Effects of hyperthermic intraoperative peritoneal lavage on intra-abdominal pressure in an experimental model of peritonitis: A randomized, controlled, blinded interventional study

Background: Hyperthermic Intraoperative Peritoneal Lavage (HIPL) is useful for bacterial decontamination and prevention of hypothermia during damage-control surgery (DCS). Little is known about the effect of HIPL on intraabdominal pressure (IAP) alone or in combination with peritonitis. Aim: To determine the effects of HIPL at graded temperatures on IAP in the context of DCS. Materials and Methods: A total of 40 rabbits randomly assigned to aseptic-thermal (AT) and peritonitis-thermal (PT) groups and subgroups underwent HIPL at 40°C, 43°C, 46°C, and 49°C. The AT subgroup assigned 40°C was the control group. HIPL was done with a volume of 100 ml/kg. Hourly IAP measurement by two independent observers who were mutually blinded was done through a peritoneal balloon pouch connected to a manometer for 12 hours. Results: All rabbits in group AT survived for at least 11 hours, while all the rabbits in group PT died between 4 and 8 hours. There was signifi cant IAP rise at 4 hours in all subgroups in comparison with the control (IAT40): IIIAT46 (P 0.01), IVAT49 (P 0.001), VPT40 (P 0.01), VIPT43 (P 0.01), VIIPT46 (P 0.001), and P49 (P 0.001) except II AT43 (P = 0.85). Multiple linear regression analysis showed a positive correlation: Coefficient of regression {r = 0.85 (AT) and r = 0.89 (PT)} and coefficient of determination {r² = 0.73 (AT) and r² = 0.80 (PT)}. Conclusion: Our findings suggest that beyond 3°C above the normal body temperature in this species, HIPL acts synergistically with peritonitis to exacerbate intra-abdominal hypertension and is associated with a shortened survival postoperatively due to abdominal compartment syndrome.