High Intra-abdominal Pressure Research Articles

Abdominal Congestion as a Predictor of Worsening Renal Function in Patients With Acute Decompensated Heart Failure.

Worsening renal function is a frequent finding in patients with acute decompensated heart failure (ADHF) and is a powerful independent prognostic factor for adverse outcomes. The link between abdominal congestion and worsening renal function in such patients is not yet fully addressed. To evaluate the role of abdominal congestion in the early prediction of worsening renal function in hospitalized patients with acute decompensated heart failure. This was a prospective study that enrolled 100 patients with a diagnosis of ADHF and received intravenous diuretic therapy. Intra-abdominal pressure (IAP), splenic Doppler impedance indices and serum prouroguanylin were measured on admission, 24 h after admission and on discharge. Patients were then divided into 2 groups: those who developed WRF (WRF group), and those who did not (non-WRF group). Worsening renal function was defined as an increase in serum creatinine level ≥0.3 mg/dL above baseline admission value. Intrabdominal pressure was measured transvesically using standard Foley catheter. Splenic Doppler impedance indices (resistivity and pulsatility indices) were measured using splenic Doppler ultrasound. Among recruited patients (age: 54.73 ± 13.1 years, 72% are male), there was a significant decline in IAP (6.67 mmHg vs 8.36 mmHg, p = 0.001) and significant rise in splenic resistivity index (0.69 vs 0.67, p = 0.002) before discharge compared to admission values. The median level of serum prouroguanylin before discharge showed significant decline compared to admission level (29.2 vs 34.6 ng/l, p = 0.006). WRF developed in 37 (37%) patients. Independent predictors of WRF during hospitalization were high splenic arterial resistivity index 24 h after admission, high intra-abdominal pressure (≥8 mmHg) 24 h after admission, and low LVEF on admission. In ADHF patients receiving diuretic therapy, transvesical measurement of intra-abdominal pressure and splenic resistivity index by splenic Doppler early after admission can help to identify patients at increased risk of WRF near discharge.

Intra-abdominal hypertension as a risk factor for acute kidney injury in geriatric patients after emergency abdominal surgery

Intra-abdominal hypertension is an often underestimated risk factor for acute kidney injury (AKI). But the values of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP), which are critical for the development of AKI in elderly patients after urgent abdominal surgery, are still not defined.Objective. To evaluate the relationship between IAP and APP and the development of acute kidney injury in geriatric patients after emergency abdominal surgery.Materials and methods. A prospective single-center study included 66 patients older than 60 years who underwent surgery for peritonitis and were transferred to the intensive care unit. Statistical processing was performed using the program "STATISTICA for Windows 13" (StatSoftInc., No. JPZ804I382130ARCN10-J).Results. Among the examined patients, 48 developed AKI (73%). The average values of IAP in patients with AKI and without AKI were 10.4 (7.4, 13.3) mm Hg and 6.7 (4.4; 9.6) mm Hg respectively (p<0.0001). APP in patients with AKI, respectively, was significantly lower (72 (61.5, 83.7)) than in patients without AKI (85.6 (74.5, 94.4; p<0.0001)). According to the results of logistic regression analysis, a relationship between high IAP values and the development of AKI was revealed: the odds ratio (OR) was 3.4 with the value of the criterion x2=32.4 (р<0.0001). The odds ratio between the reduction of APP and the development of AKI was 2.3 with the value of the criterion x2=13.4 (p=0.0002).ROC analysis showed that IAP>10.4 mm Hg. is the threshold level for the development of AKI with a sensitivity of 46% and a specificity of 90.5%, with an area under the AUC curve of 0.74 (p<0.001). APP<79.12 mm Hg is critical for the development of AKI, with a sensitivity of 66.4% and a specificity of 70%, with an area under the AUC curve of 0.68 (p<0.001).Conclusions. High values of IAP and reduction of APP are associated with the occurrence of acute kidney injury in elderly patients after emergency abdominal surgery.

