Carbon dioxide pneumoperitoneum-related liver injury is pressure dependent: A study in an isolated-perfused organ model.
BACKGROUND
Disturbed liver function tests are associated with the pneumoperitoneum applied for biliary and non-biliary laparoscopic surgical procedures. The extent, duration and reversibility of such an injury are unknown. An isolated organ model was used to assess reversibility of liver injury in a CO(2)-pneumoperitoneum-like environment.


METHODS
Rat livers (n = 63) were isolated and perfused within a chamber pressurized at 0, 3, 5, 8, 12, 15 or 18 mmHg for 60 minutes. Pressure was annulled during the ensuing 61-90 minutes in one-half of the groups and markers of liver function were measured and recorded.


RESULTS
Inflow pressure level, flow rate, effluent partial O(2) and CO(2) pressures, O(2) extraction rate, lactate dehydrogenase level, lactic to pyruvic acid ratio, and total xanthine oxidase and dehydrogenase levels became abnormal, starting at 15 minutes after a pressure >5 mmHg was applied in the chamber. Signs of injury slowly reversed towards baseline values in all groups except for the 15 mmHg and 18 mmHg-pressurized ones, even after pressure had been annulled for 30 minutes.


CONCLUSIONS
CO(2)-pneumoperitoneum-like conditions directly injured rat liver tissue to a degree which correlated with the amount of applied pressure. Damage caused by pressure >or=15 mmHg was no longer reversible if it had been applied over a 60-minute period.
Endoscopic Surgery Service, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Amir
A
Szold
Avi A
AA
Weinbroum
D000818:Animals; D002245:Carbon Dioxide / Q000009:adverse effects*; D066298:In Vitro Techniques; D008107:Liver Diseases / Q000209:etiology* / Q000378:metabolism; D008297:Male; D010477:Perfusion; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011312:Pressure; D051381:Rats; D017208:Rats, Wistar
D002245:Carbon Dioxide