Effect of pneumoperitoneum on renal functions during laparoscopic cholocystectomy

INTRODUCTION: To determine the effects of pneumoperitoneum on renal functions during laparo­scopic cholecystectomy (LC). and compare with open cholecystectomy (OC).
METHODS: In this study, twenty-two cholelithiazis patients were divided into two groups. 10 patients underwent OC and LC (15 mm Hg of intraabdominal pressure) was applied in 12 patients. Patients in the latter group were operated under 15 mmHg intraperitoneal presure. 24 hours before the operation, the urine samples were collected and preoperative (preop) clearance of creatinine, IL-1, IL-6, TNF-alpha, beta-2-microglobuline, albumin, n-acetyl-beta-D-glu­coseaminidase (NAG) values were measured. Dynamic renal scintigraphies were taken with Tc- 99mEC. The same procedure was also performed postoperatively.
RESULTS: 12 patients, 9 female and 3 male, with a mean age of 49.8 (26'.69) underwent LC. 10 patients, 9 female and a male with a mean age of 52.2 (32-72) underwent OC. The mean oper­ation time was 58.75 (35-85) minutes for LC and was 80 (60-100) minutes for OC. There were significant differences between postop and preop values of creatine clearance (p=0.002), IL-6 (p=0.017 ), urinary albumin (p=0.006 ) and T1;2 (p=0,0034 for right kidney, p=0.001 for left kid­ney) in patients who underwent LC, whereas there was significant difference between postop and preop values of Tmax (p=0.013 for right kidney, p=0,012 for left kidney) in the patients who underwent OC. In terms of preop and postop NAG values, no significant change was observed in the LC (p=O. 75) and the OC groups (p=O.O 16). Postoperative increase in NAG lev­els was found to be significantly higher in the LC group compared to the OC group (p=0.048). There were no significant differences in TNF alpha, B2 microglobulin, IL-1 in both groups.
DISCUSSION AND CONCLUSION: Minimal renal tubular defects due to pneumoperitoneum may occur when Le's per­formed under 15 mmHg of intraperitoneal pressure. lnconclusion it would be more secure to hold intraperitoneal pressure as low as possible in the patients with critical renal functions.

Laparoskopik Kolesistektomide Pnömoperitonun Renal Fonksiyonlar Üzerine Etkisi

GİRİŞ ve AMAÇ: To determine the effects of pneumoperitoneum on renal functions during laparo­scopic cholecystectomy (LC). and compare with open cholecystectomy (OC).
YÖNTEM ve GEREÇLER: In this study, twenty-two cholelithiazis patients were divided into two groups. 10 patients underwent OC and LC (15 mm Hg of intraabdominal pressure) was applied in 12 patients. Patients in the latter group were operated under 15 mmHg intraperitoneal presure. 24 hours before the operation, the urine samples were collected and preoperative (preop) clearance of creatinine, IL-1, IL-6, TNF-alpha, beta-2-microglobuline, albumin, n-acetyl-beta-D-glu­coseaminidase (NAG) values were measured. Dynamic renal scintigraphies were taken with Tc- 99mEC. The same procedure was also performed postoperatively.
BULGULAR: 12 patients, 9 female and 3 male, with a mean age of 49.8 (26'.69) underwent LC. 10 patients, 9 female and a male with a mean age of 52.2 (32-72) underwent OC. The mean oper­ation time was 58.75 (35-85) minutes for LC and was 80 (60-100) minutes for OC. There were significant differences between postop and preop values of creatine clearance (p=0.002), IL-6 (p=0.017 ), urinary albumin (p=0.006 ) and T1;2 (p=0,0034 for right kidney, p=0.001 for left kid­ney) in patients who underwent LC, whereas there was significant difference between postop and preop values of Tmax (p=0.013 for right kidney, p=0,012 for left kidney) in the patients who underwent OC. In terms of preop and postop NAG values, no significant change was observed in the LC (p=O. 75) and the OC groups (p=O.O 16). Postoperative increase in NAG lev­els was found to be significantly higher in the LC group compared to the OC group (p=0.048). There were no significant differences in TNF alpha, B2 microglobulin, IL-1 in both groups.
TARTIŞMA ve SONUÇ: Minimal renal tubular defects due to pneumoperitoneum may occur when Le's per­formed under 15 mmHg of intraperitoneal pressure. lnconclusion it would be more secure to hold intraperitoneal pressure as low as possible in the patients with critical renal functions.