Extraperitoneal approach reduces neutrophil activation, systemic inflammatory response and organ dysfunction in aortic aneurysm surgery

Objectives: to compare tile effects of transperitoneal and extraperitoneal approaches on systemic inflammatory response neutrophil activation and orga n dysfunction ill elective abdominal aortic aneurysm (AAA) repair. Patients ann methods: twenty patients admitted for elective intrarenal AAA repair were prospectively randomised into transperitoneal (n=10) or extrape ritoneal (n=10) group. Neutrophil activation was assessed by measuring the plasma levels of neutrophil elastase/alpha (1)-anti-trypsin complexes befor e surgery, intraoperatively and at 6 h, 12 h, 24 h and then daily after sur gery. Venous blood samples for estimation of liver function tests, full blo od counts, urea and electrolytes and arterial samples for blood gas analysi s were taken daily from preoperatively to day 5 after surgery. Multiple org an dysfunction (MOD) and systemic inflammatory response (SIR) scores were c alculated daily. Results: the concentrations of neutrophil elastase/alpha1-anti-trypsin comp lexes were significantly higher in the transperitoneal group at 6 12 after surgery compared to thr extraperitoneal group (799(455-921) ng/ml (median(i .q.r.)) vs 307(171-395) ng/ml, p <0.005), and at 12 h (397(364-936) ng/ml v s 319(134-352) ng/ml, p <0.05). The MOD scores were significantly higher in tile transperitoneal group in comparison to the extraperitoneal group at d ay 1 (2.5(2-3.3) vs 1(0-1), p <0.001) ann day 2 (2.5(2-3.3) vs 1(0-1), p <0 .001). The SIR scores were also significantly higher at day 1 (1(0-2) vs 0, p <0.001), day 2 (1.5(0-2.3) vs 0, p <0.01), and day 3 (1(0-1) vs 0, p <0. 05). Conclusions: neutrophil activation, systemic inflammatory response anf orga n dysfunction are increased in elective AAA repair when a transperitoneal a pproach is used. This may be related to intestinal manipulation and mesente ric traction which are reduced ill tile extraperitoneal approach.