Endoscopic components separation for abdominal compartment syndrome.
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.
Voss
Miranda
M
Division of Surgery, Box 3479, Duke University Medical Center, Durham, NC 27707, USA. mvoss@duke.edu
Pinheiro
Jose
J
Reynolds
James
J
Greene
Rebecca
R
Dewhirst
Mark
M
Vaslef
Steven N
SN
Clary
Erik
E
Eubanks
W Steve
WS
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
D010100:Oxygen