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Vol. 25, Art. 22 (pp. 383-421)    |    2024       

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Microcirculation and oxydative metabolism measured by laser doppler flowmetry and laser fluorescent spectroscopy and its role in bowel anastomosis leakage assessment

Trushin A.A., *Kursenko R.V., Vervekin I.V., Ten O.A., Belyaev M.A., Zakharenko A.A.

First Pavlov State Medical University of St. Petersburg

Brief summary

Background. Intraoperative objective noninvasive assessment of bowel viability has remained unresolved surgical problem. Laser fluorescent spectroscopy (LFS) of oxidative metabolism and laser doppler flowmetry (LDF) of microcirculation were shown as promising tools in previous experimental studies. Reference numerical rates of LDF and LFS for intraoperative bowel viability assessment and it?s role in anastomotic leakage risk assessment are seemed to be useful in clinical practice. Materials and methods. LDF and LFS numerical rates of small bowel and colon were assessed during elective right hemicolectomy after vascular mobilisation. Frequency of anastomotic leakage and LDF and LFS rates in that cases were analysed. LDF and LFS were analysed as diagnostic tools in anastomotic leakage risk assessment. Results. N=103 patients were included in study. Mean LDF and LFS rates in viable bowel segments were 27,7+/-1,54p.u. and 1,19+/-0,21r.u. Anastomotic leakage frequency was 10,7% (n=11). It was significant microcirculation and oxidative metabolism deterioration by LDF and LFS in anastomotic leakage cases. Decrease of LDF in more than 24,5% and increase of LFS in more than 88,1% were significant risk factors of anastomotic leakage (p<0,0001). Conclusion. Microcirculation and oxidative metabolism deterioration of bowel diagnosed intraoperatively by LDF and LFS are significant risk factors for anastomotic leakage. LDF and LFS are clinically useful for intraoperative bowel viability assessment.


Key words

microcirculation; anastomotic leakage; bowel viability; autofluorescence; NADH

Reference list

Sartelli M. The challenge of post-operative peritonitis after gastrointestinal


surgery. Updates Surg. 2015; 67(4): 373-381.


2. 2015 European Society of Coloproctology collaborating group. The relationship


between method of anastomosis and anastomotic failure after right


hemicolectomy and ileocaecal resection: an international snapshot audit.


Colorectal Dis. 2017; 38(1): 42-49.


3. Kashenko V.A., Lodigin A.V., Volkova E.S. i dr. ICG-flyorescentnaya


navigaciya v kolorektalnoi hiryrgii. Klinicheskaya bolnica. 2019; (28)2:


12-17. [Kashchenko V.A., Lodygin A.V., Volkova E.S., Napalkov A.N.,


Korobicyna A.M. ICG-fluorescent navigation in colorectal surgery. The


Hospital No 2. 2019; 2(28): 12-7. (in Russian)].


4. Dyess D.L., Bruner B.W., Donnell C.A., et al. Intraoperative evaluation of


intestinal ischemia: a comparison of methods. South Med. J. 1991; 84(8): 966-


974.


5. Kingham T.P., Pachter H.L. Colonic Anastomotic Leak: Risk Factors,


Diagnosis, and Treatment. J. Am. College Surg. 2009(2): 269-278.


6. Urbanavičius L., Pattyn P., Putte D.V., Venskutonis D. How to assess intestinal


viability during surgery: A review of techniques. World J. Gastrointest Surg.


2011; 3(5): 59-69.


7. Horgan P.G., Gorey T.F. Operative assessment of intestinal viability. Surg. Clin.


North Am. 1992; 72: 143-155.


MEDLINE.RU, TOM 25, HIRYRGIYa, 10 IUNYa 2024


419


8. Karliczek A., Harlaar N.J., Zeebregts C.J.. et al. Surgeons lack predictive


accuracy for anastomotic leakage in gastrointestinal surgery. Int. J. Colorectal


Dis. 2009; 24(5). 569-576.


9. Bulkley G.B., Zuidema G.D., Hamilton S.R., et al. Intraoperative determination


of small intestinal viability following ischemic injury: a prospective, controlled


trial of two adjuvant methods (Doppler and fluorescein) compared with standard


clinical judgment. Ann. Surg. 1981; 193: 628-637.


10. Strand-Amundsen R.J., Reims H.M., Reinholt F.P., et al. Ischemia/reperfusion


injury in porcine intestine - Viability assessment. World J. Gastroenterol. 2018;


24(18): 2009-2023.


