Physiologic effects of elevated intraabdominal pressure after aneurysm repair Papavassiliou B, Anderton M, Loftus IN, et al. Eur J Vasc Endovasc Surg 2003;26:293-8

AbstractConclusionElevated intraabdominal pressure (IAP) was associated with significant organ dysfunction after repair of ruptured abdominal aortic aneurysm (AAA). Elevated IAP was not found to be a significant complicating factor after elective or endovascular AAA repair.SummaryIn a prospective observational study the authors measured IAP after AAA surgery and correlated outcomes with levels of IAP. The study included 75 patients undergoing infrarenal AAA repair, 40 with conventional elective repair of a nonruptured infrarenal AAA, 13 with endovascular repair of a nonruptured AAA, and 22 with conventional repair of a ruptured infrarenal AAA. IAP was determined with bladder manometry at the end of the operative procedure and every 24 hours after surgery in patients in whom ventilation tubes remained. The patients were then observed for indications of organ dysfunction.After abdominal closure for ruptured AAA, IAP was higher (15.4 mm Hg) than after elective open repair (10.5 mm Hg) or endovascular elective repair (6.4 mm Hg). Patients with IAP measurements greater than 15 mm Hg had significant impairment of organ dysfunction compared with patients with IAP less than 15 mm Hg with regard to pH (P = .027), base excess (P = .005), peak inspiratory pressure (P = .0015), and central venous pressure and urine output (P = .0029). A receiver operator characteristic curve analysis indicated that a cutoff of 15 mm Hg of IAP indicated patients at risk for death with sensitivity of 66% and specificity of 79%.CommentThe adverse effects of elevated IAP after abdominal surgery have become more widely recognized. The data presented here suggest that initial mesh closure of the abdomen, followed by removal of the mesh and primary closure when immediate postoperative swelling has resolved, may lead to improved outcomes in patients with initial IAP exceeding 15 mm Hg after AAA repair