Abstract
Background
Intra-abdominal high pressure and acidosis by carbon dioxide (CO2) pneumoperitoneum is known to affect various organ functions. In this study, changes in liver functions and liver histology were investigated during CO2 pneumoperitoneum in a large animal model.
Methods
Fourteen white pigs were anesthetized with intubation and controlled ventilation. The pigs in the pneumoperitoneum group (PG) were exposed to CO2 pneumoperitoneum at an intra-abdominal pressure of 8 mmHg, and those in the open laparotomy group (OG) were subjected to laparotomy. Hemodynamics were measured and liver function tests were performed in the carotid artery and portal vein, and the liver tissue was histologically examined.
Results
The blood pressure, PO2, PCO2, and pH in the carotid artery did not significantly differ between the groups. In the PG, blood pressure, PO2, and PCO2 in the portal vein were elevated while the pH was low. There were no significant differences in the levels of aminotransferases and lactate between the groups. In the PG, the arterial ketone body ratio (AKBR) was low at 90 min and the ICG retention rate was high at 180 min; these values differed significantly compared to those at 0 min. Histological examination revealed liver congestion in the PG and no significant change in the OG. In the PG, the TUNEL assay revealed positive staining in the area with focal lytic changes.
Conclusions
CO2 pneumoperitoneum at an intra-abdominal pressure of 8 mmHg in a porcine model affected liver functions and caused histological changes in the liver. Although it is uncertain whether these alterations observed in the porcine liver occur in humans as well and whether the alterations are reversible after pneumoperitoneum, it may be necessary to pay attention to liver damage during laparoscopic surgery.
Similar content being viewed by others
References
Costi R, Denet C, Sarli L, Perniceni T, Roncoroni L, Gayet B (2003) Laparoscopy in the last decade of the millennium: have we really improved? Surg Endosc 17:791–797
Vittimberga FJ Jr, Foley DP, Meyers WC, Callery MP (1998) Laparoscopic surgery and the systemic immune response. Ann Surg 227:326–334
Gupta A, Watson DI (2001) Effect of laparoscopy on immune function. Br J Surg 88:1296–1306
Safran DB, Orlando R 3rd (1994) Physiologic effects of pneumoperitoneum. Am J Surg 167:281–286
Henny CP, Hofland J (2005) Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum. Surg Endosc 19:1163–1171
Demyttenaere S, Feldman LS, Fried GM (2007) Effect of pneumoperitoneum on renal perfusion and function: a systematic review. Surg Endosc 21:152–160
Halevy A, Gold-Deutch R, Negri M, Lin G, Shlamkovich N, Evans S, Cotariu D, Scapa E, Bahar M, Sackier JM (1994) Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Ann Surg 219:362–364
Morino M, Giraudo G, Festa V (1998) Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 12:968–972
Saber AA, Laraja RD, Nalbandian HI, Pablos-Mendez A, Hanna K (2000) Changes in liver function tests after laparoscopic cholecystectomy: not so rare, not always ominous. Am Surg 66:699–702
Hasukic S (2005) Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopic cholecystectomy. Surg Endosc 19:1451–1455
Bickel A, Weiar A, Eitan A (2008) Evaluation of liver enzymes following elective laparoscopic cholecystectomy: are they really elevated? J Gastrointest Surg 12:1418–1421
Klopfenstein CE, Morel DR, Clergue F, Pastor CM (1998) Effects of abdominal CO2 insufflation and changes of position on hepatic blood flow in anesthetized pigs. Am J Physiol 275:900–905
Junghans T, Bohm B, Grundel K, Schwenk W, Muller JM (1997) Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow? Surgery 121:206–211
Richter S, Olinger A, Hildebrandt U, Menger MD, Vollmar B (2001) Loss of physiologic hepatic blood flow control (“hepatic arterial buffer response”) during CO2-pneumoperitoneum in the rat. Anesth Analg 93:872–877
Alexakis N, Gakiopoulou H, Dimitriou C, Albanopoulos K, Fingerhut A, Skalistira M, Patsouris E, Bramis J, Leandros E (2008) Liver histology alterations during carbon dioxide pneumoperitoneum in a porcine model. Surg Endosc 22:415–420
Meierhenrich R, Gauss A, Vandenesch P, Georgieff M, Poch B, Schutz W (2005) The effects of intraabdominally insufflated carbon dioxide on hepatic blood flow during laparoscopic surgery assessed by transesophageal echocardiography. Anesth Analg 100:340–347
Sharma KC, Brandstetter RD, Brensilver JM, Jung LD (1996) Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest 110:810–815
Guven HE, Oral S (2007) Liver enzyme alterations after laparoscopic cholecystectomy. J Gastrointest Liver Dis 16:391–394
Nickkholgh A, Barro-Bejarano M, Liang R, Zorn M, Mehrabi A, Gebhard MM, Buchler MW, Gutt CN, Schemmer P (2008) Signs of reperfusion injury following CO2 pneumoperitoneum: an in vivo microscopy study. Surg Endosc 22:122–128
Valenza F, Aletti G, Fossali T, Chevallard G, Sacconi F, Irace M, Gattinoni L (2005) Lactate as a marker of energy failure in critically ill patients: hypothesis. Crit Care 9:588–593
Ozawa K, Aoyama H, Yasuda K, Shimahara Y, Nakatani T, Tanaka J, Yamamoto M, Kamiyama Y, Tobe T (1983) Metabolic abnormalities associated with postoperative organ failure. A redox theory. Arch Surg 118:1245–1251
Williamson DH, Lund P, Krebs HA (1967) The redox state of free nicotinamide-adenine dinucleotide in the cytoplasm and mitochondria of rat liver. Biochem J 103:514–527
Caban A, Wiaderkiewicz R, Kaminski M, Oczkowicz G, Ziaja J (2000) Arterial ketone index in assessing liver function and its detoxicative capability after ischemia-reperfusion injury. Acta Biochim Pol 47:1137–1146
Qian T, Nieminen AL, Herman B, Lemasters JJ (1997) Mitochondrial permeability transition in pH-dependent reperfusion injury to rat hepatocytes. Am J Physiol 273:1783–1792
Jaeschke H, Lemasters JJ (2003) Apoptosis versus oncotic necrosis in hepatic ischemia/reperfusion injury. Gastroenterology 125:1246–1257
Sakka SG, van Hout N (2006) Relation between indocyanine green (ICG) plasma disappearance rate and ICG blood clearance in critically ill patients. Intensive Care Med 32:766–769
Yavuz Y, Ronning K, Bakkelund K, Lyng O, Aadahl P, Marvik R, Gronbech JE (2006) Hemodynamic and tissue blood flow responses to long-term pneumoperitoneum and hypercapnia in the pig. Surg Endosc 20:1394–1401
Disclosures
Makoto Yoshida, Satoshi Ikeda, Daisuke Sumitani, Yuji Takakura, Masanori Yoshimitsu, Manabu Shimomura, Midori Noma, Masakazu Tokunaga, Masazumi Okajima, and Hideki Ohdan have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yoshida, M., Ikeda, S., Sumitani, D. et al. Alterations in portal vein blood pH, hepatic functions, and hepatic histology in a porcine carbon dioxide pneumoperitoneum model. Surg Endosc 24, 1693–1700 (2010). https://doi.org/10.1007/s00464-009-0831-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0831-6