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