11. Vignali A., Gianotti L., Braga M., et al. Altered microperfusion at the rectal


stump is predictive for rectal anastomotic leak Dis. Colon Rectum. 2000; 43(1):


76-82.


12. Chiu C.J., McArdle A.H., Brown R., et al. Intestinal mucosal lesion in low-flow


states. Arch. Surg. 1970; 101(4): 478-483. doi: 10.1001/


archsurg.1970.01340280030009.


13. Blikslager A.T., Moeser A.J., Gookin J.L., et al. Restoration of barrier function


in injured intestinal mucosa. Physiol. Rev. 2007; 87: 545-564.


14. Vlasov T.D., Kornushin O.V., Papayan G.V. Vozmojnosti


aytoflyorescentnoi organoskopii pri ishemicheskom i reperfyzionnom


povrejdenii tonkoi kishki in vitro. Regionarnoe krovoobrashenie i


mikrocirkylyaciya. 2009; 2: 73-75. [Vlasov T.D., Kornjushin O.V., Papajan


G.V. Possibilities of autofluorescence organoscopy in ischemic and reperfusion


injury of the small intestine in vitro. Regionarnoe krovoobrashhenie i


mikrocirkuljacija. 2009; 2: 73-75. (In Russian)].


15. Rose, J. High-resolution intravital NADH fluorescence microscopy allows


measurements of tissue bioenergetics in rat ileal mucosa. Microcirculation.


2006; 13(1): 41-47.


MEDLINE.RU, TOM 25, HIRYRGIYa, 10 IUNYa 2024


420


16. Sidorov V.V., Ribakov U.A., Gykasov V.M. Diagnosticheskii podhod dlya


ocenki sostoyaniya mikrocikylyatorno-tkanevoi sistemi s ispolzovaniem


lazernih tehnologii i temperatyrnoi fykcionalnoi probi. Innovatika


i ekspertiza. 2018; 22(1): 135-141. [Sidorov V.V., Rybakov Ju.A., Gukasov


V.M. A diagnostic approach to assessing the state of the microcirculatory tissue


system using laser technologies and temperature functional testing. Innovatika i


jekspertiza. 2018; 22(1): 135-141. (In Russian)].


17. Klauke H., Minor T., Vollmar B., et al. Microscopic analysis of NADH


fluorescence during aerobic and anaerobic liver preservation conditions: A


noninvasive technique for assessment of hepatic metabolism. Cryobiology.


1998; 36(2): 108-114. doi: 10.1006/cryo.1997.2068.


18. Zaharenko A.A., Belyaev M.A., Tryshin A.A., i dr. Kombinirovannaya ocenka


jiznesposobnosti kishki metodami lazernoi dopplerovskoi floymetrii


i lazernoi flyorescentnoi spektroskopii. Regionarnoe krovoobrashenie


i mikrocirkylyaciya. 2021; 20(2): 70-76. https://doi.org/10.24884/1682-6655-


2021-20-2-70-76 [Zaharenko A.A., Beljaev M.A., Trushin A.A., et al.


Combined assessment of intestinal viability using laser Doppler flowmetry and


laser fluorescence spectroscopy. Regionarnoe krovoobrashhenie i


mikrocirkuljacija. 2021; 20(2): 70-76. (In Russian)].


19. Hripyn A.I., Pryamikov A.D., Shyrigin S.N., i dr. Lazernaya


dopplerovskaya floymetriya v vibore obema rezekcii kishechnika y


bolnih ostrim arterialnim narysheniem mezenterialnogo


krovoobrasheniya. Hiryrgiya. Jyrnal im. N.I. Pirogova. 2012; 10: 40-44.


[Hripun A.I., Prjamikov A.D., Shurygin S.N., et al. Laser Doppler flowmetry in


choosing the volume of intestinal resection in patients with acute arterial


disturbance of mesenteric circulation. Hirurgija. Zhurnal im. N.I. Pirogova.


2012; 10: 40-44. (In Russian)].


20. Belyaev A.M., Syrov D.A., Semencov K.V. Odnoetapnie operacii pri


levostoronnei tolstokishechnoi neprohodimosti. Vestnik hiryrgii im.


I.I. Grekova. 2010; 169(4): 36-38. [Beljaev A.M., Surov D.A., Semencov K.V.


One-stage operations for left-sided colonic obstruction. Vestnik hirurgii im. I.I.


Grekova. 2010; 169(4): 36-38. (In Russian)]

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