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ISSN 1665-2576 (Print)

2002, Number 3

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Rev Mex Cir Endoscop 2002; 3 (3)

Pneumoperitoneum physiopathology. Ten years of studies in search of an unifying theory

Edgardo BO, Szomstein S, Mailapur RV, Zundel N, Jacobo RR

Language: Spanish
References: 91
Page: 101-108
PDF size: 54.52 Kb.


ABSTRACT

The wide use of the pneumoperitoneum in laparoscopic surgery, and the frequent observation of high intra-abdominal pressure (IAP) in surgical patients and trauma victims, exposes the general surgeon to the problem of intra-abdominal hypertension in his daily practice. Even though the severity of the problem or its clinical consequences are not always evident, the abdominal pressure is an important parameter in the hemodynamic instability or in the organic disfunction. The mechanism through which IAP affects the different organs and systems is the subject of numerous investigations. The accumulated evidence shows that, more than the local pressure of the abdomen, it is the pressure which is transmitted to other distant compartments the one that is responsible, by far, of the effects that are observed. The intra-cranial compartment, protected by the osseous structure, is subjected to quick pressure changes, only partially compensated by the local self-regulatory mechanisms. The pressure transmitted from the abdomen to the brain can result in the liberation of stress mediators and hemodynamic effectors, such as catecholamines and vasopressin. The adverse hemodynamic effects of intra-abdominal hypertension can be reverted by lowering the abdominal pressure, or changing the parameters that contribute to the rise in ICP (intra-cranial pressure), such as the hemodynamic status (volume) or position. Blocking the neuro-hormonal mediators that have been liberated in response to the elevation of the ICP might be the treatment to investigate in the future.


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