Chronic effect of pneumoperitoneum on renal histology

Background and Objective: Transient intraoperative oliguria is a constant p henomenon during laparoscopic procedures. Laboratory studies have demonstra ted that this effect is secondary to a decrease in renal blood flow caused by the pneumoperitoneum, With the advent of laparoscopic harvest of the kid ney for renal transplantation, a concern is that increased intra-abdominal pressure may compound the effect of acute cold and warm renal ischemia duri ng transplantation. Acute transient renal ischemia can produce chronic scle rosing histopathologic changes in native kidneys which are similar to those seen in chronic allograft rejection. The effect of positive-pressure abdom inal pneumoperitoneum (15 mm Hg) on native kidneys was examined using a rod ent model. The effects on renal function and histologic features were also studied. Materials and Methods: Twenty-four Harlan Wistar-Furth rats were divided in to four groups: controls, 1-hour pneumoperitoneum-91-day survival, 5-hour p neumoperitoneum-91-day survival, and 5-hour pneumoperitoneum-7-day survival . Control animals underwent placement of the Veress needle and anesthesia b ut no induction of pneumoperitoneum, At the time of sacrifice, blood was sa mpled for serum creatinine measurement. Both kidneys were harvested for fro zen and permanent section and stained using hematoxylin and eosin, Specimen s were graded for inflammatory and ischemic/sclerotic changes in the inters titium, tubules, glomeruli, and vasculature by a renal pathologist using a histologic score (0-3), Results: In all groups, at a sacrifice interval of either 1 week or 3 month s, there were no statistical differences in the histologic score, serum cre atinine concentration, or renal weight. Conclusions: In a rodent model, no signs of chronic ischemic histologic cha nges were detected for a period of 3 months after up to 5 hours of pneumope ritoneum, As well, there was no change in the serum creatinine concentratio n.