Document Detail


Retroperitoneal approach to abdominal aortic aneurysm repair preserves splanchnic perfusion as measured by gastric tonometry.
MedLine Citation:
PMID:  19748210     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We investigated if minimizing bowel manipulation and mesenteric traction using the retroperitoneal approach in open abdominal aortic aneurysm (AAA) repair preserves splanchnic perfusion, as measured by gastric tonometry, and reduces the systemic inflammatory response and dysfunction of the various organs. METHODS: Patients undergoing elective AAA repair were randomized into three groups. Group I had repair via the retroperitoneal approach, while groups II and III were repaired via the transperitoneal approach with the bowel packed within the peritoneal cavity or exteriorized in a bowel bag, respectively. A tonometer was used to measure gastric intramucosal pH (pHi), as an indicator of splanchnic perfusion, just prior to aortic clamping, during clamping, and at 0.5, 1, 2, 4, 6, and 12 hr after clamp release. Multiorgan dysfunction syndrome (MODS) and systemic inflammatory response syndrome (SIRS) scores were calculated and systemic interleukins (IL-6 and IL-10) measured at predetermined intervals. RESULTS: Thirty-four patients were successfully randomized. The gastric pHi was significantly lower in group II (n=12) and group III (n=11) compared to group I (n=11) during aortic clamping and immediately after clamp release (p<0.05). The aortic clamp time, blood loss, MODS and SIRS scores, and systemic cytokine response were similar in all three groups. When the three groups were combined, there were significant positive correlations between the operation time, aortic clamp time, and amount of blood lost and transfused with plasma IL-6 levels and MODS score on the first postoperative day. CONCLUSION: The retroperitoneal approach for open AAA repair is associated with gastric tonometric evidence of better splanchnic perfusion compared to the transperitoneal approach.
Authors:
Nityanand Arya; Muhammad Anees Sharif; Luk Louis Lau; Bernard Lee; Raymond J Hannon; Ian S Young; Chee Voon Soong
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-09-11
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-08     Completed Date:  2010-05-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  321-7     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Vascular and Endovascular Unit, Belfast City Hospital, and Department of Medicine, Queen's University, Belfast, UK. nityaarya@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / physiopathology,  surgery*
Biological Markers / blood
Blood Transfusion
Blood Vessel Prosthesis Implantation / adverse effects,  methods*
Female
Gastric Acidity Determination*
Gastric Mucosa / blood supply*
Humans
Interleukin-10 / blood
Interleukin-6 / blood
Male
Manometry*
Middle Aged
Multiple Organ Failure / etiology,  prevention & control
Prospective Studies
Retroperitoneal Space / surgery
Risk Assessment
Risk Factors
Splanchnic Circulation*
Surgical Procedures, Elective
Systemic Inflammatory Response Syndrome / etiology,  prevention & control
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/IL10 protein, human; 0/IL6 protein, human; 0/Interleukin-6; 130068-27-8/Interleukin-10

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