Intestinal barrier function in patients undergoing colectomy.
OBJECTIVE
The aim of this pilot study was to determine whether the type of approach (open or laparoscopic) and the order of devascularization during laparoscopic colectomy affect intestinal barrier function, local inflammatory response and clinical outcome.


METHODS
Twenty-two patients undergoing elective colectomy from April 2006 to July 2008 were randomized to two sequences of vascular ligation, starting with either the inferior mesenteric artery or the ileocolic artery. Eighteen patients scheduled for open surgery served as a prospective control group. To assess the intestinal barrier function, release of intestinal fatty-acid binding protein (I-FABP; a marker of mucosal injury and ischaemia) was measured pre- and postoperatively. Mesenteric lymph nodes were harvested to assess the expression of inflammatory mediator-related genes using multiplex ligation probe amplification. The study was registered under NTR1025.


RESULTS
Laparoscopic devascularization starting at the ileocolic artery resulted in a significantly increased excretion of I-FABP over time (P = 0.002). In this group, the I-FABP levels were significantly increased on postoperative days 1 and 3 compared with preoperative values (P = 0.011 and P = 0.001, respectively). There were no differences in expression of inflammatory mediator-related genes or postoperative morbidity among the groups.


CONCLUSIONS
In this pilot study, devascularization commencing at the ileocolic artery during laparoscopic colectomy was associated with prolonged intestinal mucosal ischaemia.
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
M S
MS
Vlug
G M P
GM
Diepenhorst
P J
PJ
van Koperen
W
W
Renooij
M B M
MB
de Smet
J F M
JF
Slors
M A
MA
Boermeester
W A
WA
Bemelman
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001158:Arteries / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000276:immunology / Q000502:physiology* / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D007413:Intestinal Mucosa / Q000276:immunology / Q000502:physiology* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000378:metabolism; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008875:Middle Aged; D010865:Pilot Projects; D012333:RNA, Messenger / Q000378:metabolism*; D018709:Statistics, Nonparametric; D055815:Young Adult
D050556:Fatty Acid-Binding Proteins; D018836:Inflammation Mediators; D012333:RNA, Messenger