C Ansorge1, S Regner, R Segersvärd, L Strömmer. 1. Division of Surgery, Department of Clinical Science, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
Abstract
BACKGROUND: Ischaemia and local protease activation close to the pancreaticojejunal anastomosis (PJA) are potential mechanisms of postoperative pancreatic fistula (POPF) formation. To provide information on the pathophysiology of POPF, intraperitoneal microdialysis was used to monitor metabolic changes and protease activation close to the PJA after pancreaticoduodenectomy (PD). METHODS: In patients who underwent PD, intraperitoneal metabolites (glycerol, lactate, pyruvate and glucose) were measured by microdialysis, and lactate and glucose in blood were monitored, every 4 h for 5 days, starting at 12.00 hours on the day after surgery. Trypsinogen activation peptide (TAP) was measured in microdialysates as a marker of protease activation. RESULTS: Intraperitoneal glycerol levels and the ratio of lactate to pyruvate were higher after PD and glucose levels were lower in seven patients who later developed symptomatic POPF than in eight patients with other surgical complications (OSC) and 33 with no surgical complications (NSC) (all P < 0·050). TAP was detected at a concentration greater than 0·1 µg/l in six of seven patients with POPF, two of eight with OSC and two of 33 with NSC. Intraperitoneal lactate concentrations were higher than systemic levels in all patients on days 1 to 5 after surgery (P < 0·001). In patients with POPF, high intraperitoneal lactate concentrations were observed without systemic hyperlactataemia. CONCLUSION: Early in the postoperative phase, patients who later developed clinically significant POPF had higher intraperitoneal glycerol concentrations and lactate/pyruvate ratios, and lower glucose concentrations in combination with a TAP level exceeding 0·1 µg/l close to the PJA, than patients who did not develop POPF.
BACKGROUND:Ischaemia and local protease activation close to the pancreaticojejunal anastomosis (PJA) are potential mechanisms of postoperative pancreatic fistula (POPF) formation. To provide information on the pathophysiology of POPF, intraperitoneal microdialysis was used to monitor metabolic changes and protease activation close to the PJA after pancreaticoduodenectomy (PD). METHODS: In patients who underwent PD, intraperitoneal metabolites (glycerol, lactate, pyruvate and glucose) were measured by microdialysis, and lactate and glucose in blood were monitored, every 4 h for 5 days, starting at 12.00 hours on the day after surgery. Trypsinogen activation peptide (TAP) was measured in microdialysates as a marker of protease activation. RESULTS: Intraperitoneal glycerol levels and the ratio of lactate to pyruvate were higher after PD and glucose levels were lower in seven patients who later developed symptomatic POPF than in eight patients with other surgical complications (OSC) and 33 with no surgical complications (NSC) (all P < 0·050). TAP was detected at a concentration greater than 0·1 µg/l in six of seven patients with POPF, two of eight with OSC and two of 33 with NSC. Intraperitoneal lactate concentrations were higher than systemic levels in all patients on days 1 to 5 after surgery (P < 0·001). In patients with POPF, high intraperitoneal lactate concentrations were observed without systemic hyperlactataemia. CONCLUSION: Early in the postoperative phase, patients who later developed clinically significant POPF had higher intraperitoneal glycerol concentrations and lactate/pyruvate ratios, and lower glucose concentrations in combination with a TAP level exceeding 0·1 µg/l close to the PJA, than patients who did not develop POPF.
Authors: Massimo Sartelli; Alain Chichom-Mefire; Francesco M Labricciosa; Timothy Hardcastle; Fikri M Abu-Zidan; Abdulrashid K Adesunkanmi; Luca Ansaloni; Miklosh Bala; Zsolt J Balogh; Marcelo A Beltrán; Offir Ben-Ishay; Walter L Biffl; Arianna Birindelli; Miguel A Cainzos; Gianbattista Catalini; Marco Ceresoli; Asri Che Jusoh; Osvaldo Chiara; Federico Coccolini; Raul Coimbra; Francesco Cortese; Zaza Demetrashvili; Salomone Di Saverio; Jose J Diaz; Valery N Egiev; Paula Ferrada; Gustavo P Fraga; Wagih M Ghnnam; Jae Gil Lee; Carlos A Gomes; Andreas Hecker; Torsten Herzog; Jae Il Kim; Kenji Inaba; Arda Isik; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Yoram Kluger; Kaoru Koike; Victor Y Kong; Ari Leppaniemi; Gustavo M Machain; Ronald V Maier; Sanjay Marwah; Michael E McFarlane; Giulia Montori; Ernest E Moore; Ionut Negoi; Iyiade Olaoye; Abdelkarim H Omari; Carlos A Ordonez; Bruno M Pereira; Gerson A Pereira Júnior; Guntars Pupelis; Tarcisio Reis; Boris Sakakhushev; Norio Sato; Helmut A Segovia Lohse; Vishal G Shelat; Kjetil Søreide; Waldemar Uhl; Jan Ulrych; Harry Van Goor; George C Velmahos; Kuo-Ching Yuan; Imtiaz Wani; Dieter G Weber; Sanoop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2017-07-10 Impact factor: 5.469