Intraperitoneal Pressure Research Articles

Factors affecting intraperitoneal pressure (IPP) and its prognostic value in predicting leak risk and gastrointestinal symptoms in adult peritoneal dialysis patients: a systematic review and meta-analysis.

Intraperitoneal pressure measurementoffers therapeutic and prognostic benefits in predicting leak risks and gastrointestinal symptoms in Peritoneal Dialysis (PD) patients. This systematic review aims to evaluate the prognostic utility of intraperitoneal pressure measurements and different estimated intraperitoneal pressure equations in predicting the risk of non-infectious complications in PD patients. Databases including MEDLINE, EMBASE and Cochrane were searched up to July 2023. Randomised and non-randomised trials were included, focusing on End-Stage Kidney Disease (ESKD) patients undergoing PD. Primary outcomes were variables associated with intraperitoneal pressure, while secondary outcomes included PD-related non-infectious complications and gastrointestinal symptoms. Data synthesis combined meta-analysis with narrative synthesis.This review has been registered on PROSPERO (CRD42023475138). Out of 1828 identified studies, 12 were included for systematic review and 10 for meta-analysis. Body Mass Index (BMI) and Body Surface Area (BSA) showed a consistent positive correlation with intraperitoneal pressure (BMI: r = 0.49, 95% CI 0.35-0.61, I2 = 67.39%, p = 0.003; BSA: r = 0.2, 95% CI 0.08-0.31, I2 = 14.10%, p = 0.324). Conversely, the association between intraperitoneal pressure and age, intraperitoneal volume, and Charlson Comorbidity Index were less consistent. Subgroup analysis demonstrated an association between higher intraperitoneal pressure in patients with increased BMI and BSA. However, the relationship between intraperitoneal pressure and non-infectious mechanical complications remained inconclusive. This review underscores a significant association between intraperitoneal pressure and anthropometric measures (BMI and BSA). The majority of the studies identified included a small sample and considerable bias. However, the association between intraperitoneal pressure and clinically relevant outcomes was not clear. While increasing body mass index and body surface areas are associated with increasing intraperitoneal pressure, the clinical relevance of measuring intraperitoneal pressure in an adult population remains unclear, particularly given the absence of an association with clinically relevant non-infectious outcomes.

Pressure induces peritoneal fibrosis and inflammation through CD44 signaling

Peritoneal dialysis (PD) is a widely used sustainable kidney replacement therapy. Prolonged use of PD fluids is associated with mesothelial-mesenchymal transition, peritoneal fibrosis, and eventual ultrafiltration (UF) failure. However, the impact of pressure on the peritoneum remains unclear. In the present study, we hypothesized increased pressure is a potential contributing factor to peritoneal fibrosis and investigated the possible mechanisms. In vitro experiments found that pressurization led to a mesenchymal phenotype, the expression of fibrotic markers and inflammatory factors in human mesothelial MeT-5A cells. Pressure also increased cell proliferation and augmented cell migration potential in MeT-5A cells. The mouse PD model and human peritoneum equilibrium test (PET) data both showed a positive association between higher pressure and increased small solute transport, along with decreased net UF. Mechanistically, we found that significant upregulation of CD44 in mesothelial cells upon pressurization. Notably, the treatment of CD44 neutralizing antibodies prevented pressure-induced phenotypic changes in mesothelial cells, while a CD44 inhibitor oligo-fucoidan ameliorated pressure-induced peritoneal thickening, fibrosis, and inflammation in PD mice. To conclude, intraperitoneal pressure results in peritoneal fibrosis in PD via CD44-mediated mesothelial changes and inflammation. CD44 blockage can be utilized as a novel preventive approach for PD-related peritoneal fibrosis and UF failure.

Gynecological Laparoscopic Surgeries under Spinal Anesthesia: Benefits and Challenges.

