Intestinal Manipulation During Elective Aortic Aneurysm Surgery Leads to Portal Endotoxaemia and Mucosal Barrier Dysfunction

Objectives to investigate the effect of intestinal manipulation on intestinal permeability and endotoxaemia during elective abdominal aortic aneurysm (AAA) surgery. Design prospective randomised controlled study.Patients and methods fourteen patients undergoing elective infrarenal AAA repair were randomised into either the transperitoneal (n=7) or extraperitoneal approach (n=7). Intestinal permeability was measured preoperatively (PO), and at day 1 (D1) and day 3 (D3) after surgery using the lactulose/mannitol absorption test. Portal and systemic blood samples were taken before clamping, at completion of proximal and distal anastomoses and immediately before abdominal wound closure, for endotoxin measurement using the chromogenic limulus amoebocyte lysate assay. Results intestinal permeability was significantly increased at D1 (0.107±0.04 (mean±S.E.M.)) in the transperitoneal group compared to the PO level (0.020±0.004, p