Optimisation of Intra-Abdominal Pressure in the Perioperative Period and Its Effect on Outcome in Patients Undergoing Laparotomies in a Tertiary Care Setting: An Experimental study

INTRODUCTION: The role of abdominal compartment syndrome (ACS) in the pathogenesis of multi-organ failure is well established. The effect of intra-abdominal hypertension without overt ACS in the outcome of abdominal surgeries is to be still analysed. AIMS AND OBJECTIVES: To find the incidence of IAH in elective and emergency laparotomies and to correlate whether optimisation of IAP has a positive effect on the outcome in these patients. MATERIALS AND METHODS: This study was conducted among patients undergoing elective and emergency laparotomies. 84 patients were enrolled (26 cases and 58 controls). Saline manometer technique via an indwelling foley’s catheter was used to measure IAP. IAP monitoring was done in the pre-operative period and post operatively at 0, 6, 24 and 48 hours. Among cases, intervention to reduce IAP was carried out according to the WCACS protocols. Incidence of intra-abdominal hypertension in the pre-operative period was computed and Chi-square test was used to correlate between the occurrence of complications in cases and controls. RESULTS: The incidence of IAP in the pre-operative period (at admission) ranged from 21%-25% in elective cases and 75% - 79% in emergency cases. Contamination, mass abdomen and vascular bowel lesions were the predominant intra-abdominal findings. The overall complication rate was significantly lower in cases (intervention group) than controls (p value = 0.029). When individually analysed, abdominal wall complications of IAH (wound and rectus dehiscence) were significantly lower in cases (0.038). The occurrence of other complications like anastamotic leak and peritonitis were not significant among the two groups. CONCLUSION: This is an experimental study to analyse the effect of optimization of post-operative IAP on the outcome of laparotomies, both elective and emergency. The study population comprised of 84 patients and was carried out over a period of one year. 26 of the patients were taken as cases and the remaining 58 as controls. IAP was monitored both pre-operatively and post operatively and in cases, the increase in IAP post operatively was countered using graded interventions as recommended by the WCACS. On analysis it was found that the incidence of pre operative IAH was 21% – 25% in elective cases and 75% – 79% in cases of elective laparotomies. This highlights the importance of vigilant fluid resuscitation in the stabilization phase. Overzealous fluid resuscitation in these patients where the IAP is already elevated would only further worsen end organ failure. Thus routine measurement of IAP at the time admission is highly warranted as it can serve as a very efficient tool to guide fluid administratio