Effects of Carbon Dioxide Pneumoperitoneum On Renal Function in Obstructive Jaundice: An Experimental Study in a Rat Model

Merter Gulen, MD, Mustafa Sare, MD, Banu Sancak, MD, Mehmet Senes, MD, Seher Yuksel. Department of General Surgery Gazi University School of Medicine, Department of Biochemistry Gazi University School of Medicine, Ankara Teaching and Research Hospital

Introduction: Laparoscopic approaches are being applied in all areas of surgery with an increasing frequency. Different effects of pneumoperitoneum and obstructive jaundice on many organ systems has been reported. Both pneumoperitoneum and obstructive jaundice impair the renal function, but the combined insult has not been previously examined. In this study, we aimed to investigate the effects of carbon dioxide (CO2) pneumoperitoneum on renal function in a rat model of obstructive jaundice.
Methods and Procedures: Forty-eight male Wistar-Albino rats weighing 350 to 400g were divided into eight groups including 6 rats in each group: group 1; sham-operated group, in group 2,3 and 4 a 5-10-15 mmHg CO2 pneumoperitoneum was induced respectively, group 5; obstructive jaundice group, group 6,7 and 8 obstructive jaundice with 5-10 and 15 mmHg pneumoperitoneum was induced respectively. CO2 pneumoperitoneum was provided by Veress needle, maintained for 60 min. Common bile duct was ligated and divided in the obstructive jaundice groups. After 2 days, a 5-10-15 mmHg pneumoperitoneum was induced by minilaparotomy with a Veress needle in group 6-7 and 8, maintained for 60 min. Blood samples were drawn for the measurement of standart biochemical accounts, cystatin-C and NGAL for the assessment of renal functions.
Results: There were no statistically significant differences between the all groups with regard to standart biochemical accounts for renal functions including BUN and creatinin (p>0.05). Furthermore NGAL values are high in obstructive jaundice groups and there were statistically significant differences between other groups (p<0.05). The obstructive jaundice with 10 and 15 mmHg pneumoperitoneum group cystatin-C values are high comparison with the same pressure of only pneumoperitoneum group. There were statistically significant differences between these groups (p<0.05).
Conclusions: Conventional renal function tests were normal while NGAL and cystatin-C was found to be effective in showing an early stage of renal injury. Renal injury became more apperent with obstructive jaundice potentiated by the pneumoperitoneum. Consideration and appropriate mesaures should be taken for the development of renal injury in patients with obstructive jaundice during pneumoperitoneum.
Keywords: Obstructive jaundice, Pneumoperitoneum, Renal functions