A comparison of the inflammatory response and the recovery of bowel function between trans- and extraperitoneal approaches of abdominal aortic aneurysmectomy.
OBJECTIVE
To determine whether surgical stress is less with transperitoneal or extraperitoneal abdominal aortic aneurysmectomy, blood concentrations of inflammatory cytokines and other inflammatory markers with recovery of bowel function were examined.


METHODS
Patients who underwent abdominal aortic aneurysmectomy electively via the transperitoneal (T-group; n=15) or the extraperitoneal approach (E-group; n=17) were evaluated. Inflammatory cytokines (interleukin[IL]) IL-6, IL-8, C-reactive protein concentrations, and systemic inflammatory response syndrome score were determined before operation and after operation on days (POD) 1, 3, 7, and 14. Recovery of bowel function was estimated by the time taken for resumption of bowel movement and oral intake, and by the volume of fluid collection from the nasogastric tube.


RESULTS
Cytokine (IL-8) concentrations were higher in the T-group than the E-group with significant difference on POD 7 (4.8+/-0.5 versus 3.4+/-0.2 pg/mL, respectively; P=0.02). Recovery of bowel function and oral intake were earlier, and the volume of fluid collection from the nasogastric tube was smaller in the E-group than the T-group significantly.


CONCLUSIONS
Early recovery of bowel function and low concentration of inflammatory cytokines suggest that the extraperitoneal approach to the abdominal aorta is less stressful to the transperitoneal approach. Postoperative inflammatory response may mainly depend on damage of the bowel in the operation of the abdominal aortic aneurysm.
Shindo
S
S
Second Department of Surgery, Faculty of Medicine, University of Yamanashi, Nakakoma-gun, Yamanashi, Japan.
Kubota
K
K
Kojima
A
A
Matsumoto
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D007249:Inflammation / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007410:Intestinal Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011183:Postoperative Complications; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D002097:C-Reactive Protein