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Intramural pH: A quantitative measurement for predicting colorectal anastomotic healing

  • Original Contributions
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Diseases of the Colon & Rectum

Abstract

Leakage and stenosis are serious complications of gastrointestinal anastomotic surgery that may, in part, be related to local ischemia. The ability to accurately quantitate the degree of gastrointestinal anastomotic ischemia remains a challenging clinical problem. The purpose of this study was to: 1) develop a model of colorectal anastomotic stenosis following local ischemia; 2) compare the accuracy of laser Doppler velocimetry and intramural colonic pH in quantitating critical levels of intestinal anastomotic ischemia; and 3) compare the anastomotic healing process using either a standard two-layer Czerny-Lembert handsewn or EEA ™ stapled anastomotic technique under ischemic conditions. The studies reported here were performed in two phases. Phase I was the pilot study in which the authors developed a model of colorectal anastomotic ischemia and defined critical levels of ischemia using laser Doppler velocimetry and intramural pH (≤200 mV; ≤7.0, respectively). These parameters were then tested prospectively in Phase II, assessing the effects of anastomotic ischemia on animals kept alive for 5, 11, 21, and 60 days after surgery. Overall there was a 70 percent incidence of anastomotic healing complications in the Phase II trial with laser Doppler velocimetry correctly predicting anastomotic outcome in 70 percent of cases and tissue pH in 93 percent of cases. The results indicate that, although laser Doppler velocimetry and intramural pH measurements provide safe, easy techniques for assessing the effects of ischemia on the colorectal anastomosis, measurement of intramural pH provides an optimal quantitative method for predicting subsequent anastomotic outcome and tissue viability.

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References

  1. Jex RK, van Heerden JA, Wolff BG, Ready RL, Ilstrup DM. Gastrointestinal anastomoses: factors affecting early complications. Ann Surg 1987;206:138–41.

    PubMed  Google Scholar 

  2. Schrock TR, Deveney CW, Dunphy JE. Factors contributing to leakage of colonic anastomoses. Ann Surg 1973;177:513–8.

    PubMed  Google Scholar 

  3. Stephens FO, Hunt TC. Effect of changes in inspired oxygen and carbon dioxide tensions on wound tensile strength: An experimental study. Ann Surg 1971;173:515–9.

    PubMed  Google Scholar 

  4. Shandall A, Lowndes R, Young HL. Colonic anastomotic healing and oxygen tension. Br J Surg 1985;72:606–9.

    PubMed  Google Scholar 

  5. Cooperman M, Pace WG, Martin EW Jr., et al. Determination of viability of ischemic intestine by Doppler ultrasound. Surgery 1978;83:705–10.

    PubMed  Google Scholar 

  6. Lynch TG, Hobson RW, Kerr JC, et al. Doppler ultrasound, laser doppler, and perfusion fluorometry in bowel ischemia. Arch Surg 1988;123:483–6.

    PubMed  Google Scholar 

  7. Bulkley GB, Zuidema GD, Hamilton SR, et al. Intraoperative determination of small intestinal viability following ischemic surgery. Ann Surg 1981;193:628–37.

    PubMed  Google Scholar 

  8. Carlton MS, Fantini GA, Sammartano RJ, et al. Qualitative and quantitative fluorescein fluorescence in determining intestinal viability. Am J Surg 1984;147:117–23.

    PubMed  Google Scholar 

  9. Wakefield TW, Whitehouse WM Jr., Pittenger GL, et al. Early diagnosis of acute colon ischemia by hollow-viscus tonometry in a canine model. Gastroenterology 1983;84:1344.

    Google Scholar 

  10. Fiddian-Green RG, Anelin PM, Herrmann JB, et al. Prediction of the development of sigmoid ischemia on the day of aortic operating: indirect measurements of intramural pH in the colon. Arch Surg 1986;121:654–60.

    PubMed  Google Scholar 

  11. Schiedler MG, Cutler BS, Fiddian-Green RG. Sigmoid intramural pH for prediction of ischemic colitis during aortic surgery. Arch Surg 1987;122:881–86.

    PubMed  Google Scholar 

  12. Waxman BP. Large bowel anastomoses. II. The circular staplers. Br J Surg 1983;70:64–7.

    PubMed  Google Scholar 

  13. Killingback M. Intrapelvic restorative resection for carcinoma of the large bowel. Hunterian Lecture, Royal College of Surgeons of England; 1981.

  14. Leff E, Hoexter B, Labow SB, Eisenstat TE, Rubin RJ, Salvati EP. The EEA stapler in low colorectal anastomoses: initial experience. Dis Colon Rectum 1982;25:704–7.

    PubMed  Google Scholar 

  15. Silverman DG, Harford WE, Cooper HS, et al. Quantification of fluorescein distribution of strangulated rat ileum. J Surg Res 1983;3:179–186.

    Google Scholar 

  16. Kvietys PR, Shepherd AP and Granger DN. Laser-doppler, H2O clearance and microsphere estimates of mucosal blood flow. Am J Physiol 1985;249:G221.

    PubMed  Google Scholar 

  17. Gana TJ, Huhlewych R, Koo J. Focal gastric mucosal blood flow by laser-doppler and hydrogen gas clearance: A comparative study. J Surg Res 1987;43:337–43.

    PubMed  Google Scholar 

  18. Murakami M, Moriga M, Miyake T, Uchino H. Contact electrode method in hydrogen gas clearance technique: a new method for determination of regional gastric mucosal blood flow in animals and humans. Gastroenterology 1982;82:457.

    PubMed  Google Scholar 

  19. Semb BKH. Gastric flow measured with hydrogen clearance technique. Scand J Gastroenterol 1979;14:641.

    PubMed  Google Scholar 

  20. Granger DN, Kuietys PR. Recent advances in measurement of gastrointestinal blood flow. Gastroenterology 1985;88:1073–6.

    PubMed  Google Scholar 

  21. Shepherd AP, Riedel GL. Continuous measurement of intestinal mucosal blood flow by laser doppler velocimetry. Am J Physiol 1982;242:G668–72.

    PubMed  Google Scholar 

  22. Feld AD, Fondacaro JD, Holloway G, Jacobson ED. Measurement of mucosal blood flow in the canine intestine with laser Doppler velocimetry. Life Sci 1982;31:1509–17.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Research, Ferguson Clinic, 75 Sheldon Blvd., S.E., 49503, Grand Rapids, Michigan

    Anthony Senagore M.D., M.S. & W. Patrick Mazier M.D.

  2. School of Veterinary Medicine, Michigan State University, East Lansing, Michigan

    Anthony Senagore M.D., M.S., Richard K. Walshaw B.V.M.S. & Robert Dunstan D.V.M.

  3. Department of Surgery, Michigan State University, East Lansing, Michigan

    Jeffrey W. Milsom M.D. & Irshad H. Chaudry Ph.D.

  4. Department of Physiology, Michigan State University, East Lansing, Michigan

    Anthony Senagore M.D., M.S. & Irshad H. Chaudry Ph.D.

Authors
  1. Anthony Senagore M.D., M.S.
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  2. Jeffrey W. Milsom M.D.
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  3. Richard K. Walshaw B.V.M.S.
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  4. Robert Dunstan D.V.M.
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  5. W. Patrick Mazier M.D.
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  6. Irshad H. Chaudry Ph.D.
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Senagore, A., Milsom, J.W., Walshaw, R.K. et al. Intramural pH: A quantitative measurement for predicting colorectal anastomotic healing. Dis Colon Rectum 33, 175–179 (1990). https://doi.org/10.1007/BF02134174

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