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Kanwar S, Windsor AC, Welsh F, et al. Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery. Ann Surg. 2000;231(1):88-95doi: 10.1097/00000658-200001000-00013.
Kanwar, S., Windsor, A. C., Welsh, F., Barclay, G. R., Guillou, P. J., & Reynolds, J. V. (2000). Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery. Annals of surgery, 231(1), 88-95. https://doi.org/10.1097/00000658-200001000-00013
Kanwar, S, et al. "Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery." Annals of surgery vol. 231,1 (2000): 88-95. doi: https://doi.org/10.1097/00000658-200001000-00013
Kanwar S, Windsor AC, Welsh F, Barclay GR, Guillou PJ, Reynolds JV. Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery. Ann Surg. 2000 Jan;231(1):88-95. doi: 10.1097/00000658-200001000-00013. PMID: 10636107; PMCID: PMC1420970.
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Ann Surg. 2000 Jan;231(1):88-95. doi: 10.1097/00000658-200001000-00013.

Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery.

Annals of surgery

S Kanwar, A C Windsor, F Welsh, G R Barclay, P J Guillou, J V Reynolds

Affiliations

  1. Academic Department of Surgery, St. James's University Hospital, Leeds, England.

PMID: 10636107 PMCID: PMC1420970 DOI: 10.1097/00000658-200001000-00013

Abstract

OBJECTIVE: To determine the influence of abnormal gut barrier function on the risk of septic complications in patients undergoing major resectional surgery for upper 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 compelling, corroborative evidence from studies in humans is sparse. This study attempted to correlate both preoperative gut barrier dysfunction and the pattern of change after surgery with septic outcome.

METHODS: Sixty-eight patients undergoing curative resectional surgery for upper gastrointestinal cancer were monitored for 30-day septic morbidity (intraabdominal abscesses/empyema and pneumonia). Intestinal permeability, serum IgM and IgG anti-endotoxin 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 outcome. Major surgery was associated with increased intestinal permeability and evidence of endotoxin exposure. Comparing sepsis and nonsepsis groups, however, there was no significant difference in intestinal permeability, endotoxin 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 permeability had no predictive value for sepsis. This study failed to support the thesis that gut barrier dysfunction is directly linked to sepsis.

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