Intra-abdominal pressure and residual renal function decline in peritoneal dialysis: a threshold-based investigation

Background The potential impact of elevated intra-abdominal pressure (IAP) on residual renal function (RRF) has not been determined. The objective of this study was to investigate the relationship between IAP and the rate of RRF decline in newly initiated peritoneal dialysis (PD) patients, and to identify the optimal IAP threshold value for delaying the deterioration of RRF. Methods A cohort of 62 newly initiated PD patients who completed both 6- and 12-month follow-up evaluations was obtained using the Durand method. A logistic regression model was used to identify variables associated with a rapid decline in RRF. Receiver operating characteristic (ROC) curves were generated to determine the optimal threshold value. Another retrospective cohort analysis was performed to validate the identified critical value. Results For each 1 cmH2O increase in IAP, the risk of a rapid decline in the RRF increased by a factor of 1.679. Subsequent analysis revealed that patients in the high IAP group had more significant decreases in residual renal estimated glomerular filtration rate (eGFR) (Z = −3.694, p < 0.001) and urine volume (Z = −3.121, p < 0.001) than did those in the non-high IAP group. Furthermore, an IAP ≥15.65 cmH2O was a robust discriminator for the prediction of the rate of RRF decline. Conclusion Patients in the high IAP group experienced a more rapid decline in RRF. Additionally, an optimal critical pressure of 15.65 cmH2O was identified for predicting the rate of RRF decline. IAP, as one of the factors contributing to the rapid decline in RRF in the first year of PD, should be given due attention.

Postoperative intra-abdominal hypertension predicts worse hospital outcomes in children after cardiac surgery: a pilot study†.

Our goal was to determine the incidence and characteristics of postoperative intra-abdominal hypertension (IAH) in paediatric patients undergoing open-heart surgery. This single-centre study included consecutive children (aged <16 years) who underwent open-heart surgery between July 2020 and February 2021. Patients who entered the study were followed until in-hospital death or hospital discharge. The study consisted of 2 parts. Part I was a prospective observational cohort study that was designed to discover the association between exposures and IAH. Postoperative intra-abdominal pressure was measured immediately after admission to the intensive care unit and every 6 h thereafter. Part II was a cross-sectional study to compare the hospital-related adverse outcomes between the IAH and the no-IAH cohorts. Postoperatively, 24.7% (38/154) of the patients exhibited IAH, whereas 3.9% (6/154) developed abdominal compartment syndrome. The majority (29/38, 76.3%) of IAH cases occurred within the first 24 h in the intensive care unit. Multivariable analysis showed that the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score [odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.23-2.83, P = 0.004], right-sided heart lesion (OR = 5.60, 95% CI 2.34-13.43, P < 0.001), redo sternotomy (OR = 4.35, 95% CI 1.64-11.57, P = 0.003), high baseline intra-abdominal pressure (OR = 1.43, 95% CI 1.11-1.83, P = 0.005), prolonged cardiopulmonary bypass duration (OR = 1.01, 95% CI 1.00-1.01, P = 0.005) and deep hypothermic circulatory arrest (OR = 5.14, 95% CI 1.15-22.98, P = 0.032) were independent predictors of IAH occurrence. IAH was associated with greater inotropic support (P < 0.001), more gastrointestinal complications (P = 0.001), sepsis (P = 0.003), multiple organ dysfunction syndrome (P < 0.001) and prolonged intensive care unit stay (z = -4.916, P < 0.001) and hospitalization (z = -4.710, P < 0.001). The occurrence of a composite outcome (P = 0.009) was significantly increased in patients with IAH. IAH is common in children undergoing cardiac surgery and is associated with worse hospital outcomes. Several factors may be associated with the development of IAH, including basic cardiac physiology and perioperative factors. This study was registered in the Chinese Clinical Trial Registry (Trial number: ChiCTR2000034322)URL site: https://www.chictr.org.cn/hvshowproject.html?id=41363&v=1.4.

Study of the biomechanical response of a prosthetic mesh secured with penetrating and non-penetrating fixations in IPOM ventral hernia repair.

