Structural changes in the tendinous part of the rat diaphragm under conditions of jaundice and low-pressure pneumoperitoneum

Background. Оbstructive jaundice is one of the most serious complications of diseases of the organs of the pancreaticoduodenal zone. Laparoscopy is widely used in surgical operations for jaundice and not only because of its minimally traumatic nature and contributes to the rapid recovery of the patient. In recent years, laparoscopic methods have significantly progressed in minimally invasive hepatobiliary and pancreatic surgery. However, there is still not enough data on how pneumoperitoneum caused by carbon dioxide, which is a companion of any laparoscopy, affects the abdominal organs. Objective of the work was to investigate changes in the tendon part of the diaphragm that occur in the presence of mechanical jaundice after the creation of pneumoperitoneum. Methods. The study was performed on 75 rats, divided into 5 groups. Mechanical jaundice was simulated by ligation of the common bile duct under anesthesia. Pneumoperitoneum was created using the KARL STORZ electronic laparoflator 264300 20 insufflator. The preparations were stained with hematoxylin and eosin. Results. In the intact group, the tendon part microscopically corresponded to the structure inherent to this tissue. Under the influence of jaundice, structural disorders occurred: the thickness increased, which was due to edematous loosening; collagen fibers had a tortuous appearance; increased cellular infiltration, both diffuse and with the formation of focal infiltrates. After 2 hours, edema increased and the unidirectionality of collagen fibers was disturbed. The presence of fatty tissue and macrophage and lymphocytic infiltrates was also monitored. After 3 hours, the compact arrangement of collagen fibers was partially preserved in the tendons, and over a larger area, collagen fibers were represented by an amorphous mucoid mass. Conclusion. In the presence of jaundice, looseness and tortuous course of collagen fibers with cellular infiltration in which macrophages were noted were noted. When pneumoperitoneum was used, deeper structural disorders were observed, which depended directly on the duration of intra-abdominal pressure.