Effects of hyperthermic intraoperative peritoneal lavage on intra-abdominal pressure in an experimental model of peritonitis: A randomized, controlled, blinded interventional study

Abstract

Background: Hyperthermic Intraoperative Peritoneal Lavage (HIPL) is useful for bacterial decontamination and prevention of hypothermia during damage-control surgery (DCS). Little is known about the effect of HIPL on intra-abdominal pressure (IAP) alone or in combination with peritonitis.

Aim: To determine the effects of HIPL at graded temperatures on IAP in the context of DCS.

Materials and methods: A total of 40 rabbits randomly assigned to aseptic-thermal (AT) and peritonitis-thermal (PT) groups and subgroups underwent HIPL at 40°C, 43°C, 46°C, and 49°C. The AT subgroup assigned 40°C was the control group. HIPL was done with a volume of 100 ml/kg. Hourly IAP measurement by two independent observers who were mutually blinded was done through a peritoneal balloon pouch connected to a manometer for 12 hours.

Results: All rabbits in group AT survived for at least 11 hours, while all the rabbits in group PT died between 4 and 8 hours. There was significant IAP rise at 4 hours in all subgroups in comparison with the control (I AT40):III AT46 (P < 0.01), IV AT49 (P < 0.001), V PT40 (P < 0.01), VI PT43 (P < 0.01), VII PT46 (P < 0.001), and P 49 (P < 0.001) except II AT43 ( P = 0.85). Multiple linear regression analysis showed a positive correlation:Coefficient of regression {r = 0.85 (AT) and r = 0.89 (PT)} and coefficient of determination {r2 = 0.73 (AT) and r2 = 0.80 (PT)}.

Conclusion: Our findings suggest that beyond 3°C above the normal body temperature in this species, HIPL acts synergistically with peritonitis to exacerbate intra-abdominal hypertension and is associated with a shortened survival postoperatively due to abdominal compartment syndrome.