Increased susceptibility to liver damage from pneumoperitoneum in a murine model of biliary atresia

• Published in: Journal of pediatric surgery Vol. 45; no. 9; pp. 1791 - 1796
• Main Authors: Laje, Pablo, Clark, Fred H, Friedman, Joshua R, Flake, Alan W
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2010
• Subjects: Animals; Biliary atresia; Biliary Atresia - complications; Biliary Atresia - surgery; Disease Models, Animal; Disease Susceptibility; Liver Failure - etiology; Mice; Mice, Inbred BALB C; Minimally invasive surgery; Pediatrics; Pneumoperitoneum; Pneumoperitoneum, Artificial - adverse effects; Surgery; Pneumoperitoneum; Biliary atresia; Minimally invasive surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.02.117

Abstract Hypothesis We hypothesized that livers with biliary atresia (BA) are more susceptible to the harmful effects of a high-pressure CO2 pneumoperitoneum (PP) than healthy livers. Methods A murine model of BA was used in this experiment. Mice were divided into 6 groups: (1) control Balb/c; (2) control Balb/c, CO2 -PP; (3) control BA; (4) BA-sham; (5) BA, CO2 -PP; and (6) BA, air-PP. Mice from groups 2, 5, and 6 underwent an 8-mm Hg-PP for 60 minutes. Liver samples were collected for histology, colorimetry, and flow cytometry analysis 18 to 24 hours after the procedure. Markers of apoptosis were investigated as indicators of acute cell damage. Results We observed a statistically significant higher rate of apoptosis in livers with BA exposed to a prolonged CO2 -PP or air-PP compared with control groups. There were no significant differences between groups 1 and 2, or between groups 5 and 6. Conclusions In this animal model, we have shown that livers with BA are more susceptible than healthy livers to injury by a prolonged PP. This injury was caused by both CO2 and air-PP, implying that it is the direct result of pressure. These results may have implications for the success of minimally invasive Kasai procedures.