Sutures or tacks are commonly used to secure a mesh in intraperitoneal onlay mesh (IPOM) hernia repair, but such penetrating fixations can cause local damage, that can be associated with pain. The use of an adhesive could be an alternative to reduce complications. However, a risk associated with this approach has been identified, particularly when the defect cannot be closed. A mesh glued to the peritoneum only might not provide as much mechanical reinforcement to the abdominal wall (AW) as a mesh anchored to the myofascial structure with penetrating fixations, which could lead to an increased recurrence rate. Additionally, the high elasticity of the peritoneum may increase mesh bulging. Leveraging an ex vivo approach, the objective of this study was to investigate the impact of mesh fixation using glue versus barbed sutures, on its biomechanical response for IPOM surgery. An experimental method was developed using ex vivo porcine abdominal wall samples (n = 12). A 4-cm centered circular defect was created by dissecting the skin and the subcutaneous tissue and removing muscle and extraperitoneal fat, while keeping the peritoneum intact. A 14-cm diameter mesh was secured (Dermabond™ cyanoacrylate adhesive or V-Loc™ barbed sutures) to the AW. The mesh was placed on the peritoneum to remain consistent with the IPOM placement. The sample was then subjected to some inflation tests to simulate increased levels of intra-abdominal pressure (IAP) representing daily activities. For each test, mesh bulging into the defect was assessed as a function of the pressure using Digital Image Correlation (DIC) analysis. Mesh bulging was studied for 2 configurations: suture fixation and glue. Glued meshes exhibited significantly higher bulging values than when sutured with a significant difference (p = 0.013) observed at 252 mmHg and a certain trend for statistical difference (p < 0.1) for stair climbing or coughing activities. Additionally, the stiffness of the repair was also significantly higher when the mesh was sutured compared to when it was glued to the peritoneum (p < 0.05). This study demonstrated that a mesh glued to the peritoneum exhibited higher bulging and a behavior of the repair less stiff compared to when it was sutured to the myofascial structure of the AW, particularly for high intra-abdominal pressures. However, the impact of these differences remains to be evaluated over time. Further preclinical investigations are needed to quantify their impact post-operatively.

Intra-abdominal pressure increases peri-operatively in patients undergoing deep inferior epigastric perforator flap reconstruction: A prospective study linking high intra-abdominal pressure to non-fatal lung embolism within one patient

The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. The procedure and peri-operative period are associated with the risk of severe post-operative complications, like venous thromboembolic events (VTE) and lung embolism. Whether the intra-abdominal pressure (IAP) increases after the closure of the abdominal defect, thereby potentially affecting the venous backflow and the risk of VTE, is currently not known. The primary aim is to test if the closure of the abdominal donor site increases the IAP in women undergoing secondary DIEP flap breast reconstruction. By using a Unometer, we measured the intravesical pressure as a surrogate marker for the IAP, at baseline, immediately after, and 24h after abdominal skin closure, for 13 patients. The mean IAP increased from 6.1mmHg (95% CI 4.6-7.7) at baseline to 9.0mmHg (95% CI 8.0-10.0) immediately after skin closure [mean diff. 2.9 (95% CI 1.0-4.8) (p=0.007)] and further up to 11.7mmHg (95% CI 9.0-14.5) 24h after closure [mean diff. 5.3 (95% CI 1.4-9.1) (p=0.012)]. We found that IAP varies among the patients, regardless of the tightness of abdominal closure or rectus plication (n=3). Immediately after closure, none of the isolated patients showed abnormal levels of IAP (>12mmHg), while eight out of 12 isolated patients (67%) showed IAP levels above the normal range after 24h. One patient developed a non-fatal lung embolism. The mean IAP increases significantly over the post-operative period after DIEP flap reconstruction, although abnormal IAP values are only seen 24h after the closure of the skin.

Management of abdominal gas leakage from surgical trocars in laparoscopic surgery: a preclinical study

Introduction: There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. Material and methods: We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. Results: Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. Conclusions: We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.

