S. Kanwar et al., Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery, ANN SURG, 231(1), 2000, pp. 88-95
Objective
To determine the influence of abnormal gut barrier function on the risk of
septic complications in patients undergoing major resectional surgery for u
pper gastrointestinal cancer.
Summary Background Data
A failure of the gut mucosal barrier to exclude bacteria and endotoxin from
the portal and systemic circulation is incriminated in the development of
sepsis and multiple organ failure. Although the experimental data is compel
ling, corroborative evidence from studies in humans is sparse. This study a
ttempted to correlate both preoperative gut barrier dysfunction and the pat
tern of change after surgery with septic outcome.
Methods
Sixty-eight patients undergoing curative resectional surgery for upper gast
rointestinal cancer were monitored for 30-day septic morbidity (intraabdomi
nal abscesses/empyema and pneumonia). Intestinal permeability, serum IgM an
d IgG antiendotoxin antibodies (EndoCAb), and serum C-reactive protein were
measured before surgery and on postoperative days 1 and 7.
Results
Increased intestinal permeability before surgery did not predict septic out
come. Major surgery was associated with increased intestinal permeability a
nd evidence of endotoxin exposure, Comparing sepsis and nonsepsis groups, h
owever, there was no significant difference in intestinal permeability, end
otoxin exposure, and the acute phase response after surgery.
Conclusions
This study demonstrates that gut barrier dysfunction occurs after surgery,
but the magnitude of change does not differentiate patients in whom sepsis
develops and those in whom it does not. Preoperative increased intestinal p
ermeability had no predictive value for sepsis. This study failed to suppor
t the thesis that gut barrier dysfunction is directly linked to sepsis.