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Physiologic changes with abdominal wall reconstruction in a porcine abdominal compartment syndrome model

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Abstract

Purpose

Abdominal compartment syndrome (ACS) is a severe complication of ventral hernia repair. The aims of this study were to investigate the effects of intra-abdominal pressure on the physiologic changes of abdominal wall reconstruction and component separation in a porcine model.

Methods

Ventral hernia repair (VHR) was simulated by abdominal fascial imbrication of a 10 × 15 cm defect in 45 Yorkshire pigs assigned to five experimental groups. ACS was simulated by a Stryker endoscopy insufflator with intra-abdominal pressure elevated to 20 mmHg in two groups. Component separation was performed in one of these groups and in one group without ACS. Physiological parameters were measured before and after the procedures and monitored for 4 h. The animals were euthanized for histologic analysis of organ damage.

Results

VHR led to an increase in intra-abdominal pressure, bladder pressure, and central venous pressure by an average of 14.89, 13.93, and 14.69 mmHg (p < 0.001) in all animals. Component separation was performed in 25 animals and the three pressures reduced by 9.11, 8.00, 7.89 mmHg (p < 0.001). ACS correlated with higher percentages of large and small bowel necrosis compared to groups without abdominal compartment syndrome.

Conclusions

The results confirm that primary repair of large abdominal wall defects leads to increased intra-abdominal pressure, which can be reduced with component separation. In animals with ACS, component separation may reduce the risk of organ damage. Central venous pressure, bladder pressure, and other physiologic parameters accurately correlated with elevated intra-abdominal pressure and may have utility as markers for diagnosis of ACS.

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Acknowledgments

We would like to thank TDMI for their expert animal management and assistance with surgical procedures. We would also like to thank Dr. Cinthia Drachenberg for analyzing the pathological specimens from this study and Dr. Leigh Ann Price for her input on the study design. This study was funded by a Lifecell Grant ISIS.08.01.00.ER.

Conflict of interest

RM declares no conflict of interest. HHC declares no conflict of interest. HDW declares no conflict of interest. AJN declares no conflict of interest. JAK declares no conflict of interest. GSM declares no conflict of interest. MM declares no conflict of interest. ENB declares no conflict of interest. MRC declares no conflict of interest. EDR declares conflict of interest not directly related to the submitted work (Grant—Synthes CMF, KLS Martin; support for travel—Synthes CMF; payment for lectures—CME Outfitters). This study was funded by a grant provided by Lifecell (Grant ISIS.08.01.00.ER). Eduardo D. Rodriguez received MD DDS—Grants (Synthes CMF, KLS Martin) and payments for lectures (Synthes CMF), travel accommodations/expenses for unrelated activities (Synthes CMF).

Ethical Standards

The experiments in this study comply with the current laws of the country in which they were performed.

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Authors and Affiliations

  1. Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA

    R. Mohan, H. G. Hui-Chou, H. D. Wang, A. J. Nam, M. Magarakis, G. S. Mundinger, E. N. Brown, A. J. Kelamis & M. R. Christy

  2. Department of Plastic Surgery, NYU Langone Medical Center, Institute of Reconstructive Plastic Surgery, 307 E 33rd st, New York, NY, 10012, USA

    E. D. Rodriguez

Authors
  1. R. Mohan
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  2. H. G. Hui-Chou
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  3. H. D. Wang
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  4. A. J. Nam
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  5. M. Magarakis
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  6. G. S. Mundinger
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  7. E. N. Brown
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  8. A. J. Kelamis
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  9. M. R. Christy
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  10. E. D. Rodriguez
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Corresponding author

Correspondence to E. D. Rodriguez.

Additional information

R. Mohan and H. G. Hui-Chou are equally contributed authors.

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Mohan, R., Hui-Chou, H.G., Wang, H.D. et al. Physiologic changes with abdominal wall reconstruction in a porcine abdominal compartment syndrome model. Hernia 19, 313–321 (2015). https://doi.org/10.1007/s10029-014-1313-x

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  • DOI: https://doi.org/10.1007/s10029-014-1313-x

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