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2 Polish Journal of Surgery

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Evaluation of Intraabdominal Presure changes after large Abdominal hernia Surgeries

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Pukacki F. , Zieliński M. , Grzeszczak M.

Polish Journal of Surgery

2010

tom 82

nr 5

259-266

Occurrence of systemic complications after a large abdominal hernia operation depends on the increase of intraabdominal pressure (IAP). It is thus essential to device a preoperative method to predict IAP level changes in perioperative period.The aim of the study was evaluation of our own mathematical calculation of hernial sac volume in prognosis of intraabdominal pressure changes after abdominal wall reconstruction.Material and methods. Between January 2006 and November 2007 32 patients were operated because of a large abdominal hernia. Secondary hernias made up 68.8%, whereas primary hernias 31.3%. Mean patients' age was 67.5 years. Using our own method of mathematical calculation of hernial sac volume, the patients were divided into groups according to hernia size. Intraabdominal pressure values and their influence on respiratory, circulatory and excretory systems have been analyzed. The operation was conducted under intratracheal anesthesia. The abdominal wall plasty was carried out using a polypropylene mesh that has been placed in the prefascial retromuscular space.Results. No perioperative deaths were observed. The highest mean IAP increase occurred after hernial ring closure, whereas the highest mean abdominal perfusion pressure (APP) drop was observed in the first 24 hours after the operation. There was observed a positive correlation between hernial sac volume (HSV) and IAP values and a negative one between HSV and APP value. There was observed a decrease of diuresis, saturation, blood pressure and an increase of urea and creatinine in the first 24 hours after the operation.Conclusions. A non-invasive hernial sac volume measurement helps to predict postoperative IAP growth and thus development of general complications. Pressure-free operations seem to be safe in terms of preventing post-operative intraabdominal pressure growth.

Utility of Measurements of Abdominal Perfusion Pressure as a Measure of Isovolemic Status and Intestinal Perfusion in Patients with Ruptured Aortic Aneurysm

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Bieda K. , Pukacki F. , Zieliński M. , Sobczyński P. , Oszkinis G. , Hartman-Sobczyńska R. , Majewski W.

Polish Journal of Surgery

2011

tom 83

nr 8

443-448

Ruptured abdominal aorta aneurysm of ten results in intraabdominal hypertension (IAH). When IAH exceeds 20 mm Hg, intestinal ischemia can result that is a common cause of severe postoperative complications, including death.The aim of the study was to evaluate utility of measurement of abdominal perfusion pressure (APP) to estimate intestinal perfusion and isovolemic status in patients undergoing surgical treatment for ruptured abdominal aorta aneurysm.Material and methods. A group of 40 patients of either sex, aged 47 - 93 years (average age 70 ± 10) was treated at an Intensive Care Unit after surgical reconstruction of abdominal aorta due to ruptured aortic aneurysm. The study was prospective. The following were measured: parameters of intraabdominal pressure (intraabdominal pressure - IAP, abdominal perfusion pressure - APP); parameters of intestinal perfusion - tonometric (intramucosal gastric carbon dioxide partial pressure PgCO2, intramucosal-arterial difference in carbon dioxide partial pressure - Pg-aCO2); hemodynamic parameters (mean arterial pressure - MAP, central venous pressure - CVP).Results. A statistically significant correlation was demonstrated between parameters of visceral perfusion and abdominal perfusion pressure. Pearson correlation coefficient for APP/PgCO2 and APP/Pg-aCO2 was negative and was - 0.4664 and - 0.3498, respectively.Conclusions. Abdominal perfusion pressure is an useful parameter in the evaluation of intestinal perfusion in IAH patients after surgical treatment of ruptured aortic aneurysm. MAP reflects current physiological body reserves at a critical stage of the disease, informing about possibility to provide visceral perfusion and indirectly, about adequacy of fluid replacement therapy. In intraabdominal hypertension, CVP is falsely elevated, making it of low utility in the evaluation of volemic status and intestinal perfusion.