This prospective study investigated the feasibility of performing laparoscopic pelvic surgery under spinal anesthesia and analyzed the intraoperative side effects, like pain, nausea, and vomitus, of 915 patients. The implementation and performance of laparoscopic surgery under local anesthesia on 915 patients (out of a total of 3212 who underwent laparoscopic pelvic surgery under spinal anesthesia) were analyzed in relation to BMI (body mass index), obesity, pain during surgery, amount of intraperitoneal mmHg CO2 gas pressure, and surgical complications. BMI > 30, intra-abdominal adhesions, increased duration of the operation, bleeding, and increased intraperitoneal CO2 pressure were statistically significant as the main causes of pain during laparoscopic surgery under spinal anesthesia. Underweight patients, on the other hand, had less pain when intra-abdominal pressure increased compared to those of normal weight. The appearance of pain, nausea, and vomitus occurred in 10.3% of patients, and these events were easy to manage and treat. They did not affect the surgeon's work or the course of the operation. In light of these observations, we are proposing spinal anesthesia for laparoscopic surgery as the first choice in patients who have no contraindications. To the best of our knowledge, this clinical study constitutes the largest clinical observation and dataset concerning spinal anesthesia in laparoscopic pelvic surgery. ISRCTN38987, 10 December 2019.

#470 Relationship between intraperitoneal volume and intraperitoneal pressure during peritoneal dialysis

Abstract Background and Aims Monitoring intraperitoneal pressure (IPP) has been advocated to quantitate intraperitoneal volume (IPV) during peritoneal dialysis (PD). The aim of this study was to investigate the relationship between IPV and IPP during a short PD dwell. Method Thirteen patients (age 60.2 ± 13.8 years, 5 females, BMI 28.6 ± 7.8 kg/m2) were studied during a 2-hour dwell (2 L dialysate, 2.5% dextrose) in a sitting position. IPP was measured 4x per minute by a pressure sensor integrated in the Liberty Cycler (Fresenius Medical Care, Waltham, MA, USA). Segmental abdominal bioimpedance (Hydra 4200, Xitron Technologies, San Diego, CA, USA) was done concurrently to measure IPV. Serum and dialysate creatinine and glucose concentrations were measured before and after the dwell. Dialysate density (ρ) was measured by a handheld density meter (Mettler-Toledo, Columbus, OH USA). Ultrafiltration volume (UFV) was recorded by the Liberty Cycler. A simple physical model (IPP = ρ × h × g) was used to explore the relationship between IPP and IPV (Fig. 1). Based on the model, a change in IPP (ΔIPP) depends on the change of apparent dialysate height (Δh) and dialysate density (Δρ); g is the gravity constant. The apparent cross-sectional area (A) of the peritoneal cavity was calculated as IPV/h. Results Average UFV was 0.31 ± 0.25 L (range 0.03 to 1.03 L). During the dwell, IPP decreased in 12 patients (UFV 0.03 to 0.49 L; Fig. 2) and increased in one (UFV 1.03 L). The IPP decrease (−3.81 ± 2.78 cmH2O; −21.2 ± 18%, p < 0.01) was accompanied by a decrease of apparent h (−0.04 ± 0.03 m; −20.9 ± 18.5%, p < 0.01) and ρ (−3.41 ± 0.56 kg/m3; −0.34 ± 0.06%, p < 0.0001). In patients with a decrease in IPP, the apparent dialysate h decreased from 0.19 ± 0.04 to 0.14 ± 0.04 m, and the apparent A increased from 107.8 ± 23 to 154.7 ± 34 cm2. In the patient with IPP increase, the apparent h increase from 0.14 to 0.18 m, and the apparent A from 138.4 to 164.6 cm2. ΔIPP inversely correlated with Δρ (Fig. 3) and UFV (Fig. 4). Moreover, ΔIPP correlated with D/P creatinine (Fig. 5) and with D/D0 glucose (Fig. 6). Conclusion In this proof-of-concept study, a simple physical model was used to explore the relationship between IPP and IPV. Contrary to our expectation, we found that IPP declines in most patients during the dwell. Decrease in IPP is related to increase in the apparent cross-sectional area of the peritoneal cavity. We hypothesize that during the dwell additional spaces of the peritoneal cavity become accessible to IPV. To what extent this opening of peritoneal space is associated with membrane characteristics warrants further studies.

