The Effect Of Different Surgical Managements On Intestinal Mucosal Barrier: Implications For Damage Control

Objective:To compare the effects of damage control surgery management of ligation and drainage with the traditional surgery following serious abdominal trauma on intestinal mucosal barrier.Methods:After the model establishment of multiple bowel injury associated with "lethal triad" of metabolic acidosis, coagulopathy, low body temperature in serious abdominal trauma, Female pigs were randomly divided into three groups(n=7/per group):control groups: conventional surgery with intestinal anastomosis (IA):underwent end-to-end intestinal anastomoses, peritoneal lavage and abdominal closure; damage control surgery of intestinal ligation (IL) groups: underwent intestinal ligation by silk, peritoneal lavage, temporary abdominal closure with Bagota Bag; damage control surgery of intra-intestinal drainage (ID)groups:underwent Stamm's Enterostomy with F18 tube, peritoneal lavage, temporary abdominal closure with Bagota Bag. Abdominal pressure, blood electrolytes, TNF-α, IL-10,24h intra-intestinal pressure, Portal Vein and peripheral vein bacterial cultures, small intestine conventional H&E staining and transmission electron microscope(TEM) examination were observed. And survival rate were recorded.Result:Damage control surgery groups (ID and IL) were beneficial to prooperation resuscitation, speed up to correct "metabolic acidosis, coagulopathy, low body temperature". IL group had highest white blood cell contents at 24h than that of ID and IA groups. And positive rate of bacterial culture of IL group also significant increased. Abdominal pressure,24h intra-intestinal pressure, neutrophil infiltration and pathological injuries were significant lower in the ID groups than that of IL and IA groups. TNF-αwere highest in IL groups, and lowest in ID groups.IL-10 were highest in ID groups, and lowest in IL groups. The survival rate of ID groups and IL groups were higher than that of IA groups.Conclusion:Damage control surgery(IL and ID),compared with traditional surgery, would short operation time, reduce fluid infusion, speed up to correct "metabolic acidosis, coagulopathy, low body temperature", avoid increasing further reperfusion injuries and systemic inflammatory response, prevent MODS and improve survival. But, compare with others, IA groups with highest intra-abdominal and intra-intestinal pressures, worst intestinal mucosal barrier injury, highest bacterial translocation and Inflammatory Response. Compare with other groups, ID groups would reduce fluid infusion, avoid intestinal mucosal barrier injury, decreasing further reperfusion injuries and systemic inflammatory response, prevent development of ACS and MODS, and improve survival. We believed that intra-intestinal drainage would be a better way for abdominal damage control surgery.