Skip to main content
SpringerLink
Log in

Liver necrosis and apoptosis during increased intra-abdominal pressure alleviated by ischaemic preconditioning

  • Experimental Study
  • Published:
Hellenic Journal of Surgery

Abstract

Aim

Intra-abdominal hypertension (IAH) is known to have a negative impact on liver function. The aim of this study was to observe the degree of liver necrosis and apoptosis during IAH and to test the hypothesis as to whether liver ischaemic preconditioning can alleviate these changes.

Methods

The study involved three groups of 8 pigs. In the first group (Pn), pneumoperitoneum with Helium was established and intra-abdominal pressure (IAP) was increased to 30 mmHg for 3 hours, after which the abdomen was decompressed. Liver biopsies were obtained through a mini-laparotomy before establishing pneumoperitoneum, immediately after decompression, and one hour after decompression. In the second group (IscPr), IAP initially increased to 25 mmHg for 15 minutes, followed by an equal period of decompression, after which the protocol for the first group was adopted. The third group comprised controls in which IAP was unchanged; liver biopsies were obtained during the same time periods as the Pn and IscPr groups.

Results

Liver necrosis after abdominal desufflation was significantly higher in the Pn group compared to the control group (p=0,004) and the degree of necrosis was significantly lower in the IscPr group compared to the Pn group (p=0,009). Liver apoptosis during IAH was significantly higher in the Pn group compared to that in the control Group (p=0,002), while liver apoptosis was significantly lower in the IscPr group compared to the Pn group (p=0,008). After abdominal desufflation, apoptosis was significantly higher in the Pn group compared to the control group (p<0,001) and significantly lower in the IscPr group compared to the Pn group (p<0,001).

Conclusions

IAH resulted in significantly increased liver necrosis and apoptosis. Moreover, ischaemic preconditioning resulted in a significantly smaller degree of liver necrosis and significantly reduced apoptosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ivatury RR, Diebel L, Porter JM, Simon RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am. 1997; 77:783–800.

    Article  PubMed  CAS  Google Scholar 

  2. Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Abdominal compartment syndrome. J Trauma. 1998; 45:597–609.

    Article  PubMed  CAS  Google Scholar 

  3. Moore AF, Hargest R, Martin M, Delicata RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg. 2004; 91:1102–1110.

    Article  PubMed  CAS  Google Scholar 

  4. Wendon J, Biancofiore G, Auzinger G. Intra-abdominal hypertension and the liver. In Abdominal Compartment Syndrome. 1st edition. Edited by Ivatury R. Landes Biosciences; 2006. pp 138–143.

  5. Diebel LN, Wilson RF, Dulchavsky SA, Saxe J Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma. 1992; 33: 279–283.

    Article  PubMed  CAS  Google Scholar 

  6. Toens C, Schachtrupp A, Hoer J, Junge K, Klosterhalfen B, Schumpelick V. A porcine model of the abdominal compartment syndrome. Shock. 2002; 18: 316–321.

    Article  PubMed  Google Scholar 

  7. Andrei VE, Schein M, Margolis M, Rucinski JC, Wise L. Liver enzymes are commonly elevated following laparoscopic cholecystectomy: is elevated intra-abdominal pressure the cause? Dig Surg. 1998; 15: 256–259.

    Article  PubMed  CAS  Google Scholar 

  8. Safran DB, Orlando R 3rd. Physiologic effects of pneumoperitoneum. Am J Surg. 1994; 167: 281–286.

    Article  PubMed  CAS  Google Scholar 

  9. Rasmussen IB, Berggren U, Arvidsson D, Ljungdahl M, Haglund U. Effects of pneumoperitoneum on splanchnic hemodynamics: an experimental study in pigs. Eur J Surg. 1995; 161: 819–826.

    PubMed  CAS  Google Scholar 

  10. Eleftheriadis E, Kotzampassi K, Botsios D, Tzartinoglou E, Farmakis H, Dadoukis J. Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc. 1996; 10: 324–326.

    Article  PubMed  CAS  Google Scholar 

  11. Hamilton BD, Chow GK, Inman SR, Stowe NT, Winfield HN. Increased intra-abdominal pressure during pneumoperitoneum stimulates endothelin release in a canine model. J Endourol. 1998; 12: 193–197.

    Article  PubMed  CAS  Google Scholar 

  12. Mikami O, Fujise K, Matsumoto S, Shingu K, Ashida M, Matsuda T. High intra-abdominal pressure increases plasma catecholamine concentrations during pneumoperitoneum for laparoscopic procedures. Arch Surg. 1998; 133: 39–43.

    Article  PubMed  CAS  Google Scholar 

  13. Rezende-Neto JB, Moore EE, Melo de Andrade MV, Teixeira MM, Lisboa FA, Arantes RM, de Souza DG, da Cunha-Melo JR. Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure. J Trauma. 2002; 53: 1121–1128.

