World Journal of Surgery

, Volume 34, Issue 9, pp 2057–2063 | Cite as

Splanchnic Vasoregulation After Major Abdominal Surgery in Pigs

  • Lukas E. Brügger
  • Guido Beldi
  • Mario Beck
  • Francesca Porta
  • Hendrik Bracht
  • Daniel Candinas
  • Jukka Takala
  • Stephan M. JakobEmail author



Unrecognized reduction of blood supply to intestinal organs is associated with significant postoperative morbidity in abdominal surgery. The aim of this study was to determine whether—in the absence of hypovolemia—intestinal hypoperfusion as a result of blood flow redistribution occurs after abdominal surgery.


Standardized operative trauma was induced in 14 healthy pigs. Systemic, regional, and local blood flow, intestinal and gastric intraluminal-to-end-tidal pCO2 gradients representing mucosal perfusion, and oxygen transport variables were measured for 10 postoperative hours. Normovolemia was maintained using continuous infusion of Ringer’s lactate and additional boluses of colloids in response to blood pressure, pulmonary wedge pressure, and urinary output.


Postoperative blood flow was significantly increased in the celiac trunk (76% increase [percentage of baseline flow], p = 0.003) and the hepatic (136% increase, p = 0.002) and splenic (36% increase, p = 0.025) arteries. Blood flow was significantly decreased in the mesenteric artery (25% decrease, p = 0.007) and portal vein (13% decrease, p = 0.028). Carotid and renal artery blood flow remained unchanged.


Maintenance of normovolemia is insufficient to protect from intestinal hypoperfusion after abdominal surgery. Postoperative redistribution of cardiac output results in decreased intestinal and increased hepatic and splenic arterial blood flow.


Superior Mesenteric Artery Celiac Trunk Pulmonary Artery Occlusion Pressure Blood Flow Redistribution pCO2 Gradient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was funded by the Swiss National Fund for Scientific Research (SNF 3200BO-102268).

