Impact of abdominal banding on splanchnic organ perfusion

Introduction

Abdominal banding is still recommended by some surgeons to prevent eventeration after abdominal surgery. We assessed the impact of increased abdominal pressure (IAP) caused by abdominal banding on perfusion of splanchnic organs, ventilation and hemodynamics.

Methods

The study protocol was approved by the local EC. Five mechanically ventilated patients after major abdominal surgery were studied. IAP, gastric tonometry (pCO₂ gap) with a tonometry module (Datex Ohmeda, Finland), plasma disappearance of indocyanine green (ICG-PDR) noninvasively with LiMON (Pulsion Medical Systems, Germany), pulmonary compliance (C-dyn) with a spirometry module (Datex Ohmeda, Finland), hemodynamics and diuresis were recorded (T1). Then IAP was increased by 10 mmHg with an abdominal belt and data measured after 60 min (T2). Then the abdominal bandage was released and a control measurement was done after 60 min (T3). Data are presented as median (range). Friedman analysis of variance was used for statistical analysis and P < 0.05 was considered significant.

Results

IAP increased from 12 (3; 15) to 19 (10; 21) mmHg. After release of banding, IAP decreased to 11 (4; 15) mmHg. PgCO₂ increased from 1.61 (1.39; 1.93) kPa (T1) to 2.70 (2; 3.15) kPa (T2) and stayed increased at 2.43 (1.25; 3.10) kPa (T3) (showed a trend). ICG-PDR decreased from 19.1 (7.5; 39.3)%/min to 15.8 (7.7; 20.5)%/min (T2) and increased to 18.2 (6.0; 22.9)%/min (T3) (not significant). C-dyn decreased from 67 (32; 80) ml/cmH₂O to 56 (26; 66) ml/cmH₂O and slightly improved to 59 (32; 70) ml/cmH₂O (showed a trend). HR, MAP, CVP, CO (measured in three patients) and diuresis did not change.

Conclusion

An increase in IAP caused by abdominal banding can compromise splanchnic organ perfusion and respiratory function in surgical patients.