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Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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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.