Asymmetric porous composite hydrogel patch for microenvironment-adapted repair of contaminated abdominal wall defects

Effective antibacterial property and long-term mechanical support are essential for the repair of complex abdominal wall defects associated with infection. However, clinically available repair materials often fail to meet these requirements, resulting in high surgical failure rate and complications. In this study, an asymmetric porous composite hydrogel patch (cCS/PVA@BAC) with antibacterial, anti-adhesion, pro-healing, and durable mechanical support properties is designed for the efficient repair of contaminated abdominal wall defects. By stepwise phase-conversion and soaking method, robust and stable polyvinyl alcohol hydrogel (PVAH) is integrated with the biocompatible multicomponent hydrogel made of chitosan and carboxymethyl chitosan (cCS), and benzalkonium chloride (BAC) is loaded to enhance the antibacterial property. The cCS layer of cCS/PVA@BAC has an extracellular matrix-like porous structure, which can promote fibroblasts adhesion and wound healing. In contrast, the PVAH layer on the other side with a smooth and dense structure, which can reduce fibroblasts adhesion and prevent visceral adhesion. In addition, the composite hydrogel patch has good anti-swelling and anti-deformation properties as well as stable mechanical strength, thus can withstand high intraperitoneal pressure in the wet internal microenvironment. The loaded BAC can efficiently kill bacteria and improve the local inflammatory microenvironment. With these advantages, cCS/PVA@BAC can significantly reduce inflammation, promote tissue remodeling, and accelerate the healing of contaminated abdominal wall defects in the rat model. These findings suggest a potential use of multifunctional hydrogel patch as an ideal material for effective repair of contaminated soft tissue defects.

The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complicationsin peritoneal dialysis patients.

Increased intraperitoneal pressure is associated with abdominal wall complications and technical failure of peritoneal dialysis (PD). Several equations have been developed to estimate intraperitoneal pressure. We aimed to assess the prognostic yield of the intraperitoneal pressure as estimatedby current equations on the occurrence of abdominal wall complications in peritoneal dialysis patients. This is a retrospective analysis of data from a prospective cohortwhich recruited 1207 incident PD patients. Estimated intraperitoneal pressure was calculated using four available equations(according toSigogne, Castellanos, Scanziani and deJesus Ventura). Abdominal wall complications were recorded during follow-up. Univariate analysis and multivariate analysis with competing risk regression were used to assess the predictive power of theestimates of intraperitoneal pressure in the occurrence of abdominal wall complications. During a median follow-up of 30months, 66 (5.5%) patients (1.6/100 patient-years) developed abdominal wall complications. The median time to the occurrence of abdominal wall complications was 5.7months. Only the estimated intraperitoneal pressure by the de Jesus Ventura equation significantly predicted abdominal wall complications by using univariate analyses. Associations between estimated intraperitoneal pressure by the de Jesus Ventura equation and the occurrence of abdominal wall complications disappeared after adjusting for significant clinical factors. We verified the prognostic value of estimation of intraperitoneal pressure by four availableequations in predicting abdominal wall complications in our single-center PD cohort. Due to a low diagnostic yield, a novel equation for estimating the intraperitoneal pressure is urgently needed.

The First Prospective Study Investigating the Safety and Feasibility of a Spray-Type Adhesion Barrier (AdSpray™) in Minimally Invasive Hepatectomy: An Analysis of 124 Cases at Our Institution.

