- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
Currently, the majority of colorectal surgeries is performed using laparoscopic and minimal invasive methods, providing the best outcomes in the soonest post-operative period and equal oncological safety when compared to traditional open surgeries. Data of the publications on the safety of laparoscopic surgeries in such patients are fairly contradictory.
The objective of the study: to evaluate the impact of intra-operative intra-abdominal hypertension on the course of post-operative period in the patients undergoing surgery for colorectal cancer.
Subjects and Methods. 48 patients who had surgeries for colorectal cancer were enrolled into the study. All patients were divided into 2 groups based on the course of post-operative period: with complications(no. 1, n = 36) and no complications during the post-operative period (no. 2, n = 12). The analysis included the data of invasive monitoring of arterial blood pressure, blood gases and acid-base balance of arterial and venous blood, blood lactate level, frequency of critical incidents. The patients who had laparoscopic surgeries had their level of intra-abdominal pressure recorded and intra-abdominal perfusion pressure calculated.
The statistic analysis was performed using the software of SPSS 20.0 IBM. In order to define the significance of differences between the groups, paired non-parametric Mann-Whitney test was used. Differences were considered valid with p < 0.05. Chi-square method was used to evaluate the differences between categorical values.
Results. It was found out that two and more episodes of systolic blood pressure drop during surgery significantly increased the risk of post-operative complications (χ2 test with Yates' correction of 4.636, p = 0.001; OR 24.0, RR 8.6, 95% CI 2.002–7.981).
The patients with complicated post-operative period had a significantly higher level of lactate, venoarterial differences of pСО2, more severe base deficit versus the comparison group. When laparoscopic methods were used, these differences were even more significant. When performing correlation analysis the significant association was detected between the levels of intra-abdominal pressure and lactate, BE and ΔpCO2 in 60 minutes after pneumoperitoneum and desufflation, which indirectly confirmed the impact of the increased intra-abdominal pressure on development of intra-abdominal hypoperfusion.
Conclusion. Ischemic and reperfusion damage, developed during the intra-operative period, is one of the pathogenetic stages of development of post-operative complications in the patients who had surgeries for colorectal cancer. One of the risk factors promoting its development is a decrease of arterial blood pressure during the intra-operative period for more than 20% out of the initial letter as well as intra-abdominal hypertension, caused by the increase in intra-abdominal pressure during laparoscopic pressures.
Key Words: ischemia-reperfusion, intra-abdominal pressure, critical incidence, colorectal cancer, laparoscopy
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