Conflicts of interest



  1. 1.
    Beldi G, Bisch-Knaden S, Banz V et al (2009) Impact of intraoperative behavior on surgical site infections. Am J Surg 198:157–162CrossRefPubMedGoogle Scholar
  2. 2.
    Mazeh H, Samet Y, Abu-Wasel B et al (2009) Application of a novel severity grading system for surgical complications after colorectal resection. J Am Coll Surg 208:355–361CrossRefPubMedGoogle Scholar
  3. 3.
    Luna A, Rebasa P, Navarro S et al (2009) An evaluation of morbidity and mortality in oncologic gastric surgery with the application of POSSUM, P-POSSUM, and O-POSSUM. World J Surg 33:1889–1894CrossRefPubMedGoogle Scholar
  4. 4.
    Teh SH, Diggs BS, Deveney CW et al (2009) Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines. Arch Surg 144:713–721CrossRefPubMedGoogle Scholar
  5. 5.
    Baue AE (1993) The role of the gut in the development of multiple organ dysfunction in cardiothoracic patients. Ann Thorac Surg 55:822–829CrossRefPubMedGoogle Scholar
  6. 6.
    Soong CV, Halliday MI, Barclay GR et al (1997) Intramucosal acidosis and systemic host responses in abdominal aortic aneurysm surgery. Crit Care Med 25:1472–1479CrossRefPubMedGoogle Scholar
  7. 7.
    Kuzu MA, Tanik A, Kale IT et al (2000) Effect of ischemia/reperfusion as a systemic phenomenon on anastomotic healing in the left colon. World J Surg 24:990–994CrossRefPubMedGoogle Scholar
  8. 8.
    Mythen MG, Webb AR (1994) Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost. Intensive Care Med 20:99–104CrossRefPubMedGoogle Scholar
  9. 9.
    Bennett-Guerrero E, Panah MH, Bodian CA et al (2000) Automated detection of gastric luminal partial pressure of carbon dioxide during cardiovascular surgery using the Tonocap. Anesthesiology 92:38–45CrossRefPubMedGoogle Scholar
  10. 10.
    Theodoropoulos G, Lloyd LR, Cousins G et al (2001) Intraoperative and early postoperative gastric intramucosal pH predicts morbidity and mortality after major abdominal surgery. Am Surg 67:303–308PubMedGoogle Scholar
  11. 11.
    Lebuffe G, Vallet B, Takala J et al (2004) A European, multicenter, observational study to assess the value of gastric-to-end tidal PCO2 difference in predicting postoperative complications. Anesth Analg 99:166–172CrossRefPubMedGoogle Scholar
  12. 12.
    Hamilton-Davies C, Mythen MG, Salmon JB et al (1997) Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med 23:276–281CrossRefPubMedGoogle Scholar
  13. 13.
    Vatner SF (1974) Effects of hemorrhage on regional blood flow distribution in dogs and primates. J Clin Invest 54:225–235CrossRefPubMedGoogle Scholar
  14. 14.
    Toung T, Reilly PM, Fuh KC et al (2000) Mesenteric vasoconstriction in response to hemorrhagic shock. Shock 13:267–273PubMedGoogle Scholar
  15. 15.
    Edouard AR, Degremont AC, Duranteau J et al (1994) Heterogeneous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 20:414–420CrossRefPubMedGoogle Scholar
  16. 16.
    Porta F, Takala J, Kolarova A et al (2005) Oxygen extraction in pigs subjected to low-dose infusion of endotoxin after major abdominal surgery. Acta Anaesthesiol Scand 49:627–634CrossRefPubMedGoogle Scholar
  17. 17.
    Brandt S, Regueira T, Bracht H et al (2009) Effect of fluid resuscitation on mortality and organ function in experimental sepsis models. Crit Care 13:R186CrossRefPubMedGoogle Scholar
  18. 18.
    Uusaro A, Lahtinen P, Parviainen I et al (2000) Gastric mucosal end-tidal PCO2 difference as a continuous indicator of splanchnic perfusion. Br J Anaesth 85:563–569CrossRefPubMedGoogle Scholar
  19. 19.
    Bailey RW, Brengman ML, Fuh KC et al (2000) Hemodynamic pathogenesis of ischemic hepatic injury following cardiogenic shock/resuscitation. Shock 14:451–459CrossRefPubMedGoogle Scholar
  20. 20.
    Tenhunen JJ, Uusaro A, Karja V et al (2003) Apparent heterogeneity of regional blood flow and metabolic changes within splanchnic tissues during experimental endotoxin shock. Anesth Analg 97:555–563CrossRefPubMedGoogle Scholar
  21. 21.
    Riddez L, Hahn RG, Brismar B et al (1997) Central and regional hemodynamics during acute hypovolemia and volume substitution in volunteers. Crit Care Med 25:635–640CrossRefPubMedGoogle Scholar
  22. 22.
    Jakob SM, Ruokonen E, Vuolteenaho O et al (2001) Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion. Crit Care Med 29:1393–1398CrossRefPubMedGoogle Scholar
  23. 23.
    Mackway-Jones K, Foex BA, Kirkman E et al (1999) Modification of the cardiovascular response to hemorrhage by somatic afferent nerve stimulation with special reference to gut and skeletal muscle blood flow. J Trauma 47:481–485CrossRefPubMedGoogle Scholar
  24. 24.
    Foex BA, Kirkman E, Little RA (2004) Injury (nociceptive afferent nerve stimulation) modifies the hemodynamic and metabolic responses to hemorrhage in immature swine. Crit Care Med 32:740–746CrossRefPubMedGoogle Scholar
  25. 25.
    Jakob SM, Kosonen P, Ruokonen E et al (1999) The Haldane effect—an alternative explanation for increasing gastric mucosal PCO2 gradients? Br J Anaesth 83:740–746PubMedGoogle Scholar
  26. 26.
    Lautt WW (1985) Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Physiol 249:G549–G556PubMedGoogle Scholar
  27. 27.
    Hiltebrand LB, Krejci V, tenHoevel ME et al (2003) Redistribution of microcirculatory blood flow within the intestinal wall during sepsis and general anesthesia. Anesthesiology 98:658–669CrossRefPubMedGoogle Scholar
  28. 28.
    Brandstrup B, Tonnesen H, Beier-Holgersen R et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238:641–648CrossRefPubMedGoogle Scholar
  29. 29.
    Nisanevich V, Felsenstein I, Almogy G et al (2005) Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103:25–32CrossRefPubMedGoogle Scholar
  30. 30.
    McArdle GT, McAuley DF, McKinley A et al (2009) Preliminary results of a prospective randomized trial of restrictive versus standard fluid regime in elective open abdominal aortic aneurysm repair. Ann Surg 250:28–34CrossRefPubMedGoogle Scholar
  31. 31.
    Arkilic CF, Taguchi A, Sharma N et al (2003) Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 133:49–55CrossRefPubMedGoogle Scholar
  32. 32.
    Holte K, Klarskov B, Christensen DS et al (2004) Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg 240:892–899CrossRefPubMedGoogle Scholar
  33. 33.
    Shoemaker WC, Appel PL, Kram HB et al (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186CrossRefPubMedGoogle Scholar
  34. 34.
    Boyd O, Grounds RM, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707CrossRefPubMedGoogle Scholar
  35. 35.
    Wilson J, Woods I, Fawcett J et al (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 318:1099–1103PubMedGoogle Scholar
  36. 36.
    Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Lukas E. Brügger
    • 1
  • Guido Beldi
    • 1
  • Mario Beck
    • 2
  • Francesca Porta
    • 2
  • Hendrik Bracht
    • 2
  • Daniel Candinas
    • 1
  • Jukka Takala
    • 2
  • Stephan M. Jakob
    • 2
    Email author
  1. 1.Department of Visceral Surgery and MedicineBern University Hospital and University of BernBernSwitzerland
  2. 2.Department of Intensive Care MedicineBern University Hospital and University of Bern (Inselspital)BernSwitzerland

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