Results of endotoxin absorption after a subtotal resection of the small intestine and a right hemicolectomy for severe superior mesenteric ischemia.
OBJECTIVE
The purpose of this study is to analyze the results of endotoxin absorption therapy after a subtotal resection of the small intestine and a right hemicolectomy for severe superior mesenteric ischemia.


METHODS
From April 1980 through August 1999, 82 patients with severe superior mesenteric ischemia were operated on an emergency basis, and they were divided into two groups. Group 1 (n = 51), did not undergo postoperative endotoxin absorption therapy, while group 2 (n = 31), underwent this therapy. The two groups were compared based on the outcome variables.


RESULTS
When the number of risk factors was 1 or 2, the mortality rate in group 2 was significantly lower than in group 1 (p < 0.05). For postoperative lung or liver failure, the mortality rate was significantly higher in group 1 than in group 2. For an intraabdominal abscess, the mortality rate was significantly higher in group 1 than in group 2. Twenty-two of the thirty-one patients in group 2 survived. In the surviving cases, this therapy significantly decreased the intravenous concentration of endotoxin (p = 0.04). As for the fatalities (n = 9), no significant change in the concentration of endotoxin before or after endotoxin absorption was recognized. By the first postoperative month, the survival rate was significantly lower in group 1 than in group 2 (58.8% vs. 71.0%, P = 0.04).


CONCLUSIONS
In conclusion, we may now safely say that both stoma and a resection are recommended while endotoxin absorption using blood filtration may also be an effective additional therapy for post-operative septic shock.
Tsugawa
Kouji
K
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Koyanagi
Nobuhiro
N
Hashizume
Makoto
M
Wada
Hiroya
H
Ayukawa
Katsuhiko
K
Akahoshi
Kazuya
K
Tomikawa
Morimasa
M
Sugimachi
Keizo
K
D000042:Absorption; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000097:blood / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
D004731:Endotoxins