INTRAABDOMINAL PRESSURE CHANGE UNDER ABDOMINAL SURGERY

Abstract. Statement of the problem. Intraabdominal hypertension (IAH) recognized as important consequence of surgery intraabdominal or on abdominal wall.&#x0D; For a pity there are no signs to predict the possibility of such a dangerous complication.&#x0D; Aim of study: to find out changes of intraabdominal pressure (IAP) corresponding to different kind of abdominal surgeries.&#x0D; Material and methods. IAP had been measured in 15 patients before, immediately after, and 1, and 3-4 days since open surgery. Also, IAP had been measured in 5 patients before and after laparoscopic surgeries.&#x0D; IAP was measured by urinal bladder way.&#x0D; Results and discussion. Before surgery IAP was find at level 10 cm Н2О or higher in 3 patients, but not higher than 15 cm in none of them.&#x0D; There was not estimated direct connection between IAP and diagnosis. Of 2 patients with large incisional hernia and abdominal wall defect 243 cm2 and 832 cm2 in size IAP before surgery was stated as 3 and 14 cm Н2О, respectively, while in the latter there were no any little of compression.&#x0D; There was no firm interconnection between anesthesia mode and IAP&#x0D; Immediately after surgery IAP became equal to 10 cm Н2О or higher in 13 patients, of them in 4 it was 20 cm Н2О or higher. On the next day after surgery IAP leveled to 10 cm Н2О or higher in 7 patients, of them in 3 it was 20 cm Н2О or higher. One of the latter died, all other patients survived.&#x0D; In all patients operated in laparoscopic way IAP measured through intrabladder catheter was 7-11 cm Н2О lower than those on insufflator manometer.&#x0D; Conclusions. IAP assay via urinary bladder pressure estimating is not the IAP measurement but indicator of urinary bladder tone.&#x0D; As high IAP in many cases correspond to patient’s grave condition and even death it is of importance to study the real reason of this indicator.

An Individualized Low-Pneumoperitoneum-Pressure Strategy May Prevent a Reduction in Liver Perfusion during Colorectal Laparoscopic Surgery.

High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter 'Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study' (IPPCollapse-II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG-PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG-PDR and ICG-R15. All 29 patients from the participating center were included. Median IAP was 8 (25th-75th percentile: 8-10) versus 12 (12,12) mmHg, in IPP and SPP patients, respectively (p < 0.001). ICG-PDR was higher (OR 1.42, 95%-CI 1.10-1.82; p = 0.006) and PDR-R15 was lower in IPP patients compared with SPP patients (OR 0.46, 95%-CI 0.29-0.73; p = 0.001). During laparoscopic colorectal surgery, an individualized low pneumoperitoneum may prevent a reduction in liver perfusion.

Evaluation of the relationship between intraoperative cerebral oxygen saturation and postoperative cognitive functions in laparoscopic hysterectomy surgery

Objective: Laparoscopic surgery has become more popular than traditional open surgery because it is less invasive, provides faster recovery, and provides better cosmetic success. This procedure requires insufflation of an inert gas into the peritoneal cavity. This may be an increase in arterial CO2, changes in cerebral blood flow, an increase in intra-abdominal pressure (IAP), a decrease in cardiac output. The primary outcome of this study is to show the effect of IAP levels on cerebral oxygen saturation (COS) in patients who underwent laparoscopic total abdominal hysterectomy, and the secondary outcome is to reveal the relationship between IAP and COS and the recovery of postoperative cognitive functions.&#x0D; Material and Method: Demographic data of the cases were recorded and mini-mental test (MMT) was applied to evaluate the preoperative cognitive functions of the cases before surgery. COS monitoring were performed with standard anesthesia procedure for all patients. The MMT was repeated after the surgery.&#x0D; Results: A total of 40 female patients were included in the study. Those with IAP level 12 and below were defined as Group Low-Pressure, and those above 12 were defined as Group High-Pressure. There was no statistical difference between the anesthesia times and recovery times of the two groups. While there was no statistical difference in the preoperative MMT evaluation, it was found to be significantly lower in Group H in the postoperative MMT evaluation.&#x0D; Conclusion: In this study, we evaluated the effect of intraoperative IAP levels on intraoperative COS. It is seen that high IAP level does not have a negative effect on COS. In addition, this study has evidence that high IAP affects postoperative cognitive functions. In intraoperative management for TLH surgery, we recommend maintaining the IAP level at the lowest appropriate pressure that does not impair surgical comfort.

Intra-abdominal hypertension among medical septic patients associated with worsening kidney outcomes (IAH-WK study).

