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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Intraoperative microperfusion patterns during colorectal resection: Preliminary results of 22 patients

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  • Henry Hoffmann - Universitätsspital Basel, Allgemein- und Viszeralchirurgie, Basel, Schweiz

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch203

doi: 10.3205/15dgch203, urn:nbn:de:0183-15dgch2031

Published: April 24, 2015

© 2015 Hoffmann.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: Impairment of intestinal microperfusion at the anastomotic site is one of the most important risk factors for anastomotic leakage (AL). Visual assessment of intestinal microperfusion during surgery by surgeons has been found to be inefficient to predict AL. However, microperfusion patterns during surgery are unknown and reliable intraoperative assessment of intestinal microperfusion is not established yet.

Material and methods: Patients undergoing colorectal resection initiating in July 2013 were consecutively recruited. Six microperfusion measurements were conducted during colorectal resection at different sites of the colon using a Visible Light Spectroscope (VLS). They have been perfomed as follows. Reference measurement at the caecum (M1) and proximal to planned resection margin (M2). After mobilization: proximal (M3) and distal (M4) to the resection margins. After anastomosis: 1-2cm proximal (M5) and distal (M6) to the anastomosis.

Results: 22 patients with median age of 70y (IQR 60; 79) were included. Main operation was laparoscopic sigmoidectomy (n=9, 41%). Median duration of VLS measurement was 1:49 min (IQR 1:15, 5:10). The following median (IQR) serosal StO2 levels were observed: M1: 66% (60; 70), M2: 66% (56; 68), M3: 67% (54; 76), M4: 67% (48; 74), M5: 70% (56; 76), M6: 71% (61; 75). Three AL occurred, showing poor StO2 levels during reference measurements at M1 (41%, 50%, 58%) and M2 (49%, 50%, 53%) and decelerated increase of StO2 in those patients during surgery.

Conclusion: Intraoperative microperfusion patterns during colorectal resection seems feasible and of clinical importance. The median StO2 levels during surgery (M1 to M6) show an increasing trend during surgery with individual differences. The IQR range was narrow during reference measurements (M1, M2) and at the anastomotic site (M5, M6), but showed increasing variability during mobilization (M3, M4). However, more patients need to be included to obtain a more substantial impression of intestinal microperfusion patterns during colorectal resection with the ultimate goal of correlation of serosal StO2 levels of the colon and patient outcome.

Figure 1 [Fig. 1]