Johannes M Salusjärvi1,2, Monika A Carpelan-Holmström3, Johanna M Louhimo4,3, Olli Kruuna3, Tom M Scheinin3. 1. Department of Surgery, Päijät-Häme Central Hospital and University of Helsinki, Keskussairaalankatu 7, Lahti, 15850, Finland. johannes.salusjarvi@helsinki.fi. 2. University of Helsinki, Helsinki, Finland. johannes.salusjarvi@helsinki.fi. 3. Department of Surgery, Abdominal Center, Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029, Helsinki, HUS, Finland. 4. University of Helsinki, Helsinki, Finland.
Abstract
BACKGROUND: An anastomotic leak is a fairly common and a potentially lethal complication in colorectal surgery. Objective methods to assess the viability and blood circulation of the anastomosis could help in preventing leaks. Intraoperative pulse oximetry is a cheap, easy to use, fast, and readily available method to assess tissue viability. Our aim was to study whether intraoperative pulse oximetry can predict the development of an anastomotic leak. METHODS: The study was a prospective single-arm study conducted between the years 2005 and 2011 in Helsinki University Hospital. Patient material consisted of 422 patients undergoing elective left-sided colorectal surgery. The patients were operated by one of the three surgeons. All of the operations were partial or total resections of the left side of the colon with a colorectal anastomosis. The intraoperative colonic oxygen saturation was measured with pulse oximetry from the colonic wall, and the values were analyzed with respect to post-operative complications. RESULTS: 2.3 times more operated anastomotic leaks occurred when the colonic StO2 was ≤ 90% (11/129 vs 11/293). The mean colonic StO2 was 91.1 in patients who developed an operated anastomotic leak and 93.0 in patients who did not. With logistic regression analysis, the risk of operated anastomotic leak was 4.2 times higher with StO2 values ≤ 90%. CONCLUSIONS: Low intraoperative colonic StO2 values are associated with the occurrence of anastomotic leak. Despite its handicaps, the method seems to be useful in assessing anastomotic viability.
BACKGROUND: An anastomotic leak is a fairly common and a potentially lethal complication in colorectal surgery. Objective methods to assess the viability and blood circulation of the anastomosis could help in preventing leaks. Intraoperative pulse oximetry is a cheap, easy to use, fast, and readily available method to assess tissue viability. Our aim was to study whether intraoperative pulse oximetry can predict the development of an anastomotic leak. METHODS: The study was a prospective single-arm study conducted between the years 2005 and 2011 in Helsinki University Hospital. Patient material consisted of 422 patients undergoing elective left-sided colorectal surgery. The patients were operated by one of the three surgeons. All of the operations were partial or total resections of the left side of the colon with a colorectal anastomosis. The intraoperative colonicoxygen saturation was measured with pulse oximetry from the colonic wall, and the values were analyzed with respect to post-operative complications. RESULTS: 2.3 times more operated anastomotic leaks occurred when the colonic StO2 was ≤ 90% (11/129 vs 11/293). The mean colonic StO2 was 91.1 in patients who developed an operated anastomotic leak and 93.0 in patients who did not. With logistic regression analysis, the risk of operated anastomotic leak was 4.2 times higher with StO2 values ≤ 90%. CONCLUSIONS:Low intraoperative colonicStO2 values are associated with the occurrence of anastomotic leak. Despite its handicaps, the method seems to be useful in assessing anastomotic viability.
Authors: Mark A Boccola; Petra G Buettner; Warren M Rozen; Simon K Siu; Andrew R L Stevenson; Russell Stitz; Yik-Hong Ho Journal: World J Surg Date: 2011-01 Impact factor: 3.352
Authors: Koianka Trencheva; Kevin P Morrissey; Martin Wells; Carol A Mancuso; Sang W Lee; Toyooki Sonoda; Fabrizio Michelassi; Mary E Charlson; Jeffrey W Milsom Journal: Ann Surg Date: 2013-01 Impact factor: 12.969
Authors: Jun Seok Park; Gyu-Seog Choi; Seon Hahn Kim; Hyeong Rok Kim; Nam Kyu Kim; Kang Young Lee; Sung Bum Kang; Ji Yeon Kim; Kil Yeon Lee; Byung Chun Kim; Byung Noe Bae; Gyung Mo Son; Sun Il Lee; Hyun Kang Journal: Ann Surg Date: 2013-04 Impact factor: 12.969