Print page Print page
Switch language
Rigshospitalet - a part of Copenhagen University Hospital

Severe mesenteric traction syndrome is associated with increased systemic inflammatory response, endothelial dysfunction, and major postoperative morbidity

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Preoperative oral carbohydrate to enhance recovery-need for better study analysis

    Research output: Contribution to journalComment/debateResearchpeer-review

  2. Model for end-stage liver disease score predicts complications after liver transplantation

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Entero-pancreatic hormone secretion, gastric emptying, and glucose absorption after frequently sampled meal tests

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Shock-Induced Endothelial Dysfunction is Present in Patients With Occult Hypoperfusion After Trauma

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Neurotensin secretion after Roux-en-Y gastric bypass, sleeve gastrectomy, and truncal vagotomy with pyloroplasty

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Managing patients on direct factor Xa inhibitors with rapid thrombelastography

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Quantitative fluorescence angiography detects dynamic changes in gastric perfusion

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

This study aimed to determine if mesenteric traction syndrome (MTS) triggers increased systemic inflammation and endothelial cell dysfunction. Patients developing severe MTS had pronounced early IL6 elevations followed by endothelial cell damage. Furthermore, these processes were associated with increased postoperative morbidity.

OBJECTIVE: To determine whether mesenteric traction syndrome (MTS) leads to increased systemic inflammation and dysfunction of the glycocalyx and endothelial cell and whether this correlates with the degree of postoperative morbidity.

INTRODUCTION: Severe MTS is associated with increased postoperative morbidity following major gastrointestinal surgery, but the pathophysiological mechanism has not been previously explored. Systemic inflammatory response and impaired glycocalyx and endothelial cells may be responsible for the development of symptoms.

METHODS: The study analyzed prospectively collected data from two cohorts (n = 67). The severity of the MTS response was graded intraoperatively and blood samples for PGI2, catecholamines, IL6, and endothelial biomarkers obtained at predefined time points.

RESULTS: Patients undergoing either esophagectomy (n = 45) or gastrectomy (n = 22) were included. Surgery led to significantly increased plasma concentrations of all biomarkers. Yet, patients who developed severe MTS had higher baseline epinephrine levels (p < 0.05) and higher levels of PGI2 (p < 0.05), Syndecan-1 (p < 0.001), and sVEGFR1 (p < 0.001). Peak values of IL6, Syndecan-1, sVEGFR1, and sTM all correlated to peak PGI2. Lastly, patients with high postoperative morbidity had higher baseline epinephrine (p = 0.009) and developed higher plasma IL6 (p = 0.007) and sTM (p = 0.022).

CONCLUSION: The development of severe MTS during upper gastrointestinal surgery is associated with preoperative elevated plasma epinephrine and further a more pronounced proinflammatory response and damage to the vascular endothelium. The increased postoperative morbidity seen in patients with severe MTS may thus, in part, be explained by an inherent susceptibility towards an inappropriate secretion of PGI2, which leads to an increased surgical stress response and endothelial damage. These findings must be confirmed in a new prospective cohort.

Original languageEnglish
JournalLangenbeck's Archives of Surgery
Issue number7
Pages (from-to)2457-2467
Number of pages11
Publication statusPublished - Nov 2021

    Research areas

  • Endothelial dysfunction, Endothelial glycocalyx, Flushing, General surgery, Mesenteric traction syndrome, Surgical stress

ID: 68544237