(1) Background: With the increasing demand for repeat hepatectomy, preventing perihepatic adhesion formation following initial hepatectomy is crucial. Adhesion-preventative barriers, like the new spray-type AdSprayTM (Terumo Corporation, Tokyo, Japan), have been proposed to reduce adhesion risk. However, data on their safety in minimally invasive hepatectomy (MIH) remain scarce. This is the first prospective study to evaluate the safety and feasibility of AdSprayTM in MIH. (2) Methods: A total of 124 patients who underwent MIH with AdSprayTM and 20 controls were analyzed. Subgroup analysis according to the AdSpray™ application area was conducted. Major complications were assessed using the Clavien-Dindo classification. Moreover, intraperitoneal pressure during AdSpray™ application was monitored in 20 cases. (3) Results: Major complications occurred in 6.4% of the patients, which was comparable to that in open hepatectomy. Intraperitoneal pressure remained stable below 12 mmHg during AdSpray™ application without any complications. No significant difference in complication rates was observed among subgroups. However, a potential increase in intra-abdominal abscess formation was suspected with AdSpray™ application to the resected liver surfaces. (4) Conclusions: AdSpray™ can be safely used in MIH; however, further research is needed to confirm the appropriacy of using AdSpray™, particularly over resected liver surfaces. Overall, AdSpray™ is a promising tool for enhancing the safety of MIH.

Peritoneal Dialysis Care for People with Diabetes, Polycystic Kidney Disease, or Advanced Liver Disease.

People treated with peritoneal dialysis (PD) often have complicating conditions that require careful management. Three such conditions are reviewed in this article-diabetes mellitus, polycystic kidney disease, and chronic liver disease. Each of these conditions requires an understanding of both its effect on the delivery of the PD and the effect of the PD on the condition itself. In diabetes, glucose absorption from the dialysate complicates metabolic control and affects salt and water management and patient outcome. There is particular benefit in clinical care being delivered through a multidisciplinary team that involves both kidney and diabetes experts. In relation to polycystic kidney disease, a key issue is the potential for increased intraperitoneal pressure due to the combined effect of the enlarged polycystic organs and the presence of the dialysis solution, and therefore, the PD prescription requires to be managed with a particular focus on limiting that pressure. For patients with liver disease, key issues include nutritional support because PD can add to protein losses already consequent on the liver disease itself. Considered approaches are required to manage ascites and reduce infection risk and the potential for hernias and leaks to develop. Mortality in this group is unfortunately high-however, PD may present a better management option than hemodialysis in many patients-particularly in those where the liver disease is complicated by low BP, clotting abnormalities, or troublesome ascites. Overall, the choice to use PD in patients with these complicating conditions should be based on shared decision making with the patient and their family members informed by high-quality information in which risks, benefits, and management strategies are clearly presented.

HIPEC and PIPAC for gastric cancer: technique and comparison of efficacy. Literature review

Background: According to the World Health Organization (WHO) data, gastric cancer (GC) was the 5th most common cancer and the 4th leading cause of cancer death worldwide in 2020. Peritoneal metastases (PM) are associated with a poor prognosis and detected in 30 % of patients with locally advanced GC; the median overall survival in patients with PM is 3–6 months without any treatment and 6–12 months with the use of systemic chemotherapy. Delivery of appropriate chemotherapeutic drugs directly into the abdominal cavity increases the effectiveness of treatment without severe systemic side effects. Today, various forms of intra-abdominal chemotherapy of PM are used in the world.Aim: To evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) and aerosol intraperitoneal pressure chemotherapy (PIPAC) in the treatment of GC PM.Purposes: To review current domestic and foreign publications on HIPEC and PIPAC, to compare their efficacy.Materials and methods: Articles in PubMed, Scopus, Web of Science databases were studied and analyzed for the key queries: “stomach cancer”, “carcinomatosis”, “peritoneal metastases”, “HIPEC”, “PIPAC”.Conclusions: The best results were achieved when using PIPAC as preoperative chemotherapy, followed by cytoreductive surgery in combination with HIPEC. Both procedures are promising and require further study with multicenter randomized prospective trials to assess their therapeutic potential.

