title: Intestinal manipulation during elective aortic aneurysm surgery leads to portal endotoxaemia and mucosal barrier dysfunction.
abstract: OBJECTIVE
  to investigate the effect of intestinal manipulation on intestinal permeability and endotoxaemia during elective abdominal aortic aneurysm (AAA) surgery.
  
  
  METHODS
  prospective randomised controlled study.
  
  
  METHODS
  fourteen patients undergoing elective infrarenal AAA repair were randomised into either the transperitoneal (n=7) or extraperitoneal approach (n=7). Intestinal permeability was measured preoperatively (PO), and at day 1 (D1) and day 3 (D3) after surgery using the lactulose/mannitol absorption test. Portal and systemic blood samples were taken before clamping, at completion of proximal and distal anastomoses and immediately before abdominal wound closure, for endotoxin measurement using the chromogenic limulus amoebocyte lysate assay.
  
  
  RESULTS
  intestinal permeability was significantly increased at D1 (0.107+/-0.04 (mean+/-S.E.M.)) in the transperitoneal group compared to the PO level (0.020+/-0.004, p<0.05) and to the extraperitoneal group at D1 (0.020+/-0.004, p<0.05) which showed no change in comparison with the PO level. No correlation was seen between increased intestinal permeability and aortic clamp time, operation time, amount of blood lost or transfused. However, a significantly higher concentration of portal endotoxin was detected intraoperatively in the transperitoneal group of patients in comparison to the extraperitoneal group (p<0.05). There was a significant positive correlation between portal endotoxaemia and intestinal permeability (r(s)=0.955 p=0.001).
  
  
  CONCLUSIONS
  an increase in intestinal permeability and a greater degree of portal endotoxaemia are observed during transperitoneal approach to the aorta. This suggests that intestinal manipulation may impair gut mucosal barrier function and contribute to the systemic inflammatory response seen in AAA surgery.
authors.affiliation: Vascular Surgery Unit, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, Northern Ireland.
authors.forename: L L
authors.initials: LL
authors.lastname: Lau
authors.forename: M I
authors.initials: MI
authors.lastname: Halliday
authors.forename: B
authors.initials: B
authors.lastname: Lee
authors.forename: R J
authors.initials: RJ
authors.lastname: Hannon
authors.forename: K R
authors.initials: KR
authors.lastname: Gardiner
authors.forename: C V
authors.initials: CV
authors.lastname: Soong
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D019446:Endotoxemia / Q000209:etiology*; D004731:Endotoxins / Q000097:blood; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D007421:Intestine, Small / Q000293:injuries* / Q000378:metabolism; D007431:Intraoperative Complications; D008297:Male; D010539:Permeability; D011169:Portal Vein; D011446:Prospective Studies
chemical_list: D004731:Endotoxins