Acute Effect of Subcutaneous Endoscopic Fasciotomy in a Porcine Model of Abdominal Compartment Syndrome
Abstracts
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INTRODUCTION: Treatment for abdominal compartment syndrome (ACS) involves abdominal decompression via a laparotomy which can result in significant wound-related morbidity. Our aim was to determine the acute effect of subcutaneous endoscopic abdominal fasciotomy in a porcine model of ACS on intraabdominal pressure (IAP) and superior mesenteric artery (SMA) blood flow. METHODS: A total of 6 female pigs weighing 50kg were used for the study. Each animal underwent placement of an arterial line, swan-ganz catheter, SMA blood flow probe, IAP catheter, and intraabdominal saline infusion line. After endoscopic dissection of a subcutaneous pocket overlying the rectus muscles, saline was infused into the abdomen to a pressure of 40mmHg. Physiologic parameters were measured before and after bilateral endoscopic anterior rectus fasciotomies were performed and were analyzed with a paired t-test. RESULTS: Mean subcutaneous dissection time was 42.5 +/- 11.3 minutes, mean fasciotomy time was 5.5 +/- 2.3 minutes. There were no significant changes in heart rate, cardiac output, mean arterial pressure, or pH during the experiment. IAP increased exponentially as fluid was instilled into the abdomen. SMA blood flow decreased reliably and linearly with increasing IAP. Mean baseline IAP was 4.0 +/- 1.7 mmHg. IAP decreased from 37 mmHg to 25 mmHg after fasciotomy (p<0.0002). Mean baseline SMA blood flow was 629 +/- 164 ml/min. SMA blood flow improved from 265 ml/min to 389 ml/min after fasciotomy (p<0.002). CONCLUSIONS: Subcutaneous endoscopic abdominal fasciotomy acutely lowers IAP and raises SMA blood flow in a porcine model of ACS and may be of benefit in a subset of patients. |