Clinical study of evaluating the clinical effect of Dachengqi decoction in the treatment of sepsis complication with gastrointestinal dysfunction via gastric antrum cross-sectional area measured by bedside ultrasound

To evaluate the clinical value of Dachengqi decoction in the treatment of sepsis complication with gastrointestinal dysfunction via gastric antrum cross-sectional area (CSA) measured by bedside ultrasound. A parallel group randomized controlled trial was conducted. A total of 80 patients with sepsis with gastrointestinal dysfunction admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from January 2021 to October 2022 were enrolled. According to whether patients agree to use Dachengqi decoction after admission, all patients were divided into Dachengqi decoction group (observation group) and conventional treatment group (control group) by 1 : 1 randomization, each group has 40 patients. Both groups were treated with fluid resuscitation, anti-infection, maintaining stable respiratory circulation, early nourishing feeding, promoting gastrointestinal motility, and regulating intestinal flora. The observation group was treated with Dachengqi decoction on the basis of western medicine, 30 mL decoction was taken in the morning and evening. Both groups were treated for 7 days. The CSA of the two groups was measured by bedside ultrasound before and after treatment. The gastric residual volume (GRV1 and GRV2) were calculated by formula and traditional gastric tube withdrawal method. The gastrointestinal dysfunction score, acute physiology and chronic health evaluation II (APACHE II), intraperitoneal pressure (IAP), serum preprotein (PA), albumin (Alb), white blood cell count (WBC), procalcitonin (PCT), hypersensitivity C-reactive protein (hs-CRP), length of intensive care unit (ICU) stay and incidence of aspiration were detected to evaluate the clinical efficacy of Dachengqi decoction, the correlation and advantages and disadvantages between CSA measured by bedside ultrasound and other evaluation indicators of gastrointestinal dysfunction in sepsis were also analyzed. There were no significant differences in the indicators before treatment between the two groups, which were comparable. In comparison with the pre-treatment period, CSA, GRV, gastrointestinal dysfunction score, APACHE II score, IAP, WBC, PCT, and hs-CRP of the two groups after treatment were significantly decreased, PA and Alb were significantly increased, and the observation group decreased or increased more significantly than the control group [CSA (cm2): 4.53±1.56 vs. 6.04±2.52, GRV1 (mL): 39.85±8.21 vs. 53.05±11.73, GRV2 (mL): 29.22±5.20 vs. 40.91±8.97, gastrointestinal dysfunction score: 0.87±0.19 vs. 1.35±0.26, APACHE II score: 11.54±3.43 vs. 14.28±3.07, IAP (cmH2O, 1 cmH2O ≈ 0.098 kPa): 9.79±2.01 vs. 13.30±2.73, WBC (×109/L): 9.35±1.24 vs. 12.35±1.36, PCT (μg/L): 3.68±1.12 vs. 6.43±1.45, hs-CRP (mg/L): 24.76±5.41 vs. 46.76±6.38, PA (mg/L): 370.29±45.89 vs. 258.33±34.58, Alb (g/L): 38.83±5.64 vs. 33.20±4.98, all P < 0.05]. The length of ICU stay (days: 10.56±3.19 vs. 14.24±3.45) and incidence of aspiration (12.5% vs. 25.0%) were lower than those in the control group (both P < 0.05). Correlation analysis showed that CSA measured by bedside ultrasound was positively correlated with GRV2, gastrointestinal dysfunction score, APACHE II score, and IAP (r values were 0.84, 0.78, 0.75, 0.72, all P < 0.01) and negatively correlated with PA and Alb (r values were -0.64 and -0.62, both P < 0.01). The Dachengqi decoction can significantly improve the clinical symptoms of septic patients with gastrointestinal dysfunction, reduce systemic inflammatory response, improve nutritional status, and shorten ICU hospital stay. Bedside ultrasound monitoring of CSA is a simple, accurate and effective means to evaluate gastrointestinal dysfunction, which is worthy of further clinical promotion.

