Publication:

Surgical strategies and perioperative management in patients with acute mesenteric ischemia: impact on survival and intestinal function - a systematic review

Acute mesenteric ischemia (AMI) is a fetal condition caused by an acute diminution of mesenteric flow with subsequent bowel necrosis and extremely high mortality. Early identification and immediate action are essential in enhancing outcomes. This systematic review assesses surgery and perioperative care in patients with AMI, determining how they affect survival and bowel function. A systematic search was performed in PubMed, Embase, and Cochrane Library with the use of pertinent MeSH terms and keywords. Included were studies comparing surgical and endovascular treatments, postoperative complications, survival, and bowel viability. Data extraction and quality assessment adhered to PRISMA. Among the studies that were reviewed, endovascular treatments showed superior survival when compared to surgery, with mortality at 15.6% compared to 38.6% for surgery. Early diagnosis, multidisciplinary care, and revascularization greatly improved outcomes. Comorbidities, lactate levels, and age were excellent predictors of mortality. Reoperation within 30 days was observed in 30%, and prolonged hospital stay was seen in 14% of the patients. AMI still has high mortality and morbidity rate, despite these improvements and there needs to be further optimization of surgical methods and perioperative approaches. Early imaging integration, early surgical or endovascular treatment and multidisciplinary management can optimize AMI outcomes. Optimizing management protocols and predictive markers for improved patient stratification and treatment choice should be the focus of future research.