title: Extraperitoneal approach reduces intestinal and renal dysfunction in elective abdominal aortic aneurysm repair.
abstract: 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.
authors.affiliation: Vascular Surgery Unit, Belfast City Hospital, Belfast, Northern Ireland.
authors.forename: L L
authors.initials: LL
authors.lastname: Lau
authors.forename: M I
authors.initials: MI
authors.lastname: Halliday
authors.forename: M G
authors.initials: MG
authors.lastname: Smye
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*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000503:physiopathology / Q000517:prevention & control*; D007413:Intestinal Mucosa / Q000503:physiopathology; D007674:Kidney Diseases / Q000503:physiopathology / Q000517:prevention & control*; D007684:Kidney Tubules / Q000503:physiopathology; D008297:Male; D010537:Peritoneum; D010539:Permeability; D011183:Postoperative Complications / Q000517:prevention & control*