First clinical evaluation report of using the Topol device to deliver PIPAC treatment

Pressure Intra Peritoneal Aerosol Chemotherapy (PIPAC) is a new approach to deliver a drug into the peritoneal cavity. This novel approach associates an intraperitoneal pressure obtained by the laparoscopic procedure and an aerosol distribution obtained by a specific devoted nebulizer device. A new device is now available to perform PIPAC, called Topol® (Skala). We reported earlier, as a clinical evaluation report, the first consecutive cases treated. Seven patients had gastric, appendix, ovarian and rectal peritoneal metastasis and received 12 PIPAC procedures. The injector flow was selected to be 1.5 ml/s, as proposed by the company. No abnormal hyper pressure was observed in the injector. All the procedures were successful with a pressure between 10 and 20 bars and were performed to completion for drug administration. The intended therapeutic results were obtained in each case. No adverse events were recorded during the post-PIPAC clinical evaluations. To date, two patients succumbed due to peritoneal metastasis progression, 5 are alive, and two patients considered as non-operable had been secondarily proposed for cytoreductive surgery because of tumor response. One patient underwent gastrectomy, cytoreductive surgery and HIPEC. Conclusions regarding safety, performance and conformity are favorable for this first limited clinical evaluation report.

Total intracranial migration of ventriculoperitoneal shunt

Background. The ventriculoperitoneal shunt is a common treatment for hydrocephalus. There are several complications associated with it. Shunt failure is one of the most frequent complications, but total intracranial shunt migration is quite uncommon. The exact cause of shunt migration is unknown, but several factors are thought to play a role. Case presentation. A 10-month-old boy was diagnosed with total intracranial migration of a ventriculoperitoneal shunt (Chhabra type). We used neuroendoscopy to remove this intracranially migrated shunt and implanted a new ventriculoperitoneal shunt (Medtronic type) on the opposite side. He had a favourable clinical outcome. Conclusion. Total intracranial shunt migration is an uncommon complication which is most likely caused by increased intraperitoneal pressure, strong head movements, and insufficient shunt fixation. Better patient handling combined with appropriate operative technique would be the best way to prevent shunt migration.

Re-discussion on the comprehensive treatment strategy of complex ventral hernia from the perspective of intraperitoneal pressure

Complex ventral hernia refers to a large hernia that is complicated by a series of concurrent conditions. Change in intra-abdominal pressure is one of the main pathways through which various factors exert an impact on perioperative risk and postoperative recurrence. Taking abdominal pressure reconstruction as the core, the treatment strategy for complex abdominal hernia can be formulated from three aspects: improving patients' tolerance, expanding abdominal cavity volume, and reducing the volume of abdominal contents. Improving patients' tolerance includes abdominal wall compliance training and progressive preoperative pneumoperitoneum. To expand the volume of the abdominal cavity, implanting hernia repair materials, component separation technique, autologous tissue transplantation, component expend technique, and chemical component separation can be used. Initiative content reduction surgery and temporary abdominal closure may be performed to reduce the volume of abdominal contents. For different cases of complex ventral hernia, personalized treatment measures can be safely and feasibly adopted depending on the condition of the patients and the intra-abdominal pressure situation.

Low-Pressure Pneumoperitoneum During Laparoscopic Sleeve Gastrectomy: a Safety and Feasibility Analysis.

Laparoscopy is advised under the lowest possible intra-peritoneal pressure. The aim of this study is to analyze the safety/feasibility of low pneumoperitoneum pressure (LPP) during laparoscopic sleeve gastrectomy (LSG). All primary LSGs who completed a 3-month follow-up were included. Re-do operations and LSGs performed with concomitant procedures were excluded. All LSGs were performed by the senior author. Upon trocar insertions, pressure was set to 10mmHg, and the procedure was started. The pressure was increased step-wise, according to the senior author's assessment of the quality of exposure. Doing so, three pressure groups were formed: groups 1 (10mmHg), 2 (11-13mmHg), and 3 (14mmHg). All data was retrieved from our database. Statistical analysis was performed using one-way ANOVA/Tukey's HSD test/Chi-square test. P values < 0.05 were regarded as significant. Between February 2018 and October 2022, 708 consecutive/primary LSGs were studied. No mortality/conversion/thromboembolic event was observed. Groups 1, 2, and 3 comprised 376 (53.1%), 243 (34.3%), and 89 (12.6%) patients, respectively. Demographics, initial weight, duration of surgery, history for abdominoplasty, drain output, length of stay, and %total weight loss were evenly distributed among groups. Among 16 bleeding episodes, 14 occurred in the LPP group (p = 0.019). Including the only leak and stenosis, 8/9 of Clavien-Dindo 3b + 4 complications were observed in the LPP group (p = 0.092). LSG with LPP is feasible in about half of the patients. However, almost all potentially life-threatening complications occurred in the LPP group where a significantly higher rate of bleeding was observed. Our findings suggest caution for routinely using LPP during LSG.

