title: Does elevated intra-abdominal pressure during laparoscopic colorectal surgery cause acute gastrointestinal injury?
abstract: BACKGROUND
  The incidence of acute gastrointestinal injury (AGI) after colorectal surgery is low when laparoscopic techniques are used. While elevated intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with AGI grade II, little is known about the relation between increased IAP during laparoscopy and subsequent AGI.
  
  
  OBJECTIVE
  To assess the impact of increased IAP during laparoscopic colorectal surgery on the incidence of postoperative AGI.
  
  
  METHODS
  Sixty-six patients (41 men and 25 women) with colorectal cancer undergoing elective laparoscopic colorectal surgery were randomized into 3 groups, according to different IAP levels during CO2 pneumoperitoneum (10 mm Hg, 12 mm Hg and 15 mm Hg). We recorded the incidence of AGI after surgery by assessing the following parameters: time to first flatus/defecation, time to first bowel movement, time to tolerance of semi-liquid food and the occurrence of vomiting/diarrhea. Moreover, inflammatory mediators were measured before the induction of CO2 pneumoperitoneum and on postoperative day 1.
  
  
  RESULTS
  Acute gastrointestinal injury occurred in 15 (27.3%) patients. In all 3 study groups, the elevation of IAP during CO2 pneumoperitoneum did not significantly increase the occurrence of symptoms of AGI, vomiting or diarrhea. Lower IAP levels did not significantly accelerate recovery of gastrointestinal function or shorten postoperative hospital stay. The changes in serum IL-6 after surgery did not correlate with the value of IAP.
  
  
  CONCLUSIONS
  The level of IAP elevation during laparoscopic colorectal surgery does not increase the occurrence of AGI after surgery.
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhenghao
authors.initials: Z
authors.lastname: Cai
authors.affiliation: Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium.
authors.forename: Manu L N G
authors.initials: ML
authors.lastname: Malbrain
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Ruijun
authors.initials: R
authors.lastname: Pan
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Junjun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Feng
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Dong
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Minhua
authors.initials: M
authors.lastname: Zheng
keywords: acute gastrointestinal injury; colorectal carcinoma; inflammatory mediators; intra-abdominal pressure; laparoscopic surgery; postoperative recovery