Improved abdominal wall wound healing by helium pneumoperitoneum

Abstract

The results suggest that helium pneumoperitoneum may ameliorate wound healing within the abdominal wall and could therefore represent a beneficial gas for endoscopic hernia repair.

Evaluation of the effects of carbon dioxide pneumoperitoneum on abdominal wall wound healing in rats undergoing segmental resection and anastomosis of the left colon

“…The most commonly used parameters to evaluate the healing process include clinical assessment of animals, tensile strength, analysis of anti-inflammatory activity, collagenous tissue expressed by hydroxyproline concentration or morphometric analysis, and histopathological analysis using optical microscopy [10][11][12] . Among these parameters, measurement of tensile strength is particularly relevant in cases of intervention through the abdominal wall, because tensile strength testing provides accurate and prompt results and reflects the reality of clinical practice, in which a pulling force is exerted on the surgical wound whenever patients contract their abdomen 9,11,13 .…”

“…Throughout the three phases, the scar tissue is arranged so that progressive collagen formation and remodeling can be observed [9][10][11][12]16 .…”

“…However, in the same period, the use of helium to create the pneumoperitoneum has been shown to increase collagen synthesis 10,12 .…”

“…It has been suggested that CO 2 pneumoperitoneum may affect tensile strength, because a decrease in pH is observed in the subcutaneous, intraarterial, and intra-abdominal tissue after the creation of a CO 2 pneumoperitoneum, a fact that leads to suppression of cellular differentiation of lineages derived from monocytes (which have a role in healing), thus altering collagen formation locally and systemically 10,12,17 .…”

“…Potential effects of chemical and cellular magnitude, such as those observed in metalloproteinases or peritoneal macrophage concentration, can be regarded as minimal, thus failing to promote changes in the criteria analyzed and, consequently, failing to present important clinical significance 4,8,10,12,17 .…”