WCN23-0370 The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complications among peritoneal dialysis patients

WCN23-0370 The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complications among peritoneal dialysis patients

Novel equations for estimating intraperitoneal pressure among peritoneal dialysis patients.

Increased intraperitoneal pressure (IPP) is associated with abdominal wall complications and technical failure in peritoneal dialysis (PD). Since the standard measurement of IPP is limited due to its cumbersome procedures, we aimed to develop and validate equations for estimating IPP. We performed a cross-sectional study with a total of 200 prevalent PD patients who were divided into development and validation datasets after random sampling matched by body mass index. The IPPs were measured using the Durand method, with whole-body and abdominal anthropometry indices collected. Equations with 2.0-L and 1.5-L fill volumes were generated by stepwise linear regression modelling. The bias, accuracy and precision of the estimated IPP (eIPP) with 2-L and 1.5-L fill volumes were compared with actual IPPs by the Durand method. The eIPP for the 2-L fill volume was also compared with other existing equations. Two new equations incorporating waist circumference and height from the decubitus plane to mid-axillary line were generated. The eIPPs exhibited small biases in relation to the Durand method , with median differences of -0.24cmH2O and -0.10cmH2O for 2L and 1.5L, respectively. The precisions evaluated by the standard deviation of the absolute value of the differences were 2.59cmH2O and 2.50cmH2O, respectively. The accuracies evaluated by the value of the percentage of estimates that differed by >20% for the eIPP were 26% for 2.0L and 27% for 1.5L. Better bias, precision and accuracy were observed for the eIPP equation compared with other existing equations for the 2.0-L fill volume. We provided two new equations developed from abdominal anthropometry indices to accurately estimate the IPP in the PD population.

