Sequential Fasciotomies for Managing Abdominal Compartment Syndrome: Porcine Experimental Study

IF 1.8 3区 医学 Q2 SURGERY
Javier Lopez-Monclus MD, PhD, FACS , Amparo Gómez-Cruz MD, PhD , Joaquin M. Munoz-Rodriguez MD, PhD, FACS , Sandra Catalina García-Perrote MD , Laura Román García de León MD , Luis A. Blazquez-Hernando MD, PhD , Álvaro Robin Valle De Lersundi MD, PhD , Martin Santos-González DVM, PhD , José Luis Lucena de la Poza MD, PhD , Miguel A. Garcia-Urena MD, PhD, FACS
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引用次数: 0

Abstract

Introduction

Abdominal compartment syndrome (ACS) poses a significant clinical challenge, with high morbidity and mortality rates. Conventional treatment via decompressive laparotomy with open abdomen and temporary closure presents significant drawbacks. This experimental study evaluates the efficacy of open minimally invasive sequential fasciotomy in managing simulated ACS in a porcine model.

Methods

Ten adult pigs were included in this prospective experimental investigation, wherein a mechanical model of abdominal hypertension was induced by pneumoperitoneum via a Veres needle. Open minimally invasive sequential fasciotomy, involving bilateral external oblique muscles (EOMs) and linea alba (LA), was performed. Physiological parameters were recorded preprocedure and postprocedure.

Results

In our study, 70% of pigs completed the fasciotomy sequence. Unilateral EOM fasciotomy significantly reduced intravesical pressure and femoral venous pressure by 18% and 16%, respectively. Bilateral EOM fasciotomies led to a 35.7% decrease in both parameters. Following re-establishment of intra-abdominal pressure to 20 mmHg, LA fasciotomy resulted in a 47% drop in intravesical pressure and femoral venous pressure. Significant increases in tidal volume and abdominal perimeter were observed after each fasciotomy.

Conclusions

This study establishes that open minimally invasive sequential fasciotomy of bilateral EOM and LA is an effective strategy for managing simulated ACS in a porcine model. Each fasciotomy resulted in a significant reduction in intra-abdominal pressure. These findings suggest that sequential fasciotomy techniques offer a promising alternative to decompressive laparotomy in ACS management. Further research is essential to validate these outcomes in human subjects.
治疗腹腔隔室综合征的连续筋膜切开术:猪实验研究
简介:腹腔隔室综合征(ACS)是一项重大的临床挑战,发病率和死亡率都很高。传统的开腹减压术和临时闭合术存在很大缺陷。本实验研究评估了开放式微创连续筋膜切开术在猪模型中处理模拟 ACS 的疗效:方法:10 头成年猪参与了这项前瞻性实验研究,通过维雷斯针腹腔积气诱发机械性腹腔高压模型。进行开放式微创连续筋膜切开术,涉及双侧腹外斜肌(EOMs)和白线(LA)。记录术前和术后的生理参数:结果:在我们的研究中,70%的猪完成了筋膜切开术。单侧EOM筋膜切开术显著降低了膀胱内压和股静脉压,降幅分别为18%和16%。双侧EOM筋膜切开术使这两个参数降低了35.7%。腹腔内压力恢复到20 mmHg后,LA筋膜切开术使膀胱内压和股静脉压下降了47%。每次筋膜切开术后,潮气量和腹围都有显著增加:本研究证实,开放式微创双侧 EOM 和 LA 顺序筋膜切开术是在猪模型中处理模拟 ACS 的有效策略。每次筋膜切开术都能显著降低腹内压。这些研究结果表明,连续筋膜切开术是一种替代减压开腹手术治疗 ACS 的有效方法。进一步的研究对于在人体中验证这些结果至关重要。
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来源期刊
CiteScore
3.90
自引率
4.50%
发文量
627
审稿时长
138 days
期刊介绍: The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.
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