High intra-abdominal pressure (IAP) is associated with acute kidney injury (AKI). However, the relationship between intra-abdominal hypertension (IAH) and AKI in medical septic patients is still inconclusive. This prospective cohort study enrolled patients admitted in the Medical Intensive Care Unit from April 2020 to February 2021. Demographic, therapeutic, and laboratory data were obtained upon admission. The evaluation of IAP was performed via the intra-vesical method during the first and second 24 hours of admission. Kidney function was evaluated on the first 3 days and at least on the 7th day of enrollment. Among 79 patients, 30 (38%) developed IAH, while 50 (63.3%) developed AKI within 7 days. On the first day, the mean IAP was 15.4 (interquartile range [IQR], 4) and 7.0 (IQR, 3.7) mm Hg in the IAH and non-IAH groups, respectively. A total of 52 patients (65.8%) developed the primary outcome (i.e., a composite outcome including AKI, treatment with kidney replacement therapy, or death). On Cox proportional-hazards model between IAH and outcomes, after adjustment for multiple covariates, IAH was associated with a composite outcome (hazard ratio [HR], 6.5; 95% confidence interval [CI], 2.3-18.6; P < .005) and the development of AKI (HR, 6.5; 95% CI, 2.3-18.8; P < .005). IAH was associated with a composite outcome of AKI, treatment with kidney replacement therapy, or death in medical septic patients. thaiclinicaltrial.org, Identifier: TCTR20200531001, Registered May 24, 2020.

Incarcerated obturator hernia, an extremely rare cause of intestinal obstruction: case series.

Protrusion of abdominal contents through the obturator foramen is a rare type of abdominal wall hernia. It is usually seen unilaterally and right-sided. Predisposing factors are old age, high intra-abdominal pressure, pelvic floor dysfunction, and multiparity. Obturator hernia has one of the highest mortality rates of all abdominal wall hernias, with a difficult diagnostic process that can be misleading even for the most experienced surgeons. Therefore, to suspect and easily diagnose an obturator hernia, it is important to understand its characteristics. Computerized tomography scanning remains the best diagnostic tool with the highest sensitivity. Conservative ap-proach is not recommended in obturator hernia cases. Once diagnosed, urgent surgical repair is indicated to prevent further ischemia, necrosis, and risk of perforation that can lead to peritonitis, septic shock, and death. Although open repair is a widely used and effective method for reducing abdominal hernias, including obturator, laparoscopic repairs have been described and become preferred. In this study, we present female patients aged 86, 95, and 90 years who were operated with the diagnosis of obturator hernia on computed tomography. The diagnosis of obturatory hernia should always be kept in mind, especially in the presence of acute mechanical intestinal obstruction findings in an elderly woman.

Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review.

Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.

The Impact of intra-abdominal Pressure on Perioperative Outcomes in Robotic-Assisted Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The aim of the study is to analyze the impact of intra-abdominal pressure (IAP) on perioperative outcomes in robotic-assisted radical prostatectomy (RARP). We searched the PubMed, Cochrane Library, Science, Embase, and CNKI databases systematically, and the retrieval date was from the inception of the databases to April 2022. Randomized controlled trials on high intraabdominal pressure (HIAP) and low intraabdominal pressure (LIAP) in RARP were included. The meta-analysis was performed using Review Manager software (version 5.3). Six studies involving 2,271 patients were included in the meta-analysis. Compared with patients who experienced HIAP, those who experienced LIAP had a lower incidence of postoperative ileus (POI) (risk ratio (RR): 0.42; 95% confidence interval (CI): 0.24 to 0.72; p = 0.002). However, there were no significant differences in hematoma (RR 2.22; 95% CI, 0.61 to 8.15; p = 0.23), positive margin rate (RR, 1.06; 95% CI, 0.84 to 1.32; p = 0.64), urinary retention (RR, 0.99; 95% CI, 0.51 to 1.94; p = 0.98), operative time (mean difference (MD), -0.36; 95% CI, -12.24 to 6.12; p = 0.51), or intraoperative blood loss (MD, -21.80; 95% CI, -55.28 to 11.68; p = 0.20) among patients undergoing LIAP and HIAP. Our study of published trials indicates that using LIAP during RARP may reduce the incidence of POI, and there were no differences in terms of hematoma, positive margin rate, urinary retention, operative time, or intraoperative blood loss.

