Elsevier

Journal of Pediatric Surgery

Volume 22, Issue 12, December 1987, Pages 1207-1211
Journal of Pediatric Surgery

The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects*

https://doi.org/10.1016/S0022-3468(87)80739-XGet rights and content

Visceral ischemia secondary to increased intraabdominal pressure (IAP) following closure of abdominal wall defects presents a serious postoperative problem. Currently, the method of closure and postoperative management are determined by clinical impressions rather than measurement of IAP. In this study various methods of indirectly measuring IAP were compared in 17 rabbits in which IAP was sequentially increased with an intraabdominal balloon. Vesical and inferior vena caval (IVC) pressures were found to have good statistical correlation with IAP. Other methods tested were gastric, rectal, superior vena caval, femoral and brachial artery, and rectus compartment pressures. All were found tobe poor indicators of actual JAP. In nine of the rabbits, radiolabeled microspheres were used to assess cardiac output and visceral blood flow. Renal blood flow was very sensitive to increased IAP with dramatic impairment at IAP above 10 to 15 mmHg. Small intestinal flow was less sensitive and did not become significantly diminished until IAP exceeded 25 to 30 mmHg. Our studies suggest that vesical and IVC pressure monitoring should be used to evaluate IAP in the clinical setting. If IAP is in excess of 10 to 15 mmHg surgical intervention is indicated to prevent the development of renal ischemia.

References (23)

  • EinSH et al.

    Gastroschisis: Primary closure or silon pouch

    J Pediatr Surg

    (1980)
  • CantyTG et al.

    Primary fascial closure in infants with gastroschisis and omphalocele: A superior approach

    J Pediatr Surg

    (1983)
  • SchwartzMZ et al.

    Staged reduction using a silastic sac is the treatment of choice for large congenital abdominal wall defects

    J Pediatr Surg

    (1983)
  • HeymannMA et al.

    Blood flow measurements with radionuclide-labeled particles

    Prog Cardiovasc Dis

    (1977)
  • FilstonHC

    Gastroschisis—Primary fascial closure: The goal for optimal management

    Ann Surg

    (1983)
  • DenmarkSM et al.

    Primary closure of gastroschisis facilitation with postoperative muscle paralysis

    Arch Surg

    (1983)
  • StoneHH

    Immediate permanent fascial prosthesis for gastroschisis and massive omphalocele

    Surg Gynecol Obstet

    (1981)
  • SwartzKR et al.

    Ventral hernia in the treament of omphalocele and gastroschisis

    Ann Surg

    (1985)
  • SmithLA et al.

    Treatment of defects of the anterior abdominal wall in newborns

    Mayo Clin Proc

    (1983)
  • MooreTC et al.

    An international survey of gastroschisis and omphalocele

    Pediatr Surg Int

    (1986)
    MooreTC et al.

    An international survey of gastroschisis and omphalocele

    Pediatr Surg Int

    (1986)
    MooreTC et al.

    An international survey of gastroschisis and omphalocele

    Pediatr Surg Int

    (1986)
  • MayerTM et al.

    Gastroschisis and omphalocele, an eight-year review

    Ann Surg

    (1980)
  • Cited by (0)

    *

    Presented at the 18th Annual Meeting of the American Pediatric Surgical Association, Hilton Head Island, South Carolina, May 6–9, 1987.

    1

    From the Section of Pediatric Surgery, Department of Surgery, The University of Buffalo, The State University of New York, and the Department of Pediatric Surgery, The Children's Hospital of Buffalo.

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