Retroperitoneal approach to abdominal aortic aneurysm repair preserves splanchnic perfusion as measured by gastric tonometry.
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.


CONCLUSIONS
The retroperitoneal approach for open AAA repair is associated with gastric tonometric evidence of better splanchnic perfusion compared to the transperitoneal approach.
Arya
Nityanand
N
Vascular and Endovascular Unit, Belfast City Hospital, and Department of Medicine, Queen's University, Belfast, UK. nityaarya@hotmail.com
Sharif
Muhammad Anees
MA
Lau
Luk Louis
LL
Lee
Bernard
B
Hannon
Raymond J
RJ
Young
Ian S
IS
Soong
Chee Voon
CV
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000098:blood supply*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013152:Splanchnic Circulation; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D016753:Interleukin-10