An Individualized Low-Pneumoperitoneum-Pressure Strategy May Prevent a Reduction in Liver Perfusion during Colorectal Laparoscopic Surgery
Issued Date
2023-03-01
Resource Type
eISSN
22279059
Scopus ID
2-s2.0-85152713685
Journal Title
Biomedicines
Volume
11
Issue
3
Rights Holder(s)
SCOPUS
Bibliographic Citation
Biomedicines Vol.11 No.3 (2023)
Suggested Citation
Olmedilla Arnal L.E., Cambronero O.D., Mazzinari G., Pérez Peña J.M., Zorrilla Ortúzar J., Rodríguez Martín M., Vila Montañes M., Schultz M.J., Rovira L., Argente Navarro M.P. An Individualized Low-Pneumoperitoneum-Pressure Strategy May Prevent a Reduction in Liver Perfusion during Colorectal Laparoscopic Surgery. Biomedicines Vol.11 No.3 (2023). doi:10.3390/biomedicines11030891 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/81623
Title
An Individualized Low-Pneumoperitoneum-Pressure Strategy May Prevent a Reduction in Liver Perfusion during Colorectal Laparoscopic Surgery
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Instituto de Investigación Sanitaria La Fe
Hospital General Universitario Gregorio Marañon
Hospital Universitari i Politècnic La Fe
Hospital General Universitario de Valencia
Nuffield Department of Medicine
Universitat de València
Amsterdam UMC - University of Amsterdam
Instituto de Investigación Sanitaria La Fe
Hospital General Universitario Gregorio Marañon
Hospital Universitari i Politècnic La Fe
Hospital General Universitario de Valencia
Nuffield Department of Medicine
Universitat de València
Amsterdam UMC - University of Amsterdam
Other Contributor(s)
Abstract
High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter ‘Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study’ (IPPCollapse–II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG–PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG–PDR and ICG–R15. All 29 patients from the participating center were included. Median IAP was 8 (25th–75th percentile: 8–10) versus 12 (12,12) mmHg, in IPP and SPP patients, respectively (p < 0.001). ICG–PDR was higher (OR 1.42, 95%-CI 1.10–1.82; p = 0.006) and PDR–R15 was lower in IPP patients compared with SPP patients (OR 0.46, 95%-CI 0.29–0.73; p = 0.001). During laparoscopic colorectal surgery, an individualized low pneumoperitoneum may prevent a reduction in liver perfusion.