Tzu-Chi Hsu1. 1. Division of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, #92, Section 2, Chung-San North Road, and Taipei Medical University, Taiwan. tzuchi@ms2.mmh.org.tw
Abstract
PURPOSE: Ankle/brachial pressure is used as a predictor for the outcome of femoro-popliteal bypass. It has been suggested that a mean inferior mesenteric artery stump pressure (IMASP) below 40 mmHg after aortic reconstruction may be similarly predictive of postoperative ischemic colitis. No previous report has considered IMASP as a predictor of the integrity of colorectal anastomosis. The aim of the study is to examine the correlation between IMASP and anastomotic leakage rate after left colectomy. MATERIALS AND METHODS: From April 2004 to March 2006, 99 patients undergoing left colon resection by a single surgeon were measured for their IMASP and arm systemic pressure (SP). All but two patients were operated for carcinoma of the colon or rectum. Sixty-nine patients had primary anastomosis without diverting stomies. RESULTS: The stump mean pressure varied from 24 to 75 mmHg. Seventy-nine patients (79.8%) had pressures equal or above 40 mmHg. IMASP/SP ratios ranged from 0.21 to 0.7. Sixty-seven patients (67.7%) had IMASP/SP ratios equal or above 0.4. Two patients were found to have postoperative leakage of anastomosis. Their IMASP were 35 and 70 mmHg, and their IMASP/SP ratios were 0.28 and 0.62, respectively. We could not identify a significant difference between the two groups, and the pressure of the inferior mesenteric artery could not be proven to be a relevant predictor of anastomotic leakage. CONCLUSION: This series suggested that IMASP lower than 40 mmHg or an IMASP/SP ratio less than 0.4 does not correlate with an increased leakage rate. Neither IMASP nor the IMASP/SP ratio is a reliable indicator for predicting the outcome of colorectal anastomosis.
PURPOSE: Ankle/brachial pressure is used as a predictor for the outcome of femoro-popliteal bypass. It has been suggested that a mean inferior mesenteric artery stump pressure (IMASP) below 40 mmHg after aortic reconstruction may be similarly predictive of postoperative ischemic colitis. No previous report has considered IMASP as a predictor of the integrity of colorectal anastomosis. The aim of the study is to examine the correlation between IMASP and anastomotic leakage rate after left colectomy. MATERIALS AND METHODS: From April 2004 to March 2006, 99 patients undergoing left colon resection by a single surgeon were measured for their IMASP and arm systemic pressure (SP). All but two patients were operated for carcinoma of the colon or rectum. Sixty-nine patients had primary anastomosis without diverting stomies. RESULTS: The stump mean pressure varied from 24 to 75 mmHg. Seventy-nine patients (79.8%) had pressures equal or above 40 mmHg. IMASP/SP ratios ranged from 0.21 to 0.7. Sixty-seven patients (67.7%) had IMASP/SP ratios equal or above 0.4. Two patients were found to have postoperative leakage of anastomosis. Their IMASP were 35 and 70 mmHg, and their IMASP/SP ratios were 0.28 and 0.62, respectively. We could not identify a significant difference between the two groups, and the pressure of the inferior mesenteric artery could not be proven to be a relevant predictor of anastomotic leakage. CONCLUSION: This series suggested that IMASP lower than 40 mmHg or an IMASP/SP ratio less than 0.4 does not correlate with an increased leakage rate. Neither IMASP nor the IMASP/SP ratio is a reliable indicator for predicting the outcome of colorectal anastomosis.
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