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Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension

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Abstract

Background

Low splanchnic perfusion is an immediate effect of pneumoperitoneum-induced intra-abdominal hypertension (IAH). Anatomical structure results in the intestinal mucosa being the area most sensitive to hypoperfusion. The relationship between intestinal injury and clinical parameters of tissue perfusion [abdominal perfusion pressure (APP), gastric intramucosal pH (pHi) and lactic acid (Lc)] has not been previously studied. This study aimed to monitorize intestinal pathogenesis through sequential ileal biopsies and to measure APP, pHi, and Lc levels at different pneumoperitoneum-induced intra-abdominal pressures (20, 30, and 40 mmHg) to evaluate the potential relationships between them.

Materials and methods

Fifty pigs were divided into four groups; a control group (C) and three experimental groups with different pneumoperitoneum-induced levels [20 mmHg (G20), 30 mmHg (G30), and 40 mmHg (G40)], that were maintained for 3 and 5 h. APP, pHi, and Lc were measured and ileal biopsies taken laparoscopically every 30 min. The mucosal damage was graded using the standardized Park’s Score and animals were classified as injured (I+) or uninjured (I−).

Results

Different histopathological lesions were observed in groups G20, G30, and G40 but no damage observed in group C. A 33.3% of animals in G20 and G30 were I+ after 3 h, while 93.3% were injured in G40. After 5 h, histopathological lesions were no longer seen in some animals in G20 and only 10% were I+. Conversely, in G30 I+ pigs increased to 80% while those in G40 remained at 93.3% I+. The I+ animals had significantly lower APP and pHi than those I−. Lc was the clinical parameter that showed the earliest differences, with significantly higher figures in I+ animals.

Conclusions

The evolution of intestinal injuries from pneumoperitoneum-induced IAH depends on the degree of IAP. These damages may be associated with decreases in APP and pHi, and increases in Lc.

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Acknowledgements

CCMIJU staff of Cáceres (Spain) and department of Veterinary Anatomy and Embryology at the University of Murcia (Spain) for their assistance in conducting this research.

Funding

This work was supported by one grant from Extremadura Regional Government through the Plan Regional de Investigación de Extremadura (PRI09A161 to Minimally Invasive Surgery Center Jesús Usón). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, 30100, Murcia, Spain

    Ester Párraga Ros, Rafael Latorre & Octavio López Albors

  2. Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre (JUMISC), Cáceres, Spain

    Laura Correa-Martín & Francisco M. Sánchez-Margallo

  3. Highlands Teaching and Research Farm (CEIEPAA), Faculty of Veterinary Medicine, National Autonomous University of México, Querétaro, Mexico

    Irma Eugenia Candanosa-Aranda

  4. Medical and Surgical ICU and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg/St-Erasmus, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium

    Manu L. N. G. Malbrain

  5. Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, South Africa

    Robert Wise

  6. Clinical Unit, Critical Care, Edendale Hospital, Pietermaritzburg, South Africa

    Robert Wise

  7. Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

    Robert Wise

  8. Department of General Surgery, Virgen de la Arrixaca General University Hospital, Murcia, Spain

    Gregorio Castellanos

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  1. Ester Párraga Ros
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  2. Laura Correa-Martín
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  3. Francisco M. Sánchez-Margallo
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  5. Manu L. N. G. Malbrain
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  6. Robert Wise
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  8. Octavio López Albors
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  9. Gregorio Castellanos
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Corresponding author

Correspondence to Ester Párraga Ros.

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Disclosures

M.L.N.G. Malbrain is a member of the medical advisory board of Pulsion Medical Systems. Drs. E. Párraga, L. Correa-Martín, F.M. Sánchez-Margallo, I.E. Candanosa, R. Wise, R. Latorre, O. López Albors, and G. Castellanos have no conflicts of interest or financial ties to disclose.

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Párraga Ros, E., Correa-Martín, L., Sánchez-Margallo, F.M. et al. Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension. Surg Endosc 32, 3989–4002 (2018). https://doi.org/10.1007/s00464-018-6142-z

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