M J Dworkin1, T G Allen-Mersh. 1. Department of Surgery, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London, England.
Abstract
BACKGROUND: Anastomotic leakage after restorative rectal excision may develop from ischemia associated with inadequate blood flow in the marginal artery-dependent colon. STUDY DESIGN: We have used laser Doppler flowmetry to measure blood flow change during mobilization of the sigmoid colon before excision of the sigmoid colon or rectum in 26 patients and proximal to the colorectal anastomosis during the first five postoperative days in five patients. RESULTS: There was a significant (p < 0.005) fall (median, 50 percent interquartile range, 41 to 86 percent) in sigmoid colon serosal flow after ligation of the inferior mesenteric artery (IMA) and distal marginal artery (DMA) that was not influenced by the order of vessel ligation. No increase in perianastomotic colonic perfusion was detected during the first five postoperative days. CONCLUSIONS: The significant blood flow reduction after ligation of the IMA and DMA supports the hypothesis that anastomotic leakage after restorative rectal excision may result from ischemia associated with inadequate blood flow in the marginal artery-dependent sigmoid colon. Improvement in inadequate intraoperative colonic perfusion from increased collateral circulation is unlikely to develop in the marginal artery-dependent colon during the first five postoperative days.
BACKGROUND:Anastomotic leakage after restorative rectal excision may develop from ischemia associated with inadequate blood flow in the marginal artery-dependent colon. STUDY DESIGN: We have used laser Doppler flowmetry to measure blood flow change during mobilization of the sigmoid colon before excision of the sigmoid colon or rectum in 26 patients and proximal to the colorectal anastomosis during the first five postoperative days in five patients. RESULTS: There was a significant (p < 0.005) fall (median, 50 percent interquartile range, 41 to 86 percent) in sigmoid colon serosal flow after ligation of the inferior mesenteric artery (IMA) and distal marginal artery (DMA) that was not influenced by the order of vessel ligation. No increase in perianastomotic colonic perfusion was detected during the first five postoperative days. CONCLUSIONS: The significant blood flow reduction after ligation of the IMA and DMA supports the hypothesis that anastomotic leakage after restorative rectal excision may result from ischemia associated with inadequate blood flow in the marginal artery-dependent sigmoid colon. Improvement in inadequate intraoperative colonic perfusion from increased collateral circulation is unlikely to develop in the marginal artery-dependent colon during the first five postoperative days.
Authors: Henry Hoffmann; Tarik Delko; Philipp Kirchhoff; Rachel Rosenthal; Juliane Schäfer; Marko Kraljević; Christoph Kettelhack Journal: World J Surg Date: 2017-11 Impact factor: 3.352
Authors: T Urade; R Fujinaka; T Abe; K Murata; Y Mii; H Sawa; M Man-I; S Oka; Y Iwatani; D Kuroda Journal: Tech Coloproctol Date: 2018-09-18 Impact factor: 3.781