Surgical Endoscopy

, Volume 32, Issue 9, pp 3989–4002 | Cite as

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

  • Ester Párraga Ros
  • Laura Correa-Martín
  • Francisco M. Sánchez-Margallo
  • Irma Eugenia Candanosa-Aranda
  • Manu L. N. G. Malbrain
  • Robert Wise
  • Rafael Latorre
  • Octavio López Albors
  • Gregorio Castellanos



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−).


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.


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.


Intestinal injury Histopathological changes Porcine model Intra-abdominal hypertension Pneumoperitoneum Abdominal compartment syndrome 



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.


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.

Compliance with ethical standards


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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ester Párraga Ros
    • 1
  • Laura Correa-Martín
    • 2
  • Francisco M. Sánchez-Margallo
    • 2
  • Irma Eugenia Candanosa-Aranda
    • 3
  • Manu L. N. G. Malbrain
    • 4
  • Robert Wise
    • 5
    • 6
    • 7
  • Rafael Latorre
    • 1
  • Octavio López Albors
    • 1
  • Gregorio Castellanos
    • 8
  1. 1.Department of Anatomy and Comparative Pathology, Veterinary FacultyUniversity of MurciaMurciaSpain
  2. 2.Laparoscopy DepartmentJesús Usón Minimally Invasive Surgery Centre (JUMISC)CáceresSpain
  3. 3.Highlands Teaching and Research Farm (CEIEPAA), Faculty of Veterinary MedicineNational Autonomous University of MéxicoQuerétaroMexico
  4. 4.Medical and Surgical ICU and High Care Burn Unit, Ziekenhuis Netwerk AntwerpenZNA Stuivenberg/St-ErasmusAntwerpBelgium
  5. 5.Pietermaritzburg Metropolitan Department of AnaestheticsCritical Care and Pain ManagementPietermaritzburgSouth Africa
  6. 6.Clinical Unit, Critical CareEdendale HospitalPietermaritzburgSouth Africa
  7. 7.Discipline of Anaesthesiology and Critical Care, School of Clinical MedicineUniversity of KwaZulu-NatalDurbanSouth Africa
  8. 8.Department of General SurgeryVirgen de la Arrixaca General University HospitalMurciaSpain

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