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Title

Bowel motility after injury to the superior mesenteric plexus during D3 extended mesenterectomy

Authors
Thorsen, Yngve
Lindstrom, Jonas Christoffer
Nesgaard, Jens Marius
Oresland, Tom
Ignjatovic, Dejan
Published in Journal of Surgical Research. 2019, vol. 239, p. 115-124
Abstract Background: Improvement of lymphadenectomy in right colectomy requires removal of all tissue surrounding the superior mesenteric vessels beneath the pancreatic notch. Shortand long-term bowel motility disorders after D3 extended mesenterectomy with consecutive superior mesenteric plexus transection are studied. Methods: Patients without pre-existing motility disorders undergoing D3 extended mesenterectomy were examined 3 times using the wireless motility capsule: before, at 3 wk, and 6 mo after surgery. Segmental transit times and contractility were analyzed using mixed effect modeling. Correlation between contractility and transit time was assessed by the Pearson correlation coefficient. Results: Fifteen patients (4 men), with median age 62 y, were included. Mean values for the three consecutive examinations are as follows. Gastric transit time increased from 237 to 402 and 403 min, respectively. Small bowel transit time decreased from 246 to 158 (P < 0.01) and 199 (P ¼ 0.03) min, respectively. Colonic transit time decreased from 1742 to 1450 and 1110 (P ¼ 0.02) min, respectively. Gastric contractions per minute (CPM) varied from 1.73 to 1.05 (P ¼ 0.01) and 2.47 (P < 0.01), respectively. Small bowel CPM decreased from 3.43 to 2.68 and 3.34, respectively. Colonic CPM ranged from 1.59 to 1.45 and 1.91 (P ¼ 0.08), respectively. Correlation between small bowel (SB) transit time and CPM was _0.45 (P ¼ 0.09) preoperatively, and _0.03 (P ¼ 0.91) 6 mo postoperatively. Conclusions: Extrinsic SB denervation leads to significantly accelerated SB transit, reduced contractility, and disturbed correlation between transit time and contractility early after denervation. Both number of contractions and transit time in the denervated SB show a clear tendency toward normalization at 6 mo.
Keywords Gastrointestinal motilityAutonomic denervationCancer of the colonColorectal surgeryGastrointestinal transitSuperior mesenteric plexusSmall bowel transit timeMesenterectomyWireless motility capsuleRight colectomy
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THORSEN, Yngve et al. Bowel motility after injury to the superior mesenteric plexus during D3 extended mesenterectomy. In: Journal of Surgical Research, 2019, vol. 239, p. 115-124. https://archive-ouverte.unige.ch/unige:114653

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Deposited on : 2019-02-28

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