Efstathios A Antoniou1, Evi Kairi2, Georgios A Margonis3, Nikolaos Andreatos3, Kazunari Sasaki3, Christos Damaskos1, Nikolaos Garmpis1, Mario Samaha3, Eriphyli Argyra4, George Polymeneas5, Matthew J Weiss3, Timothy M Pawlik3, Dionysios Voros5, Gregory Kouraklis6. 1. Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece. 2. Department of Pathology, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece. 3. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A. 4. First Department of Anesthesiology, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece. 5. Second Department of Surgery, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece. 6. Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece gkouraklis@hotmail.com.
Abstract
BACKGROUND: While reduction of portal venous (PV) blood flow has been described in animal models of intra-abdominal hypertension, reports on compensatory changes in hepatic arterial (HA) flow, known as the hepatic arterial buffer response are controversial. MATERIALS AND METHODS: Pneumoperitoneum with helium was induced in 13 piglets. Hemodynamic measurements and pathological assessment were conducted at baseline and during the three subsequent phases: Phase A: 45 minutes with a stable intra-abdominal pressure of 25 mmHg; phase B: 45 minutes with a stable intra-abdominal pressure of 40 mmHg; and phase C during which the abdomen was re-explored and reperfusion of the liver was allowed to take place. RESULTS: Phase B pressure was significantly greater than phase A pressure in both the PV and the inferior vena cava, demonstrating a positive association between escalating intra-abdominal hypertension and the pressure in these two vessels (all p<0.001). In contrast, HA pressure was comparable between baseline and phase A, while it tended to decrease in phase B. Regarding histology, the most notable abnormality was the presence of inflammatory infiltrates and hepatocyte necrosis. CONCLUSION: Helium-insufflation increased PV pressure with a partial compensatory decrease of HA pressure. Nonetheless, findings consistent with hepatic ischemia were observed on pathology. Copyright
BACKGROUND: While reduction of portal venous (PV) blood flow has been described in animal models of intra-abdominal hypertension, reports on compensatory changes in hepatic arterial (HA) flow, known as the hepatic arterial buffer response are controversial. MATERIALS AND METHODS: Pneumoperitoneum with helium was induced in 13 piglets. Hemodynamic measurements and pathological assessment were conducted at baseline and during the three subsequent phases: Phase A: 45 minutes with a stable intra-abdominal pressure of 25 mmHg; phase B: 45 minutes with a stable intra-abdominal pressure of 40 mmHg; and phase C during which the abdomen was re-explored and reperfusion of the liver was allowed to take place. RESULTS: Phase B pressure was significantly greater than phase A pressure in both the PV and the inferior vena cava, demonstrating a positive association between escalating intra-abdominal hypertension and the pressure in these two vessels (all p<0.001). In contrast, HA pressure was comparable between baseline and phase A, while it tended to decrease in phase B. Regarding histology, the most notable abnormality was the presence of inflammatory infiltrates and hepatocyte necrosis. CONCLUSION:Helium-insufflation increased PV pressure with a partial compensatory decrease of HA pressure. Nonetheless, findings consistent with hepatic ischemia were observed on pathology. Copyright
Authors: Steven Gertjan Strang; Esther M M Van Lieshout; Oscar J F Van Waes; Michael H J Verhofstad Journal: J Trauma Acute Care Surg Date: 2016-09 Impact factor: 3.313
Authors: J G Mogilner; H Bitterman; L Hayari; V Brod; A G Coran; R Shaoul; M Lurie; S Eldar; I Sukhotnik Journal: Eur J Pediatr Surg Date: 2008-12-05 Impact factor: 2.191