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      Effects of carbon dioxide pneumoperitoneum on hepatic and renal morphology of rats after segmental colectomy and colonic anastomosis Translated title: Efeitos do pneumoperitônio com dióxido de carbono sobre a morfologia renal e hepática de ratos submetidos à colectomia segmentar e anastomose colônica

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          Abstract

          PURPOSE: To evaluate the effects of increased intraperitoneal pressure caused by carbon dioxide pneumoperitoneum on the hepatic and renal morphology of rats. METHODS: Fifty-four adult male rats were randomly divided into three groups (P, PP and C) after anesthesia: P - in 18 animals, pneumoperitoneum was established for 30 minutes immediately before laparotomy; PP - in 18 animals, pneumoperitoneum was established for 60 minutes divided into 30 immediately before laparotomy and 30 after abdominal closure; control group (C) - 18 animals underwent laparotomy without pneumoperitoneum induction. The pneumoperitoneum was maintained at a pressure of 5 mm Hg. Nine animals in each group were killed on the 3rd and 7th postoperative days, when kidney and liver samples were collected for morphological analysis. The liver specimens were stained with hematoxylin and eosin (HE), and the kidney specimens, with HE and von Kossa. Blinded examiners analyzed the slides. RESULTS: No changes in renal morphology were found. Liver samples showed histological signs of degeneration in animals in the pneumoperitoneum groups killed on the 7th postoperative day (p=0.029). CONCLUSION: The CO2 pneumoperitoneum did not affect renal morphology but caused hydropic degeneration in the liver of animals killed on the 7th postoperative day.

          Translated abstract

          OBJETIVO: Avaliar os efeitos do aumento de pressão intraperitonial causada pelo pneumoperitônio com dióxido de carbono na morfologia renal e hepática de ratos submetidos à colectomia segmentar a anastomose colônica. MÉTODOS: 54 ratos machos da linhagem Winstar, que, após serem anestesiados, foram aleatoriamente distribuídos em três grupos (P, PP e C): P - 18 animais submetidos a pneumoperitônio por 30 minutos imediatamente antes da laparotomia PP - 18 animais submetidos a pneumoperitônio por 60 minutos, 30 imediatamente antes da laparotomia e 30 após a laparorrafia ; C - (grupo controle) - 18 animais submetidos à laparotomia sem o uso de pneumoperitônio. Os animais foram mortos no terceiro e sétimo dia pós-operatório, quando ocorreu a coleta do rim e parte do fígado. As peças foram coradas com Hematoxilina e Eosina e Von Kossa e analisadas por um patologista que desconhecia os grupos. RESULTADOS: Não foram observadas alterações nas estruturas renais. Nas amostras hepáticas foram observados achados histológicos como a degeneração hidrópica no grupo de animais mortos no sétimo DPO (p= 0,029). CONCLUSÃO: O pneumoperitônio com dióxido de carbono não afetou a morfologia renal e causou a degeneração hidrópica no fígado dos animais mortos no 7º dia pós-operatório.

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          Loss of physiologic hepatic blood flow control ("hepatic arterial buffer response") during CO2-pneumoperitoneum in the rat.

          We analyzed whether a compensatory increase of hepatic arterial (HA) flow, known as the "hepatic arterial buffer response" (HABR), may serve for maintenance of liver blood supply during laparoscopy-associated portal venous (PV) flow reduction. We assessed HA and PV flow, as well as hepatic tissue oxygenation (PO2) during CO2-pneumoperitoneum in anesthetized and mechanically ventilated Sprague-Dawley rats (n = 7). Control animals (n = 7) without pneumoperitoneum, but tourniquet-induced PV flow reduction served to demonstrate physiologic HABR. Although stepwise tourniquet-induced reduction of PV flow to 20% of baseline values led to a significant (P < 0.05) increase of HA flow from 4.3 +/- 0.7 mL/min to 9.9 +/- 1.7 mL/min, stepwise intraabdominal pressure-induced decrease of PV flow was paralleled by a linear reduction of HA flow from 2.4 +/- 0.3 mL/min to 1.2 +/- 0.5 mL/min at 18 mm Hg intraabdominal pressure. This loss of HABR was sustained during a subsequent 2 h-period of CO2-pneumoperitoneum contrasting the 2 h of maintenance of HABR in controls. Hepatic tissue PO2 decreased during the 2 h-period of pressure- and tourniquet-induced PV flow reduction by 35% to 51%, respectively. On tourniquet release, all variables regained baseline values, whereas evacuation of the pneumoperitoneum allowed all variables except hepatic PO2 to return to baseline, indicating prolonged tissue hypoxia despite restored total liver blood flow in the Laparoscopic group. Concomitantly, increased liver enzyme activities reflected moderate tissue damage after 2 h of pneumoperitoneum. In conclusion, intraabdominal CO2-insufflation-induced hemodynamic alterations may impair tissue oxygenation and enzyme release, indicating the potential risk for hepatic tissue damage after prolonged periods of laparoscopic interventions. We investigated the effect of CO2-pneumoperitoneum on liver blood flow, hepatic tissue oxygenation (PO2) and liver enzyme release. CO2-insufflation reduces portal venous flow without a compensatory increase of hepatic arterial flow ("hepatic arterial buffer response"), resulting in reduced hepatic PO2 and increased ratios of serum alanine aminotransferase to serum aspartate aminotransferase.
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            The correlation between reactive oxygen species and histopathology of the liver, gut, and kidneys in animals with elevated intra-abdominal pressure.

            Clinical and experimental studies have shown that the laparoscopic procedure provides a typical model of ischemia-reperfusion injury in the organs by oxygen-derived free radicals. A pneumoperitoneum produces ischemia during insufflation and reperfusion during desufflation. The aim of this study was to assess the causative role of free radical-mediated reactions in tissue damage under different intra-abdominal insufflation pressures.
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              Efeitos do pneumoperitônio em ratos

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                acb
                Acta Cirurgica Brasileira
                Acta Cir. Bras.
                Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (São Paulo )
                1678-2674
                August 2011
                : 26
                : 4
                : 279-284
                Affiliations
                [1 ] Universidade de Brasília Brazil
                [2 ] Universidade de Brasília Brazil
                Article
                S0102-86502011000400006
                10.1590/S0102-86502011000400006
                4a212bd0-8a67-42c6-8c37-c8beee9a9236

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0102-8650&lng=en
                Categories
                SURGERY

                Surgery
                Kidney,Liver,Pneumoperitoneum, Artificial,Carbon Dioxide,Laparoscopy,Rats,Rim,Fígado,Pneumoperitônio Artificial,Dióxido de Carbono,Laparoscopia,Ratos

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