CAUSES OF INGUINAL HERNIAS RECURRENCE DURING THE LIECHTENSTEIN OPERATION

Numerous methods of plastic surgery of inguinal hernias with own tissues, which were developed by surgeons, gave relapses up to 35%. A large number of relapses in the treatment of inguinal hernias with tension methods forced surgeons to look for new ways to solve this problem.&#x0D; Without pathological changes in the deep inguinal ring, a hernia cannot occur, and this leads to the conclusion that all existing methods, which are aimed at strengthening only the front wall of the inguinal canal, are pathogenetically unfounded and often a recurrence of the hernia can be expected.&#x0D; Therefore, a justified operation for various types of inguinal hernia is the strengthening of the deep ring and the back wall of the inguinal canal.&#x0D; Changing the concept of the approach to the treatment of inguinal hernias should be aimed at minimizing trauma and take into account the pathogenetic features of the development of hernias.&#x0D; The reason for the development of inguinal hernias is expansion, destruction, functional insufficiency of deep inguinal openings: medial and lateral.&#x0D; The back wall of the inguinal canal does not have a protective function when intraperitoneal pressure increases and cannot resist hernia formation. At the same time, its weakening, destruction can contribute to the increase of the internal inguinal opening. Although we did not come across any publication that gave an example of a hernia exiting directly through the back wall of the inguinal canal.&#x0D; Based on our own clinical experience, as well as the processing of a large number of literary sources, we offer a modified type of Lichtenstein's operation in the following interpretation: a typical incision of the skin and subcutaneous tissue with the opening of the aponeurosis of the external oblique abdominal muscle; mobilization of the spermatic cord; mobilization of the hernia sac, its opening, stitching at the base and removal. With a direct inguinal hernia, if the bag is small, there is no need to remove it. Revision of the internal inguinal ring in case of an oblique hernia and, if necessary, sewing it to the required size (the tip of the little finger should pass between the cord and the ring).&#x0D; Revision of the medial deep ring in direct inguinal hernia and its suturing "tightly" over the hernial protrusion.&#x0D; Prepare a mesh implant so that its dimensions cover both deep holes, dissect it according to our proposed method. Fix the net to the deep ring using the described method. Sew the lower part of the mesh with an overlap of 1-1.5 cm to the pubic bone, fix the lateral edge of the implant to the pubic ligament with a wrapping suture or knotted single sutures.&#x0D; Above the spermatic cord, the legs of the dissected implant are sewn together and sewn to the aponeurosis of the external oblique muscle of the abdomen from below.&#x0D; The medial edge of the mesh is sewn to the internal oblique muscle and to the aponeurosis of the external oblique muscle in the manner described above.&#x0D; The middle part of the mesh is fixed to the sewn medial deep inguinal ring and to the middle of the inguinal canal with separate knotted stitches. We lay the spermatic cord on the mesh, over which we sew the aponeurosis of the external oblique muscle of the abdomen, subcutaneous tissue and skin.&#x0D; In our opinion, the method of surgery proposed by us for direct and oblique inguinal hernias is the most optimal, minimally traumatic, which best meets the modern requirements of the pathogenesis of the disease. But even this method of plastic inguinal hernias is not ideal and needs constant improvement.

Retracted: Botulinum Toxin Type A Injection Improves the Intraperitoneal High Pressure in Rats Treated with Abdominal Wall Plasty.

[This retracts the article DOI: 10.1155/2022/1054299.].

Effect of Carbondioxide Pneumoperitoneum on Liver Enzymes Following Laproscopic Cholecystectomy In Rural Indian Population

Introduction: Laparoscopic cholecystectomy, a minimal-access procedure for removing the gallbladder, has various benefits, including a significantly shorter hospital stay ,lower cost and a low patient comorbidity Materials and Methods:- this was a prospective study. The study was conducted on 60 patients of cholecystectomy ,who underwent laparoscopic cholecystectomy under constant intraperitoneal pressure of 15mmhg in GEMS medical hospital, ragolu, Srikakulam, Andhra Pradesh. This study was designed to evaluate the complications of carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy using the liver enzymes Results:- Total bilirubin pre-operative was 0.72±0.13 mg/dl, increased 24 h after surgery to 1.11 ± 0.30 mg/dl by 138% . Aspartate aminotransferase (AST) pre-operative was 19.523 ± 16 U/l increased 24 h after surgery to 30.12± 18.35 U/l by 154 %. Alanine aminotransferase (ALT) was 22.58 ± 5.09 U/l increased 24 h after surgery to 38.62 ± 12.15U/l by 171%. Alkaline phosphatase pre-operative values were 103.8 ± 23.32 U/ and after 24 h was 147.8 ± 36.54 U/l by 142 % Conclusion: laparoscopic operations produce a transient rise in serum liver enzymes ,our study too demonstrated bilirubin, AST, ALT, ALP elevated following laparoscopic cholecystectomy . when combined with data from earlier research These changes could be attributable to a decrease in portal venous flow caused by a pneumoperitoneum's high pressures.

Successful Measurement of Intraperitoneal Pressure (IPP) in Peritoneal Dialysis Patients With a Pressure Transducer Demonstrates Significant Interindividual Variation and a Complex Relationship With IP Volume

Successful Measurement of Intraperitoneal Pressure (IPP) in Peritoneal Dialysis Patients With a Pressure Transducer Demonstrates Significant Interindividual Variation and a Complex Relationship With IP Volume