Development of a severe mesenteric traction syndrome during major abdominal surgery is associated with increased postoperative morbidity: Secondary data analysis on prospective cohorts

Olsen, August A; Strandby, Rune Broni; Nerup, Nikolaj; Ambrus, Rikard; Gøtze, Jens Peter; Svendsen, Lars Bo; Achiam, Michael Patrick

doi:10.1007/s00423-019-01847-1

Cited by 15 publications

(5 citation statements)

References 38 publications

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“…Ambrus et al [3] demonstrated that even in patients with facial ush, blood pressure had been stable by administering a high dose of vasopressor. A high dose of vasopressors during open esophagectomy may be related to increased risk of gastrointestinal dehiscence [4]. In the present study, the nadir systolic blood pressure was lower in Group CM than in the other three groups, but the dose of vasopressors was not different among the four groups.…”

Section: Discussioncontrasting

confidence: 55%

“…We also found that prophylactic administration of urbiprofen signi cantly reduced the incidence of MTS and signi cantly increased the incidence of postoperative leakage or bleeding among the patients who did not develop MTS. The reason for morbidity due to MTS had been suspected as intraoperative hypotension and endothelial cell damage [3,4,11]. Ambrus et al [3] demonstrated that even in patients with facial ush, blood pressure had been stable by administering a high dose of vasopressor.…”

Section: Discussionmentioning

confidence: 99%

“…Even though MTS is transient in many cases, some patients develop serious complications during surgery [2]. Several studies demonstrated that the development of severe MTS is associated with morbidity after esophageal or gastrointestinal surgery [3,4]. The main mechanism of the development of MTS is the release of prostacyclin from gut stress [5].…”

Section: Introductionmentioning

confidence: 99%

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Contribution of prophylactic administration of flurbiprofen for mesenteric traction syndrome to postoperative leakage or bleeding in gastrointestinal surgery: a retrospective observational study

Suzuki,

Shibata,

Mochizuki

et al. 2023

Langenbecks Arch Surg

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PurposeMesenteric traction syndrome sometimes occurs during abdominal surgery. Prophylactic administration of urbiprofen, a non-steroidal anti-in ammatory drug, prevents the development of mesenteric traction syndrome. However, administration of non-steroidal anti-in ammatory drugs for postoperative pain increases the incidence of postoperative bleeding. Our aim was to examine the effect of prophylactic urbiprofen administration on postoperative leakage or bleeding after gastrointestinal surgery. MethodsA retrospective observational study on patients who underwent open or laparoscopic abdominal surgery was conducted. Perioperative, anesthesia and medical records were reviewed. Patients who did (Group F) or did not receive (Group C) prophylactic urbiprofen administration were compared. Then, Group F (Group FM and Group FC) and Group C (Group CM and Group CC) were each divided into patients who did or did not develop mesenteric traction syndrome, respectively. ResultsThis study included 188 patients (Group FM, 1 patient; Group FC, 31 patients; Group CM, 59 patients; Group CC, 97 patients). Seventeen patients developed postoperative leakage or bleeding. Eleven group CM patients (18.6%), 4 group FC patients (12%), and only 2 group CC patients (2%) developed postoperative leakage or bleeding. ConclusionProphylactic urbiprofen administration increased the risk of postoperative leakage or bleeding among patients who did not develop mesenteric traction syndrome.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Contribution of prophylactic administration of flurbiprofen for mesenteric traction syndrome to postoperative leakage or bleeding in gastrointestinal surgery: a retrospective observational study

Suzuki,

Shibata,

Mochizuki

et al. 2023

Langenbecks Arch Surg

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“…Prolonged traction and manipulation of the abdominal viscera (and thereby the mesentery), initially caused higher discomfort to the patient and, subsequently, may have elicited the mesenteric traction syndrome (MTS). MTS is characterized by a triad of hypotension, tachycardia, and facial flushing, and the trigger mechanism may be splanchnic hypoperfusion as a result of mesenteric traction or exploration of the abdominal contents during surgery [ 24 , 25 ]. Further studies could investigate the role of specific surgical technical difficulties (e.g., higher BMI, smaller pelvis height in men, prolonged surgical demolition phase) on anesthesiological care.…”

Section: Discussionmentioning

confidence: 99%

Neuraxial anesthesia for abdominal surgery, beyond the pandemic: a feasibility pilot study of 70 patients in a suburban hospital

