Local and systemic impact of pnemoperitoneum on prepuberal rats

Abstract

Pneumoperitoneum (PN) and the gas used to insufflate the abdominal cavity during laparoscopy seem to be responsible for local and systemic modifications. The aim of this study was to verify the effects of intra-abdominal carbon dioxide (CO(2)) and air insufflation on the peritoneum, as well as the cortico-surrenal response in prepuberal rats. Sixty prepuberal rats were divided into three groups: in the first (S, n = 36), PN was induced with CO(2), whereas in the second (A, n = 14), it was induced with filtered room air; in both conditions, insufflation lasted 30 min at a pressure of 10-12 mmHg. The third group (C, n = 10), underwent general anesthesia only. Two hours after inducing anaesthesia, 12 rats in group S, 6 in group A and 6 in group C were killed and the remaining, after 24 h; specimens of the visceral and the parietal peritoneum were obtained for histological examination, blood sample was taken for cortisol and DHEA-S assays at the different study periods. At the histological examination performed 2 h later, the groups S and A presented inflammatory cell infiltrate in the parietal and visceral peritoneum; this finding was even more marked in group A, which presented also congestion, hemorrhage and disruption of the cell line. Twenty-four hours after the experiment, the peritoneum of the two insufflated groups presented chronic infiltrate and reactive mesothelial cells with congestion, which was more evident in group A, but totally absent in group C. Cortisol levels were significantly higher in groups S and A (2.15:1 ratio) killed 2 h later compared to those killed 24 h later and to the control group. DHEA-S levels were not significantly different between the groups. Our results demonstrate that the chemical, physical and molecular impact of CO(2) on the peritoneum causes inflammation and tissue damage, this was even more evident 24 h after our experiment and in the air insufflated group. PN induced a significant variation in blood cortisol levels at 2 h. The CO(2) insufflation should be limited in patients with pre-existing peritoneal damage.

Prosthetic Mesh for Obliteration of the Nephrosplenic Space in Horses: 26 Clinical Cases

“…It is thought that discomfort is due to stretching of abdominal muscle fibers during the period of increased intra‐abdominal pressure. Another potential cause of postoperative colic could be a transient chemical peritonitis from insufflation with CO 2 ; however, this is not reported commonly in other laparoscopic procedures.…”

Peritoneal changes due to laparoscopic surgery

“…Inflammatory cells have been found in the peritoneum already 2 h after initiation of a pneumoperitoneum, whereas after 24 h, a chronic infiltrate and reactive mesothelial cells with congestion were observed [15]. Suematsu et al [11] found that peritoneal changes during laparoscopy may be affected by the choice of insufflation gas, the amount of pressure, and the duration of insufflation.…”

Peritoneal Morphological Changes due to Pneumoperitoneum: The Effect of Intra-abdominal Pressure

“…The choice of the selected pressures was made based on our previous experience and related to other studies. 4,6,9,10 In all the groups, anesthesia was inducted by an intramuscular injection of tiletamine-zolazepam hydrochloride in a 1:1 ratio (Zoletil 100) at a dose of 0.2 mg/kg in association jointly with xylazine (Xylor) at a dose of 5 mg/kg into the legs of the animal; 15 minutes later, after shaving and cleansing the middle abdominal wall, a Veress needle was introduced in the abdomen and PN was induced with an insufflator (Storz Electronic CO 2 Endoflator, Karl Storz GmbH & Co., Tuttlingen, Germany) delivering filtered medical CO 2 or purified air at body temperature, with a flow rate of 0.5 L/min for 30 minutes. All the rats were sacrificed 24 hours after PN induction with an overdose of Zoletil.…”

“…These changes were aggravated by air PN. 6 Volz et al 7 have shown characteristic ultrastructural changes in the peritoneal surface after insufflation of CO 2 : the mesothelial cells were swollen with widening of intercellular junctions. Peritoneal macrophages were observed in the intercellular gaps.…”