High intra-abdominal pressure during hyperthermic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery (CRS) for peritoneal surface malignancies

Objective Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) represent a mainstay of treatment for peritoneal malignancies. There is evidence that HIPEC using high intra-abdominal pressure (IAP) results in increased tissue penetration, although its safety profile remains relatively unknown. We thus aim to evaluate differences in intra- and post-operative outcomes in patients undergoing CRS-HIPEC with different levels of IAP. Methods This pilot prospective cohort study was conducted from January 2020 to February 2021 with patients undergoing CRS-HIPEC. Low IAP during HIPEC was defined as <18 mmHg and high IAP as ≥18 mmHg. Data was collected on patient and tumor characteristics, intra-operative clinical and biochemical parameters, and immediate post-operative outcomes. Results 40 patients underwent CRS-HIPEC (n low = 20, n high = 20). Median IAP in the low and high IAP groups were 12.0 and 19.0 mmHg respectively. During HIPEC, both groups experienced increase in heart rate, central venous pressure, end tidal CO2, temperature, and serum glucose, with decrease in mean arterial pressure and base excess. There were no significant differences in hemodynamics between the 2 groups. Mild electrolyte derangements and a decrease in hemoglobin were noted in the high IAP group but were of small magnitude. Post-operatively, high IAP did not result in increased rate of complications, time to full feeds, ICU or total hospital stay. Conclusions High IAP in HIPEC is well tolerated and did not result in additional adverse events.

New Technique Seeking Prophylaxis in the Displacement of Distal Ventriculoperitoneal Shunt Catheter – Case Report

AbstractIdiopathic intracranial hypertension is a comorbidity treated in neurosurgical practice today with the ventriculoperitoneal derivation technique. However, despite its great safety and efficacy, this technique is susceptible to infrequent failures, such as displacement of the catheter leading to the need for reoperation. In the present article, we report a case involving a peritoneal catheter tip retropulsion for subcutaneous tissue in an obese patient with posterior correction using an extending connector to the distal catheter, without harming the drainage flow. In our case report, the patient went on without complications and without the occurrence of new displacement after 8 months of surgery. The results obtained by this technique supported the idea that this alternative construction minimizes the risk of displacement of the peritoneal tip catheter in obese patients and with high intra-abdominal pressure, helping to reduce the need for reoperations. In addition, the present case report supports the need for further studies and clinical trials on the subject.

Relationship between high intra-abdominal pressure and compliance of the pelvic floor support system in women without pelvic organ prolapse: A finite element analysis.

Previous studies mainly focused on the relationship between the size of the prolapse and injury to the supporting tissues, but the strain and stress distributions of the supporting tissues as well as high-risk areas of injury are still unknown. To further investigate the effect of supporting tissues on organs and the interactions between organs, this study focused on the relationship between high intra-abdominal pressure and the compliance of the pelvic floor support system in a normal woman without pelvic organ prolapse (POP), using a finite element model of the whole pelvic support system. A healthy female volunteer (55 years old) was scanned using magnetic resonance imaging (MRI) during rest and Valsalva maneuver. According to the pelvic structure contours traced by a gynecologist and anatomic details measured from dynamic MRI, a finite element model of the whole pelvic support system was established, including the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, and obturator internus and coccygeal muscles. This model was imported into ANSYS software, and an implicit iterative method was employed to simulate the biomechanical response with increasing intra-abdominal pressure. Stress and strain distributions of the vaginal wall showed that the posterior wall was more stable than the anterior wall under high intra-abdominal pressure. Displacement at the top of the vagina was larger than that at the bottom, especially in the anterior–posterior direction. These results imply potential injury areas with high intra-abdominal pressure in non-prolapsed women, and provide insight into clinical managements for the prevention and surgical repair plans of POP.

Recruitable alveolar collapse and overdistension during laparoscopic gynecological surgery and mechanical ventilation: a prospective clinical study

