Abdominal compliance is an important determinant and predictor of available workspace during laparoscopic surgery. Furthermore, critically ill patients with a reduced abdominal compliance are at an increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome both of which are associated with high morbidity and mortality. Despite of this, abdominal compliance is a concept, which has been neglected in the past.

Abdominal compliance is defined as a measure of the ease of abdominal expansion, expressed as a change in intra-abdominal volume per change in intra-abdominal pressure:

abdominal compliance = delta intra-abdominal volume / delta intra-abdominal pressure.

AC is a dynamic variable, dependent on base-line IAV and IAP as well as reshaping and stretching capacity. Whereas abdominal compliance itself can only rarely be measured, it always needs to be considered an important component of intra-abdominal pressure. Patients with decreased abdominal compliance are prone to fulminant development of abdominal compartment syndrome when concomitant risk factors for intra-abdominal hypertension are present.

This review aims to clarify the pressure-volume relationship within the abdominal cavity. It highlights how different conditions and pathologies can affect abdominal compliance and which management strategies could be applied to avoid serious consequences of decreased abdominal compliance.

We have pooled all available human data to calculate abdominal compliance values in patients acutely and chronically exposed to intra-abdominal hypertension and demonstrated an exponential abdominal pressure-volume relationship. Most importantly, patients with high level of intra-abdominal pressure have a reduced abdominal compliance. In these patients, only small reduction in intra-abdominal volume can significantly increase abdominal compliance and reduce intra-abdominal pressures.

A greater knowledge on abdominal compliance may help in selecting a better surgical approach as well as reducing complications related to intra-abdominal hypertension.


abdominal compliance, intra-abdominal hypertension, surgical complications

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