• Tetsuji Fujita, Takashi Imai, and Sadao Anazawa.
• Department of Surgery, Jikei University School of Medicine, Tokyo, Japan. dai3geka@jikei.ac.jp
• Ann. Surg. 2003 Aug 1; 238 (2): 258263258-63.

ObjectiveTo evaluate the influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis.Summary Background DataIt has not been determined whether endotoxin translocation in small amounts is a physiological phenomenon or whether it is a potential health hazard.MethodsBlood endotoxin, antithrombin III (ATIII), secretory immunoglobulin A (sIgA), which was selected as a marker of cholestasis, C-reactive protein (CRP), and alpha-1-antitrypsin (AAT) concentrations were measured from the 20 patients undergoing curative gastrectomy for gastric cancer preoperatively and postoperatively. Portal and systemic blood samples were taken for the analysis of endotoxin and interleukin-6 (IL-6) concentrations during surgery in these patients.ResultsAlthough plasma endotoxin levels showed a significant increase during surgery, we did not find a correlation with ATIII, sIgA, CRP, and IL-6 levels. Systemic blood endotoxin levels during surgery correlated with a postoperative rise of serum AAT levels. Plasma ATIII levels transiently decreased on the first and third postoperative day, and sIgA levels were shown to increase on the seventh postoperative day. There was a weak relationship between the extent of postoperative endotoxemia and a reduction in ATIII concentrations.ConclusionsThe influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis was limited, and increased translocational endotoxemia during abdominal surgery may be a physiological phenomenon to trigger off an acute-phase protein response.

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