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Vol. 25, Art. 29 (pp. 542-578)    |    2024       

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Microcirculation and oxydative metabolism measured by laser doppler flowmetry and laser fluorescent spectroscopy and it’s 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

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

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