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Colon Perfusion Patterns During Colorectal Resection Using Visible Light Spectroscopy

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Abstract

Background

The impact of blood supply to the anastomosis on development of anastomotic leakage is still a matter of debate. Considering that bowel perfusion may be affected by manipulation during surgery, perfusion assessment of the anastomosis alone may be of limited value. We propose perfusion assessment at different time points during surgery to explore the dynamics of bowel perfusion during colorectal resection and its impact on outcome.

Methods

In this prospective cohort study, patients undergoing elective colorectal resection were eligible. Colon perfusion was evaluated using visible light spectroscopy. Main outcome was the difference in colon perfusion, quantified by measuring tissue oxygen saturation (StO2) in the colonic serosa, before and after anastomosis during surgery.

Results

We included 58 patients between July 2013 and November 2015. Colon perfusion increased by an average of 5.9% StO2 during surgery (95% confidence interval 3.1, 8.8; P < 0.001). The number of patients with abnormal perfusion (defined as StO2 < 65%) decreased from 50% at the beginning to 24% by the end of surgery. Six patients (10%) developed anastomotic leaks (AL), of which five patients had abnormal perfusion at the beginning of surgery, whereas four patients had normal StO2 at the anastomosis.

Conclusion

Colon perfusion significantly increased during colorectal surgery. Considering that one quarter of patients had suboptimal anastomotic perfusion without developing AL, impaired blood flow at the anastomosis alone does not seem to be critical. Further investigations including more patients are necessary to evaluate the impact of perioperative parameters on colon perfusion, anastomotic healing and surgical outcome.

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Acknowledgements

This study was funded by the Voluntary Academic Society (FAG) Basel (Switzerland) and the Gottfried and Julia Bangerter-Rhyner Foundation, Basel (Switzerland). The Basel Institute for Clinical Epidemiology and Biostatistics is supported by grants from Santésuisse and from the Gottfried and Julia Bangerter-Rhyner Foundation.

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Author notes

  1. Henry Hoffmann and Tarik Delko contribute equally as first authors.

Authors and Affiliations

  1. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Henry Hoffmann, Tarik Delko, Philipp Kirchhoff, Rachel Rosenthal, Juliane Schäfer, Marko Kraljević & Christoph Kettelhack

  2. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

    Juliane Schäfer

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  1. Henry Hoffmann
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  2. Tarik Delko
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  4. Rachel Rosenthal
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Corresponding author

Correspondence to Henry Hoffmann.

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Conflicts of interest

All authors state that there are no conflicts of interest regard the manuscript. Rachel Rosenthal has been an employee of F. Hoffmann-La Roche Ltd since May 1, 2014. The present study has no connection to her employment by the company. Rachel Rosenthal continues to be affiliated with the University of Basel. Juliane Schäfer has been an employee of F. Hoffmann-La Roche Ltd since December 1, 2016. The present study has no connection to her employment by the company.

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Hoffmann, H., Delko, T., Kirchhoff, P. et al. Colon Perfusion Patterns During Colorectal Resection Using Visible Light Spectroscopy. World J Surg 41, 2923–2932 (2017). https://doi.org/10.1007/s00268-017-4100-x

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  • DOI: https://doi.org/10.1007/s00268-017-4100-x

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