RESTRUCTURING OF THE TENDONIAL PART OF THE DIAPHRAGM UNDER THE INFLUENCE OF PNEUMOPERTONEUM OF VARIOUS DURATION CREATED BY CARBON DIOXIDE
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i1.15255Keywords:
pneumoperitoneum, carbon dioxide, diaphragm, rats, morphologyAbstract
SUMMARY. Diaphragmatic excursion may be impaired during laparoscopic surgery, including upper abdominal surgery such as cholecystectomy and pelvic surgery requiring Trendelenburg position. A sharp increase in intra-abdominal pressure can stretch and stiffen the diaphragm.
The aim – to determine the effect of carbon dioxide pneumoperitoneum (PP) on the morphology of the tendon part of the rat diaphragm at different time intervals.
Material and Methods. During the experiment, rats were divided into 5 groups of 10 individuals each as follows: Group I – intact group, which did not have any pathology, the data obtained were used as an indicator of the normal histological picture; Group II – PP for 1 hour, pressure level 10 mmHg; Group III – PP for 3 hours, pressure level 10 mmHg; Group IV – PP for 5 hours, pressure level 10 mmHg; and group V – PP for 5 hours, pressure level 10 mmHg; however, the material for the study was taken after 14 days.
Results. After 1 hour after pneumoperitoneum, fragmentation of collagen fibers and macrophage-lymphocyte infiltration and edema were noted. After 3 hours, loss of compactness, violation of the longitudinal arrangement of collagen fibers was observed, which is due to their deformation, fragmentation and partial lysis. After 5 hours, the lesion area expanded, multiple foci of destruction infiltrated by lymphocytes and macrophages were noted, which bordered on edema of the ground substance.
Conclusions. We found that the tendon part of the diaphragm undergoes changes under the influence of pneumoperitoneum created by carbon dioxide. These changes depend on the duration of intra-abdominal pressure.
References
Byshovets' SM. Pnevmoperytoneum dlya laparoskopiyi pid rehionarnoyu anesteziyeyu: zakys azotu vs dioksyd vuhletsyu [Pneumoperitoneum for laparoscopy under regional anesthesia: nitrous oxide vs carbon dioxide]. Emergency Medicine. 2018; 2(89):92-97. DOI: 10.22141/2224-0586.2.89.2018.126609. Ukrainian. DOI: https://doi.org/10.22141/2224-0586.2.89.2018.126609
Barazanchi AWH, MacFater WS, Rahiri JL, Tutone S, Hill AG, Joshi GP; PROSPECT collaboration. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth. 2018 ; 121(4):787-803. DOI: 10.1016/j.bja.2018.06.023. DOI: https://doi.org/10.1016/j.bja.2018.06.023
Bilyans'kyy LS, Abu Shamsiya RN. Laparoskopichni vtruchannya v urhentniy abdominal'niy khirurhiyi [Laparoscopic interventions in urgent abdominal surgery]. Klinichna khirurhiya. 2016; 8(892):3-4.
Buzkova K, Muller M, Rara A, Roubik K, Tyll T. Ultrasound detection of diaphragm position in the region for lung monitoring by electrical impedance tomography during laparoscopy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018; 162(1):43-46. DOI: 10.5507/bp.2018.005. DOI: https://doi.org/10.5507/bp.2018.005
Rustagi PS, Yadav A, Nellore SS. Ultrasonographic evaluation of diaphragmatic excursion changes after major laparoscopic surgeries in the Trendelenburg position under general anaesthesia: A prospective observational study. Indian J Anaesth. 2023; 67(Suppl 4):S274-S280. DOI: 10.4103/ija.ija_643_23. DOI: https://doi.org/10.4103/ija.ija_643_23
Xu Q, Guo X, Liu J, Li SX, Ma HR, Wang FX, Lin JY. Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial. BMC Anesthesiol. 2022; 22(1):72. DOI: 10.1186/s12871-022-01613-9. DOI: https://doi.org/10.1186/s12871-022-01613-9
Kravchenko B.S. Odnoportova kholetsystektomiya u khvorykh na khronichnyy kal'kul'oznyy kholetsystyt. Pokazannya, tekhnichni aspekty, prohnozuvannya ta profilaktyka uskladnen'. avtoref. dys. [Single-port cholecystectomy in patients with chronic calculous cholecystitis. Indications, technical aspects, prognosis and prevention of complications [author's abstract of dissertation]]. Zaporizhzhya: Zaporiz. nats. med. u-t; 2020. 42 s.
Xu FF, Xiao LB, Zuo JD, Tan JF, Deng L, Deng Y, Zhou J, Tan M. Shoulder pain after abdominal laparoscopic operation: a multicenter study. Chin Med J (Engl). 2013; 126(2):382-4. DOI: https://doi.org/10.3760/cma.j.issn.0366-6999.20121246
Yasir M, Mehta KS, Banday VH, Aiman A, Masood I, Iqbal B. Evaluation of post operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy. Surgeon. 2012; 10(2):71-4. DOI: 10.1016/j.surge.2011.02.003. DOI: https://doi.org/10.1016/j.surge.2011.02.003
Zhang M, Yu Y, Qiu C, Xia X, Sun Y, Wang L, Ma G, Gao X. Effect of Individualized PEEP Guided by Driving Pressure on Diaphragm Function in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer: A Randomized Controlled Trial. Med Sci Monit. 2024; 30:e944022. DOI: 10.12659/MSM.944022. DOI: https://doi.org/10.12659/MSM.944022
Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations. J Minim Access Surg. 2010; 6(4):91-4. DOI: 10.4103/0972-9941.72593. DOI: https://doi.org/10.4103/0972-9941.72593
Kritsak MYU, Rosolovs'ka SO, Levchuk OI. Sposib modelyuvannya eksperymental'noho karboksyperytoneumu u shchura. Svidotstvo pro reyestratsiyu avtors'koho prava na tvir № 126409 [Method of modeling experimental carboxyperitoneum in rats. Certificate of copyright registration for the work No. 126409]. 2024 May 16.
Kritsak MYU, Slabyy OB, Yasinovs'kyy OB. Sposib vidboru eksperymental'noho materialu diafrahmy bilykh shchuriv. Svidotstvo pro reyestratsiyu avtors'koho prava na tvir № 126059. [Method of selecting experimental material from the diaphragm of white rats. Certificate of registration of copyright for the work No. 126059]. 2024 April 29.
Mamić I, Danolić D, Puljiz M, Kasum M, Alvir I, Kostić L, Milas I, Šoštar A, Pedišić I, Bečejac T. Pneumothorax and Pneumomediastinum as a Rare Complication of Laparoscopic Surgery. Acta Clin Croat. 2016; 55(3):501-504. DOI: 10.20471/acc.2016.55.03.22. DOI: https://doi.org/10.20471/acc.2016.55.03.22
