title: Effects of carbon dioxide pneumoperitoneum on hepatic function in obstructive jaundice: an experimental study in a rat model.
abstract: OBJECTIVE
  The physiology of the patient during laparoscopy differs from that of open surgery. Both pneumoperitoneum and obstructive jaundice impair the hepatic function, but the combined insult has not been previously examined. In this study, we aimed to investigate the effects of carbon dioxide (CO(2)) pneumoperitoneum on hepatic function in a rat model of obstructive jaundice.
  
  
  METHODS
  Forty-four male Sprague-Dawley rats were divided into four groups: group 1 (n = 10), sham-operated group; group 2 (n = 12), obstructive jaundice group; group 3 (n = 10), CO(2) pneumoperitoneum group; and group 4 (n = 12), obstructive jaundice and CO(2) pneumoperitoneum group. Common bile duct was ligated and divided in the obstructive jaundice groups. After 6 days, a 12-mmHg pneumoperitoneum was induced, maintained for 60 min, and released for 120 min. Blood samples were drawn for the measurement of white blood cell and platelet counts, serum liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], total bilirubin). Tissue samples were obtained for analyses of malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) levels. We evaluated the degree of liver injury on a grading scale from 0 to 4, histopathologically.
  
  
  RESULTS
  Pneumoperitoneum after biliary obstruction resulted in an increase in AST and ALT levels and a decrease in white blood cell and platelet counts. However, changes in liver tissue MDA, GSH, and SOD levels did not correlate with the changes in AST and ALT levels and white blood cell and platelet counts. After sham operation with pneumoperitoneum, the GSH levels in liver homogenate were significantly decreased in the group 3 when compared to the group 2. On the other hand, obstructive jaundice itself caused significant reduction in the SOD activity of liver homogenate in comparison to the group 3. Histopathologically, sinusoidal congestion and vacuolization were more severe in the group 3.
  
  
  CONCLUSIONS
  Alterations in hepatic function occur in pneumoperitoneum applied jaundiced subjects. However, there were no statistically significant differences between the groups 2 and 4 with regard to white blood cell and platelet counts, serum liver enzymes including AST, ALT, and total bilirubin values, MDA and GSH levels and SOD activity of liver homogenate, and histologic damage. These results indicate that there is no additional risk on liver function associated with pneumoperitoneum performed in obstructive jaundice.
authors.affiliation: Department of Gastroenterological Surgery, Turkey Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey. ebbostanci@yahoo.com
authors.forename: Erdal Birol
authors.initials: EB
authors.lastname: Bostanci
authors.forename: Sinan
authors.initials: S
authors.lastname: Yol
authors.forename: Zafer
authors.initials: Z
authors.lastname: Teke
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.forename: Zisan
authors.initials: Z
authors.lastname: Sakaogullari
authors.forename: Ummuhani
authors.initials: U
authors.lastname: Ozel Turkcu
authors.forename: Ayse
authors.initials: A
authors.lastname: Bilgihan
authors.forename: Musa
authors.initials: M
authors.lastname: Akoglu
mesh_terms: D000818:Animals; D002245:Carbon Dioxide / Q000494:pharmacology; D004195:Disease Models, Animal; D005740:Gases / Q000494:pharmacology; D041781:Jaundice, Obstructive / Q000601:surgery*; D008107:Liver Diseases / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D051381:Rats; D017207:Rats, Sprague-Dawley
chemical_list: D005740:Gases; D002245:Carbon Dioxide