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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

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Abstract

Purpose

MTS is elicited during open abdominal surgery and is characterized by facial flushing, hypotension, and tachycardia in response to the release of prostacyclin (PGI2) to plasma. MTS seems to affect postoperative morbidity, but data from larger cohorts are lacking. We aimed to determine the impact of severe mesenteric traction syndrome (MTS) on postoperative morbidity in patients undergoing open upper gastrointestinal surgery.

Methods

The study was a secondary analysis of data from three cohorts (n = 137). The patients were graded for severity of MTS intraoperatively, and hemodynamic variables and blood samples for plasma 6-keto-PGF1α, a stable metabolite of PGI2, were obtained at defined time points. Postoperative morbidity was evaluated by the comprehensive complication index (CCI) and the Dindo-Clavien classification (DC).

Results

Patients undergoing either esophagectomy (n = 70), gastrectomy (n = 22), liver- (n = 23), or pancreatic resection (n = 22) were included. Severe MTS was significantly associated with increased postoperative morbidity, i.e., CCI ≥ 26.2 (OR 3.06 [95% CI 1.1–6.6]; p = 0.03) and risk of severe complications, i.e., DC ≥3b (OR 3.1 [95% CI 1.2–8.2]; p = 0.023). Furthermore, patients with severe MTS had increased length of stay (OR 10.1 [95% CI 1.9–54.3]; p = 0.007) and were more likely to be admitted to the intensive care unit (OR = 7.3 [95% CI 1.3–41.9]; p = 0.027), but there was no difference in 1-year mortality.

Conclusion

Occurrence of severe MTS during upper gastrointestinal surgery is associated with increased postoperative morbidity as indicated by an increased rate of severe complications, length of stay, and admission to the ICU. It remains to be determined whether inhibition of MTS enhances postoperative recovery.

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Author notes

  1. August A. Olsen and Rune B. Strandby contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark

    August A. Olsen, Rune B. Strandby, Nikolaj Nerup, Rikard Ambrus, Lars Bo Svendsen & Michael P. Achiam

  2. Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Jens Peter Gøtze

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Contributions

Study conception and design: AAO, RBS, NN, LBS, MPA. Acquisition of data: AAO, RBS, NN, RA, JPG, LLR. Analysis and interpretation of data: AAO, RBS, NN, LBS, MPA. Drafting of the manuscript: AAO, RBS. Critical revision and final approval of the manuscript: AAO, RBS, NN, RA, JPG, LLR, LBS, MPA.

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Correspondence to August A. Olsen.

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All procedures performed in the study were in accordance with the ethical standards of the institutional and national research committee and approved by the national ethical committee.

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Verbal and written informed consent were obtained from all individual participants included in the study.

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Olsen, A.A., Strandby, R.B., Nerup, N. et al. Development of a severe mesenteric traction syndrome during major abdominal surgery is associated with increased postoperative morbidity: Secondary data analysis on prospective cohorts. Langenbecks Arch Surg 405, 81–90 (2020). https://doi.org/10.1007/s00423-019-01847-1

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