Henry Hoffmann1, Tarik Delko2, Philipp Kirchhoff2, Rachel Rosenthal2, Juliane Schäfer2,3, Marko Kraljević2, Christoph Kettelhack2. 1. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. henry.hoffmann@usb.ch. 2. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. 3. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
Abstract
BACKGROUND: The impact of blood supply to the anastomosis on development of anastomotic leakage is still a matter of debate. Considering that bowel perfusion may be affected by manipulation during surgery, perfusion assessment of the anastomosis alone may be of limited value. We propose perfusion assessment at different time points during surgery to explore the dynamics of bowel perfusion during colorectal resection and its impact on outcome. METHODS: In this prospective cohort study, patients undergoing elective colorectal resection were eligible. Colon perfusion was evaluated using visible light spectroscopy. Main outcome was the difference in colon perfusion, quantified by measuring tissue oxygen saturation (StO2) in the colonic serosa, before and after anastomosis during surgery. RESULTS: We included 58 patients between July 2013 and November 2015. Colon perfusion increased by an average of 5.9% StO2 during surgery (95% confidence interval 3.1, 8.8; P < 0.001). The number of patients with abnormal perfusion (defined as StO2 < 65%) decreased from 50% at the beginning to 24% by the end of surgery. Six patients (10%) developed anastomotic leaks (AL), of which five patients had abnormal perfusion at the beginning of surgery, whereas four patients had normal StO2 at the anastomosis. CONCLUSION: Colon perfusion significantly increased during colorectal surgery. Considering that one quarter of patients had suboptimal anastomotic perfusion without developing AL, impaired blood flow at the anastomosis alone does not seem to be critical. Further investigations including more patients are necessary to evaluate the impact of perioperative parameters on colon perfusion, anastomotic healing and surgical outcome.
BACKGROUND: The impact of blood supply to the anastomosis on development of anastomotic leakage is still a matter of debate. Considering that bowel perfusion may be affected by manipulation during surgery, perfusion assessment of the anastomosis alone may be of limited value. We propose perfusion assessment at different time points during surgery to explore the dynamics of bowel perfusion during colorectal resection and its impact on outcome. METHODS: In this prospective cohort study, patients undergoing elective colorectal resection were eligible. Colon perfusion was evaluated using visible light spectroscopy. Main outcome was the difference in colon perfusion, quantified by measuring tissue oxygen saturation (StO2) in the colonic serosa, before and after anastomosis during surgery. RESULTS: We included 58 patients between July 2013 and November 2015. Colon perfusion increased by an average of 5.9% StO2 during surgery (95% confidence interval 3.1, 8.8; P < 0.001). The number of patients with abnormal perfusion (defined as StO2 < 65%) decreased from 50% at the beginning to 24% by the end of surgery. Six patients (10%) developed anastomotic leaks (AL), of which five patients had abnormal perfusion at the beginning of surgery, whereas four patients had normal StO2 at the anastomosis. CONCLUSION: Colon perfusion significantly increased during colorectal surgery. Considering that one quarter of patients had suboptimal anastomotic perfusion without developing AL, impaired blood flow at the anastomosis alone does not seem to be critical. Further investigations including more patients are necessary to evaluate the impact of perioperative parameters on colon perfusion, anastomotic healing and surgical outcome.
Authors: A Karliczek; D A Benaron; P C Baas; C J Zeebregts; A van der Stoel; T Wiggers; J T M Plukker; G M van Dam Journal: Eur Surg Res Date: 2008-09-16 Impact factor: 1.745
Authors: Mehraneh D Jafari; Steven D Wexner; Joseph E Martz; Elisabeth C McLemore; David A Margolin; Danny A Sherwinter; Sang W Lee; Anthony J Senagore; Michael J Phelan; Michael J Stamos Journal: J Am Coll Surg Date: 2014-09-28 Impact factor: 6.113
Authors: Frederic Ris; Roel Hompes; Chris Cunningham; Ian Lindsey; Richard Guy; Oliver Jones; Bruce George; Ronan A Cahill; Neil J Mortensen Journal: Surg Endosc Date: 2014-02-25 Impact factor: 4.584
Authors: Boris Jansen-Winkeln; N Holfert; H Köhler; Y Moulla; J P Takoh; S M Rabe; M Mehdorn; M Barberio; C Chalopin; T Neumuth; I Gockel Journal: Int J Colorectal Dis Date: 2019-02-02 Impact factor: 2.571
Authors: B Jansen-Winkeln; M Maktabi; J P Takoh; S M Rabe; M Barberio; H Köhler; T Neumuth; A Melzer; C Chalopin; I Gockel Journal: Chirurg Date: 2018-09 Impact factor: 0.955