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Reduced Renal and Hepatic Perfusion Caused by Pos-itive-Pressure Pneumoperitoneum: Impact on Donor Kidneys
Mahesh Goel, MD, FRCS, MCh
Arch Surg. 2007;142(12):1225.
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We read this article1 with interest; it describes an important problem. We have a few thoughts about this study: the controls were baseline studies from patients undergoing laparoscopy. Whether these baseline readings were recorded prior to or after the onset of positive-pressure pneumoperitoneum (PPP) is important, but it was not mentioned. We think that baseline studies from open surgery could have provided the extent of sympathetic activity, humoral factors, etc, in altering hepatic and renal microcirculation.
Pneumoperitoneum causes several microcirculatory changes, ranging from microscopic to clinically detectable changes. The mean intraperitoneal pressures used by the authors was 14 mm Hg, a pressure much higher than currently recommended.2-3 Mean vena-caval pressures in humans are 10 to 14 mm Hg, and pressures higher than this will compress the vena cava, inhibiting venous return and preload.2 The donor is usually a healthy individual and can easily tolerate fluid . . . [Full Text of this Article]
AUTHOR INFORMATION
RELATED LETTER
Reduced Renal and Hepatic Perfusion Caused by Pos-itive-Pressure Pneumoperitoneum: Impact on Donor Kidneys—Reply
Amitai Bickel, Norman Loberant, and Arie Eitan
Arch Surg. 2007;142(12):1225-1226.
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RELATED ARTICLE
Overcoming Reduced Hepatic and Renal Perfusion Caused by Positive-Pressure Pneumoperitoneum
Amitai Bickel, Norman Loberant, Marina Bersudsky, Moshe Goldfeld, Shimon Ivry, Miryam Herskovits, and Arie Eitan
Arch Surg. 2007;142(2):119-124.
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