title: Endoscopic components separation for abdominal compartment syndrome.
abstract: BACKGROUND
  Sustained intraabdominal pressures of 14 to 20 mm Hg have significant pathophysiological consequences, but there is currently no satisfactory low-morbidity procedure appropriate for intervention early in the disease process of abdominal compartment syndrome (ACS). The anatomical principles of abdominal wall components separation were used to develop a percutaneous procedure that increased abdominal capacity and decreased abdominal pressure.
  
  
  METHODS
  Using a porcine model, we determined abdominal capacity changes by helium insufflation. Corn oil was then used to create an episode of sustained intraabdominal hypertension and changes in intraabdominal pressure and intestinal mucosal oxygenation were determined.
  
  
  RESULTS
  Endoscopic abdominal wall components separation (EACS) increased abdominal capacity by 1 L (from 0.89 +/- 0.39 L to 1.95 +/- 0.48 L; P <0.001). During intraabdominal hypertension, EACS decreased abdominal pressure by 31.6% (from 15.9 +/- 2.1 to 11.0 +/- 1.5 mm Hg; P <0.001). Intestinal PO(2) was increased by 61% (18.8 +/- 11.4 to 30.3 +/- 11.7; P = 0.012)
  
  
  CONCLUSIONS
  A minimally invasive procedure (EACS) is feasible and has demonstrated effectiveness in a porcine model of ACS.
authors.affiliation: Division of Surgery, Box 3479, Duke University Medical Center, Durham, NC 27707, USA. mvoss@duke.edu
authors.forename: Miranda
authors.initials: M
authors.lastname: Voss
authors.forename: Jose
authors.initials: J
authors.lastname: Pinheiro
authors.forename: James
authors.initials: J
authors.lastname: Reynolds
authors.forename: Rebecca
authors.initials: R
authors.lastname: Greene
authors.forename: Mark
authors.initials: M
authors.lastname: Dewhirst
authors.forename: Steven N
authors.initials: SN
authors.lastname: Vaslef
authors.forename: Erik
authors.initials: E
authors.lastname: Clary
authors.forename: W Steve
authors.initials: WS
authors.lastname: Eubanks
mesh_terms: D034861:Abdominal Wall; D000818:Animals; D003161:Compartment Syndromes / Q000503:physiopathology / Q000601:surgery*; D004724:Endoscopy; D007327:Insufflation; D007413:Intestinal Mucosa / Q000378:metabolism; D010100:Oxygen / Q000378:metabolism; D011312:Pressure; D013552:Swine
chemical_list: D010100:Oxygen