Tendinous part of the diaphragm under the influence of carboxyperitoneum and simulated jaundice: an experimental study

Abstract

Abstract: understanding the increase in intra-abdominal pressure during pneumoperitoneum due to carbon dioxide insufflation as part of laparoscopic surgery is important as systemic changes due to carbon dioxide have become important. Despite the benefits, laparoscopic surgical procedures and insufflation affect many systems and organs, such as the brain, lungs, and liver. The aim of the study was to investigate the histological structure of the tendon parts of the diaphragms of rats with obstructive jaundice under the influence of standard pneumoperitoneum pressure formed by carbon dioxide, which is used in laparoscopic surgery, for a variety of time periods. The experimental study was performed on 70 mature rats weighing (235.0±20.0) grams. Obstructive jaundice was modelled by ligation of the common bile duct through a previously made laparotomy access. Pneumoperitoneum was created after puncture of the abdominal wall with a Veresch needle connected to an insufflator that injected carbon dioxide and maintained a given intra-abdominal pressure for a certain time. Obstructive jaundice led to thickening of the tendon due to edema. Collagen fibres acquired a tortuous direction. The cellular infiltration was distinct, with macrophages appearing in the structure. In 1 hour after pneumoperitoneum, there was an undulating direction of collagen fibres separated by intercellular substance, in which fibroblasts, lymphocytes and multiple macrophages were visualised. After 2 hours, there was a thickening of collagen fibres, homogeneity with multiple foci of decay and delimitation by the main substance containing fibroblasts and macrophages. After 3 hours, in addition to the disintegration, loss of unidirectional arrangement, in some cases, foci of chaotic accumulation of cell-fibre mass and haemorrhages were detected. In cellular infiltrates, plasmacytes appeared in small numbers among lymphocytes. The results obtained indicate that obstructive jaundice leads to structural changes in the tendon part of the diaphragm. Pneumoperitoneum with carbon dioxide exacerbates the changes in the morphological picture, which depend on the duration of the latter.