Comparisons of three surgical procedures on intestine ischemia reperfusion injury in a superior mesenteric artery injury model.
BACKGROUND
Temporary ligation, primary anastomosis, and temporary shunt have been reported to deal with superior mesenteric artery (SMA) injuries. We aimed to investigate which brought minimal ischemia reperfusion injury in a hypothermic traumatic shock swine model.


METHODS
SMA was completely clamped while pigs were hemorrhaged to a mean arterial pressure (MAP) of 40 mm Hg. Animals were then randomized into temporary ligation (A, n=8), primary anastomosis (B, n=8), temporary shunt (C, n=8), and control groups (n=4). Animals in group A remained SMA interrupted for additional 1h while the other groups underwent the corresponding procedures immediately. Intestine injury was assessed by histologic examination and measurement of lipid peroxidations at the end of ischemia and experiment.


RESULTS
Overall mortality rate was 50%, 25%, and 0% in groups A, B, and C, respectively (P<0.05). The total intestine ischemia time was predominantly shorter in group C in the other groups. Remarkable elevations of malonaldehyde (MDA) in small intestine were noted after reperfusion in group A. Animals in other groups, however, did not exacerbate during the 6-h reperfusion (resuscitation period). Group C showed the lowest MDA level at the end of experiment. Myeloperoxidase (MPO) levels showed no significant elevations during the ischemia or early reperfusion period; nevertheless, it reached approximately 3- to 6-fold in groups A and B (compared with baseline, P<0.01), and remained unchanged in group C at the end of experiment.


CONCLUSIONS
Our study suggests that temporary shunt insertion might be preferred as it shortens ischemia time, alleviates intestinal ischemia/reperfusion injury, and thus decreases early mortality in this animal model.
Ding
Weiwei
W
Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
Li
Jieshou
J
Ni
Lideng
L
Zhao
Kun
K
Ji
Wu
W
Li
Ning
N
Wu
Xingjiang
X
D000714:Anastomosis, Surgical; D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D007082:Ileum / Q000098:blood supply* / Q000378:metabolism / Q000601:surgery; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery; D008026:Ligation; D008315:Malondialdehyde / Q000378:metabolism; D017538:Mesenteric Artery, Superior / Q000293:injuries*; D065666:Mesenteric Ischemia; D023421:Models, Animal; D009195:Peroxidase / Q000378:metabolism; D015427:Reperfusion Injury / Q000503:physiopathology / Q000601:surgery*; D012774:Shock, Traumatic / Q000503:physiopathology / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods*; D013552:Swine; D014652:Vascular Diseases / Q000503:physiopathology / Q000601:surgery
D008315:Malondialdehyde; D009195:Peroxidase