Romanzi,

Dragani,

Adorni

et al. 2023

Updates Surg

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The aim of this study is to establish the feasibility of awake laparotomy under neuraxial anesthesia (NA) in a suburban hospital. A retrospective analysis of the results of a consecutive series of 70 patients undergoing awake abdominal surgery under NA at the Department of Surgery of our Hospital from February 11th, 2020 to October 20th, 2021 was conducted. The series includes 43 cases of urgent surgical care (2020) and 27 cases of elective abdominal surgery on frail patients (2021). Seventeen procedures (24.3%) required sedation to better control patient discomfort. Only in 4/70 (5.7%) cases, conversion to general anesthesia (GA) was necessary. Conversion to GA was not related to American Society of Anesthesiology (ASA) score or operative time. Only one of the four cases requiring conversion to GA was admitted to the Intensive Care Unit (ICU) postoperatively. Fifteen patients (21.4%) required postoperative ICU support. A statistically non-significant association was observed between conversion to GA and postoperative ICU admission. The mortality rate was 8.5% (6 patients). Five out of six deaths occurred while in the ICU. All six were frail patients. None of these deaths was related to a complication of NA. Awake laparotomy under NA has confirmed its feasibility and safety in times of scarcity of resources and therapeutic restrictions, even in the most frail patients. We believe that this approach should be considered as an useful asset, especially for suburban hospitals.

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“…The hemodynamic response is sudden, often presenting within 5 minutes of traction, and the severity of the PGI 2 ‐induced hypotension is usually moderate, 1,5 but severe and prolonged hypotension with little effect of vasopressor treatment has been described 1,6 . Also, severe postoperative complications after esophagectomy, gastrectomy, and pancreatic resection have been associated with MTS 2,7 …”

Section: Introductionmentioning

confidence: 99%

Mesenteric traction syndrome in pigs: A single‐blinded, randomized controlled trial

Strandby

Osterkamp

Ambrus

et al. 2021

Anim Models and Exp Med

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Background Mesenteric traction syndrome is commonly observed in patients undergoing upper abdominal surgery and is associated with severe postoperative complications. A triad of hypotension, tachycardia, and facial flushing seems provoked by prostacyclin (PGI2) release from the gut in response to mesenteric traction. The administration of nonsteroidal anti‐inflammatory drugs (NSAID) inhibits PGI2 release, stabilizing the hemodynamic response. Here, we examined the effect of mesenteric traction on splanchnic blood flow in pigs randomized to NSAID or placebo treatment. Materials and Methods Twenty pigs were allocated to either ketorolac or placebo treatment. Five minutes of manual mesenteric traction was applied. Plasma 6‐keto‐PGF1α, a stable metabolite of PGI2, hemodynamic variables, and regional blood flow (laser speckle contrast imaging) to the liver, stomach, small intestine, upper lip, and snout (laser Doppler flowmetry) were recorded prior to traction and 5 and 30 minutes thereafter. Results Both groups of pigs presented a decrease in systemic vascular resistance (P = .01), mean arterial blood pressure (P = .001), and blood flow in the gastric antrum (P = .002). Plasma 6‐keto‐PGF1α did not increase in either group (P = .195), and cardiac output, heart rate, central venous pressure, and blood flow to the liver, small intestine, upper lip, and snout remained unchanged. Conclusion Mesenteric traction resulted in cardiovascular depression, including reduced blood flow in the gastric antrum. Plasma 6‐keto‐PGF1α did not increase, and ketorolac administration did not alter the response to mesenteric traction. Furthers studies are needed to identify which substance is responsible for eliciting the cardiovascular response to mesenteric traction in pigs.

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Development of a severe mesenteric traction syndrome during major abdominal surgery is associated with increased postoperative morbidity: Secondary data analysis on prospective cohorts

Cited by 15 publications

References 38 publications

Contribution of prophylactic administration of flurbiprofen for mesenteric traction syndrome to postoperative leakage or bleeding in gastrointestinal surgery: a retrospective observational study

Contribution of prophylactic administration of flurbiprofen for mesenteric traction syndrome to postoperative leakage or bleeding in gastrointestinal surgery: a retrospective observational study

Neuraxial anesthesia for abdominal surgery, beyond the pandemic: a feasibility pilot study of 70 patients in a suburban hospital

Mesenteric traction syndrome in pigs: A single‐blinded, randomized controlled trial

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