Long-Term Effects of Elevated Intra-Abdominal Pressure on Testes An Experimental Model of Laparoscopy

Abstract

Purpose: To determine the long-term outcomes of pneumoperitoneum on the testes in an experimentallaparoscopy model.Materials and Methods: Twenty-four rats were divided into three groups: Group A, the controlgroup; Group B, exposed to a 10 mmHg intra-abdominal pressure (IAP); and Group C, exposedto a 20 mmHg IAP with CO2 pneumoperitoneum for 60 minutes. After 6 weeks, the testes wereremoved, and testicular injury score and Johnson score were examined histologically. Germ cellapoptosis was also detected using flow cytometry.Results: A significant difference was determined between all groups in terms of testicular injuryscores, Johnson scores, and germ cell apoptosis percentages. For the testicular injury score, therewere significant differences between the groups for the right testis (group A versus B, P = .009;group A versus C, P < .0001; and group B versus C, P = .001) and for the left testis (group A versusB, P = .001; group A versus C, P < .0001; and group B versus C, P = .002). Significant differenceswere determined in the Johnson scores for the right testis between all groups (group A versus B, P= .001; group A versus C, P < .0001; and group B versus C, P = .008, respectively). Percentage ofapoptotic testis cells were significantly differed between all groups (P = .001 for each).Conclusion: This study shows that increased IAP during pneumoperitoneum causes histopathologyand apoptotically-evident damage to the testes in the long-term, depending on the magnitudeof IAP increase, which may cause sub/infertility. Considering the experimental nature of this study,further clinical studies are needed for a more decisive conclusion.

Keywords

• laparoscopy
• pneumoperitoneum
• fertility
• testis
• treatment outcome