    Article  PubMed  Google Scholar 

  14. Hsu YP, Chen RJ, Fang JF, Lin BC, Huang TL, Cheng ML, Chiu DT, Tsay PK. Increased susceptibility to oxidant injury in hepatocytes from rats with intra-abdominal hypertension. J Trauma. 2004; 57: 569–575.

    Article  PubMed  Google Scholar 

  15. Borghi-Scoazec G, Scoazec JY, Durand F, Bernuau J, Belghiti J, Feldmann G, Henin D, Degott C. Apoptosis after ischemiareperfusion in human liver allografts. Liver Transpl Surg. 1997; 3: 407–415.

    Article  PubMed  CAS  Google Scholar 

  16. Meguro M, Katsuramaki T, Kimura H, Isobe M, Nagayama M, Kukita K, Nui A, Hirata K. Apoptosis and necrosis after warm ischemia-reperfusion injury of the pig liver and their inhibition by ONO-1714. Transplantation. 2003; 75: 703–710.

    Article  PubMed  CAS  Google Scholar 

  17. Potten C, Wilson J: Apoptosis: The Life and Death of Cells (Developmental & Cell Biology S). Cambridge University Press; 2004

  18. Hengartner MO. The biochemistry of apoptosis. Nature. 2000; 407: 770–776.

    Article  PubMed  CAS  Google Scholar 

  19. Patel T, Gores GJ. Apoptosis and hepatobiliary disease. Hepatology. 1995; 21: 1725–1741.

    PubMed  CAS  Google Scholar 

  20. Ishida T, Yarimizu K, Gute DC, Korthuis RJ. Mechanisms of ischemic preconditioning. Shock. 1997; 8: 86–94.

    Article  PubMed  CAS  Google Scholar 

  21. Hawaleshka A, Jacobsohn E. Ischaemic preconditioning: mechanisms and potential clinical applications. Can J Anaesth. 1998; 45: 670–682.

    Article  PubMed  CAS  Google Scholar 

  22. Shuto K, Kitano S, Yoshida T, Bandoh T, Mitarai Y, Kobayashi M. Hemodynamic and arterial blood gas changes during carbon dioxide and helium pneumoperitoneum in pigs. Surg Endosc. 1995; 9: 1173–1178.

    Article  PubMed  CAS  Google Scholar 

  23. Yilmaz S, Koken T, Tokyol C, Kahraman A, Akbulut G, Serteser M, Polat C, Gokce C, Gokce O. Can preconditioning reduce laparoscopy-induced tissue injury? Surg Endosc. 2003; 17: 819–824.

    Article  PubMed  CAS  Google Scholar 

  24. Schulz R, Walz MK, Behrends M, Neumann T, Gerken G, Heusch G. Minimal protection of the liver by ischemic preconditioning in pigs. Am J Physiol Heart Circ Physiol. 2001; 280: H198–H207.

    PubMed  CAS  Google Scholar 

  25. Compagnon P, Lindell S, Ametani MS, Gilligan B, Wang HB, D’Alessandro AM, Southard JH, Mangino MJ. Ischemic preconditioning and liver tolerance to warm or cold ischemia: experimental studies in large animals. Transplantation. 2005; 79: 1393–1400.

    Article  PubMed  Google Scholar 

  26. Yadav SS, Sindram D, Perry DK, Clavien PA. Ischemic pre-conditioning protects the mouse liver by inhibition of apoptosis through a caspase-dependent pathway. Hepatology. 1999; 30: 1223–1231.

    Article  PubMed  CAS  Google Scholar 

References

  1. Diebel LN, Wilson RF, Dulchavsky SA, Saxe J. Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 1992;33:279–282

    Article  PubMed  CAS  Google Scholar 

  2. Mogilner JG, Bitterman h, Hayari L, Brod V et al. Effect of elevated intra-abdominal pressure and hyperoxia on portal vein blood flow, hepatocyte proliferation and apoptosis in a rat model. Eur J Pediatr Surg. 2008;18:380–386

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery and First Department of Anaesthesiology, Aretaieion University Hospital, Athens, Greece

    S. Asonitis, E. Argyra, Athanasios Marinis, A. Kondi-Pafiti, A. Avraamidou & D. Voros

Authors
  1. S. Asonitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Argyra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Athanasios Marinis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kondi-Pafiti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Avraamidou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Voros
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Athanasios Marinis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Asonitis, S., Argyra, E., Marinis, A. et al. Liver necrosis and apoptosis during increased intra-abdominal pressure alleviated by ischaemic preconditioning. Hellenic J Surg 84, 106–112 (2012). https://doi.org/10.1007/s13126-012-0012-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-012-0012-2

Key words

Search

Navigation