- versus standard-pressure PNP [ 101 , 102 ].…”

Section: Discussionmentioning

confidence: 99%

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

et al. 2015

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BackgroundLaparoscopic surgery has several advantages when compared to open surgery, including faster postoperative recovery and lower pain scores. However, for laparoscopy, a pneumoperitoneum is required to create workspace between the abdominal wall and intraabdominal organs. Increased intraabdominal pressure may also have negative implications on cardiovascular, pulmonary, and intraabdominal organ functionings. To overcome these negative consequences, several trials have been performed comparing low- versus standard-pressure pneumoperitoneum.MethodsA systematic review of all randomized controlled clinical trials and observational studies comparing low- versus standard-pressure pneumoperitoneum.Results and conclusionsQuality assessment showed that the overall quality of evidence was moderate to low. Postoperative pain scores were reduced by the use of low-pressure pneumoperitoneum. With appropriate perioperative measures, the use of low-pressure pneumoperitoneum does not seem to have clinical advantages as compared to standard pressure on cardiac and pulmonary function. Although there are indications that low-pressure pneumoperitoneum is associated with less liver and kidney injury when compared to standard-pressure pneumoperitoneum, this does not seem to have clinical implications for healthy individuals. The influence of low-pressure pneumoperitoneum on adhesion formation, anastomosis healing, tumor metastasis, intraocular and intracerebral pressure, and thromboembolic complications remains uncertain, as no human clinical trials have been performed. The influence of pressure on surgical conditions and safety has not been established to date. In conclusion, the most important benefit of low-pressure pneumoperitoneum is lower postoperative pain scores, supported by a moderate quality of evidence. However, the quality of surgical conditions and safety of the use of low-pressure pneumoperitoneum need to be established, as are the values and preferences of physicians and patients regarding the potential benefits and risks. Therefore, the recommendation to use low-pressure pneumoperitoneum during laparoscopy is weak, and more studies are required.

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Section: Discussionmentioning

confidence: 99%

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

et al. 2015

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“…decreased cardiac output, vasoconstriction in the pulmonary artery, impairment of renal and splanchnic circulation (Bomberg et al 2013 ; Ross 2012 ; Schuuring et al 2013 ). It has been demonstrated in animal experiments that dual ETA/ETB endothelin blockade during endotoxaemia improves cardiopulmonary function, reduces pulmonary hypertension and lung injury and attenuates intestinal and liver microcirculatory dysfunction (Kuklin et al 2005 ; Sánchez-Etayo et al 2012 ). Also ETA receptor blockade alone improves the function of the lungs (Mercier et al 2010 ), kidney (Rullman et al 2010 ), heart (Vanêcková et al 2005 ) and aorta (Tirapelli et al 2008 ).…”

Section: Et-1 and Endothelin Receptor Antagonists In Sepsismentioning

confidence: 99%

The Role of Endothelin-1 and Endothelin Receptor Antagonists in Inflammatory Response and Sepsis

Kowalczyk

Kleniewska

Kołodziejczyk

et al. 2014

Arch. Immunol. Ther. Exp.

231

150

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Endothelin-1 (ET-1) is a potent endogenous vasoconstrictor, mainly secreted by endothelial cells. It acts through two types of receptors: ETA and ETB. Apart from a vasoconstrictive action, ET-1 causes fibrosis of the vascular cells and stimulates production of reactive oxygen species. It is claimed that ET-1 induces proinflammatory mechanisms, increasing superoxide anion production and cytokine secretion. A recent study has shown that ET-1 is involved in the activation of transcription factors such as NF-jB and expression of proinflammatory cytokines including TNF-a, IL-1, and IL-6. It has been also indicated that during endotoxaemia, the plasma level of ET-1 is increased in various animal species. Some authors indicate a clear correlation between endothelin plasma level and morbidity/mortality rate in septic patients. These pathological effects of ET-1 may be abrogated at least partly by endothelin receptor blockade. ET-1 receptor antagonists may be useful for prevention of various vascular diseases. This review summarises the current knowledge regarding endothelin receptor antagonists and the role of ET-1 in sepsis and inflammation.

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“…However, during carbon dioxide pneumoperitoneum, hepatic artery blood flow cannot compensate for the decrease in portal vein blood flow. One possible explanation was that the absorption of carbon dioxide through the peritoneum could lead to adrenergic activity and hypercapnia leading to acidosis, which was known to affect the regulation of hepatic perfusion (13,18). Further analysis showed that TP and ALB were decreased to a greater extent in the transperitoneal approach than that in the extraperitoneal approach.…”

Section: Discussionmentioning

confidence: 99%

Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy on postoperative hepatic and renal function

Lee¹,

Tang²,

Li³

et al. 2020

Gland Surg

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Background: In this retrospective study, we evaluated the effect of two approaches of robotic-assisted laparoscopic radical prostatectomy (RALP). The first approach was pneumoperitoneum via transperitoneal (TP-RALP), and the second approach was extraperitoneal (EP-RALP) on visceral function. We aimed to provide clinical evidence for the perioperative safety with RALP and to help the surgical team choose an appropriate approach for those with hepatic or renal insufficiency.Methods: One hundred and fifty-seven eligible prostate cancer patients from 2015 to 2019 were included in this study. The postoperative related laboratory tests were compared between transperitoneal and extraperitoneal. The primary endpoint was hepatic and renal function. We also evaluate the intraoperative amount of bleeding, the length of postoperative hospital stays, the occurrence of postoperative complications (lymphatic leakage, bleeding, and infection), and the prostate-specific antigen (PSA).Results: Postoperative total bilirubin and bound bilirubin in both groups were significantly increased, while total protein, albumin, globulin, urea, and uric acid were significantly decreased (P<0.05). The total protein, albumin, and globulin are significantly higher in the EP-RALP group than in the TP-RALP group (P<0.05) postoperatively. There are no statistical differences in estimated glomerular filtration rate (eGFR) and creatinine clearance (CCR) between these two groups, postoperatively.Conclusions: RALP had a significant effect on hepatic function after both TP-RALP and EP-RALP approaches, while the latter showed a lesser extent. Our results suggested that pneumoperitoneal pathways have significant effects on protein consumption. Thus, we should require a more cautious choice of surgical approaches when it comes to patients with impaired hepatic function or under risk of hepatic malfunction.

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Effect of intra‐abdominal pressure on hepatic microcirculation: Implications of the endothelin‐1 receptor

Abstract: Blocking ET(A) and ET(B) receptors partially protects sinusoidal circulation and tissue oxygenation against stress induced by high IAP.

Cited by 11 publications

References 33 publications

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

The Role of Endothelin-1 and Endothelin Receptor Antagonists in Inflammatory Response and Sepsis

Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy on postoperative hepatic and renal function

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