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ULTIMO FASCICOLOINTERNATIONAL ANGIOLOGY

Rivista di Angiologia


Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2001 Dicembre;20(4):282-7

 ORIGINAL ARTICLES

Extraperitoneal approach reduces intestinal and renal dysfunction in elective abdominal aortic aneurysm repair

Lau L. L., Halliday M. I. *, Smye M. G. **, Lee B., Hannon R. J., Gardiner K. R. *, Soong C. V.

From the Vascular Surgery Unit, Belfast City Hospital, Belfast, Northern Ireland
* Department of Surgery, The Queen’s University of Belfast, Institute of Clinical Science, Belfast, Northern Ireland
** Department of Clinical Biochemistry, The Royal Group of Hospitals, Belfast, Northern Ireland

Background. Intestinal muco­sal bar­ri­er dys­func­tion ­observed in ­patients under­go­ing trans­per­it­o­neal abdom­i­nal aor­tic aneu­rysm (AAA) ­repair may con­trib­ute to the devel­op­ment of the system­ic inflam­ma­to­ry ­response syn­drome and dys­func­tion of var­i­ous ­organs. The aim of this study is to inves­ti­gate wheth­er an extrap­e­rit­o­neal ­approach reduc­es intes­ti­nal muco­sal bar­ri­er and renal dys­func­tion in elec­tive infra­ren­al AAA ­repair.
Methods. Twenty ­patients admit­ted for elec­tive infra­ren­al AAA ­repair were ran­dom­ized into ­either the trans­per­it­o­neal ­approach (n=10) or the extrap­e­rit­o­neal ­approach (n=10). Intestinal perme­abil­ity was meas­ured pre­op­er­a­tive­ly, and at day 1 and day 3 after sur­gery using the lac­tu­lose/man­ni­tol test by cal­cu­lat­ing the dif­fe­ren­tial uri­nary excre­tion ratio of the two sug­ars after oral admin­is­tra­tion. Renal dys­func­tion was ­assessed by meas­ur­ing the uri­nary albu­min/crea­ti­nine ratio (ACR) at the same time ­points.
Results. Intestinal perme­abil­ity was sig­nif­i­cant­ly ­increased in the trans­per­it­o­neal group at day 1 [0.124±0.035 (mean±s.e.m.)] com­pared to the pre­op­er­a­tive level (0.020±0.003), (p=0.001) and to the extrap­e­rit­o­neal group at day 1 (0.025±0.008), (p<0.05) which ­showed no ­change in com­par­i­son with the pre­op­er­a­tive level (0.020±0.003). The ACR was also sig­nif­i­cant­ly ­increased in the trans­per­it­o­neal group at day 1 (16.69±5.12) com­pared to the pre­op­er­a­tive level (5.71±2.89), (p<0.05) and to the extrap­e­rit­o­neal group at day 1 (4.33±1.49), (p<0.05) which ­showed no sig­nif­i­cant ­change at any of the times exam­ined. No cor­re­la­tion was ­observed ­between the lac­tu­lose/man­ni­tol ratio and the albu­min/crea­ti­nine ratio, or ­between age, oper­at­ing time, aor­tic clamp­ing time, ­amount of blood lost or blood trans­fused.
Conclusions. These ­results sup­port the sug­ges­tion that min­i­mis­ing intes­ti­nal manip­u­la­tion using an extrap­e­rit­o­neal ­approach in AAA ­repair pre­serves intes­ti­nal muco­sal bar­ri­er and renal glo­mer­u­lar func­tions.

lingua: Inglese


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