BackgroundLaparoscopic surgery in Trendelenburg position may impede mechanical ventilation (MV) due to positioning and high intra-abdominal pressure. We sought to identify the positive end-expiratory pressure (PEEP) levels necessary to counteract atelectasis formation (“Open-Lung-PEEP”) and to provide an equal balance between overdistension and alveolar collapse (“Best-Compromise-PEEP”).MethodsIn 30 patients undergoing laparoscopic gynecological surgery, relative overdistension and alveolar collapse were assessed with electrical impedance tomography (EIT) during a decremental PEEP trial ranging from 20 to 4 cmH2O in supine position without capnoperitoneum and in Trendelenburg position with capnoperitoneum.ResultsIn supine position, the median Open-Lung-PEEP was 12 (8–14) cmH2O with 8.7 (4.7–15.5)% of overdistension and 1.7 (0.4–2.2)% of collapse. Best-Compromise-PEEP was 8 (6.5–10) cmH2O with 4.2 (2.4–7.2)% of overdistension and 5.1 (3.9–6.5)% of collapse. In Trendelenburg position with capnoperitoneum, Open-Lung-PEEP was 18 (18–20) cmH 2 O (p < 0.0001 vs supine position) with 1.8 (0.5–3.9)% of overdistension and 0 (0–1.2)% of collapse and Best-Compromise-PEEP was 18 (16–20) cmH2O (p < 0.0001 vs supine position) with 1.5 (0.7–3.0)% of overdistension and 0.2 (0–2.7)% of collapse. Open-Lung-PEEP and Best-Compromise-PEEP were positively correlated with body mass index during MV in supine position but not in Trendelenburg position.ConclusionThe PEEP levels required for preventing alveolar collapse and for balancing collapse and overdistension in Trendelenburg position with capnoperitoneum were significantly higher than those required for achieving the same goals in supine position without capnoperitoneum. Even with high PEEP levels, alveolar overdistension was negligible during MV in Trendelenburg position with capnoperitoneum.Trial registrationThis study was prospectively registered at German Clinical Trials registry (DRKS00016974).

Наш опыт ретроперитонеоскопического иссечения простых кист почек: преимущества и недостатки

bstract Objective. Assess advantages and disadvantages of retroperitoneoscopic access for the resection of renal cysts in clinical practice. Material and methods. For the period from 01/09/2020 tо 30/11/2021, in our center we performed 25 retroperitoneal endoscopic resections of renal cysts. Access was made through Lesgaft-Grunfield triangle. All patients underwent standard clinical evaluation for renal cysts. Results. Retroperitoneal access was performed for all patients by standard technique. All surgeries were finished without conversion to open surgery. Mean duration of surgery was 25,45 ± 2,55 min. Mean intraoperative blood loss was 20,4 ± 0,6 ml. Intra – andpostoperativecomplications, that required extra interventions were not encountered. Meanhospital – instaywas 4,6 ± 0,4 days and patients soon after discharge returned to their daily activities. All patients were under follow-up to 12 months. Conclusion. Retroperitoneal endoscopic access is a good alternative for laparoscopic access for surgical treatment of renal cysts, with less trauma and with no invasion into peritoneal cavity. Timeofrecoveryisthesame aswithlaparoscopy. This technique is also carries good cosmetic effect. One of main advantages is that in this access it is possible to hold high CO2 pressure, that is particularly in patients with ischemic heart disease is undesirable to hold high intraabdominal pressure

Development and evaluation of a numerical spine model comprising intra-abdominal pressure for use in assessing physiological changes on abdominal compliance and spinal stability

BackgroundAbdominal compliance is the “measure of ease of abdominal expansion” and determines whether a patient can withstand high intra-abdominal pressures. Thus, high compliance indicates that the abdomen can expand relatively freely, while low compliance restricts abdominal expansion. The global objective of the present work is to evaluate the effect of physiological changes on abdominal compliance using a comprehensive spine finite element model inclusive of intra-abdominal pressure. MethodsThe effect of changing Young's modulus, abdominal wall thickness, and abdominal radii on abdominal compliance were evaluated. Intra-abdominal pressure and thoracolumbar fascia forces were also evaluated to assess abdominal physiological changes effects on overall static spinal stability. FindingsResults showed that as wall thickness increased, compliance decreased. Similar findings were made with an increase in abdominal radius and Young's modulus. Furthermore, the active reduction in compliance, caused by increased elasticity and abdominal radius, resulted in an increase in spinal supportive forces originating from the thoracolumbar fascia and intra-abdominal pressurization, along with an increase in spine displacement from its original stable position. There was no clear stability trend for the case of changing abdominal wall thickness as fluctuations were present. InterpretationInvestigated mechanics and data trends suggested that dangerously low compliance levels might result from poor abdominal elasticity and thickening fat layers. This led to a direct discussion and recommendations for obesity conditions and laparoscopy applications. Lastly, static spinal stability showed to improve through increasing active abdominal compliance by means of actively engaging abdominal pressure, hence augmenting abdominal active elasticity.