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Intraoperative colonic pulse oximetry in left-sided colorectal surgery: can it predict anastomotic leak?

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Abstract

Background

An anastomotic leak is a fairly common and a potentially lethal complication in colorectal surgery. Objective methods to assess the viability and blood circulation of the anastomosis could help in preventing leaks. Intraoperative pulse oximetry is a cheap, easy to use, fast, and readily available method to assess tissue viability. Our aim was to study whether intraoperative pulse oximetry can predict the development of an anastomotic leak.

Methods

The study was a prospective single-arm study conducted between the years 2005 and 2011 in Helsinki University Hospital. Patient material consisted of 422 patients undergoing elective left-sided colorectal surgery. The patients were operated by one of the three surgeons. All of the operations were partial or total resections of the left side of the colon with a colorectal anastomosis. The intraoperative colonic oxygen saturation was measured with pulse oximetry from the colonic wall, and the values were analyzed with respect to post-operative complications.

Results

2.3 times more operated anastomotic leaks occurred when the colonic StO2 was ≤ 90% (11/129 vs 11/293). The mean colonic StO2 was 91.1 in patients who developed an operated anastomotic leak and 93.0 in patients who did not. With logistic regression analysis, the risk of operated anastomotic leak was 4.2 times higher with StO2 values ≤ 90%.

Conclusions

Low intraoperative colonic StO2 values are associated with the occurrence of anastomotic leak. Despite its handicaps, the method seems to be useful in assessing anastomotic viability.

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Authors and Affiliations

  1. Department of Surgery, Päijät-Häme Central Hospital and University of Helsinki, Keskussairaalankatu 7, Lahti, 15850, Finland

    Johannes M. Salusjärvi

  2. University of Helsinki, Helsinki, Finland

    Johannes M. Salusjärvi & Johanna M. Louhimo

  3. Department of Surgery, Abdominal Center, Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029, Helsinki, HUS, Finland

    Monika A. Carpelan-Holmström, Johanna M. Louhimo, Olli Kruuna & Tom M. Scheinin

Authors
  1. Johannes M. Salusjärvi
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  2. Monika A. Carpelan-Holmström
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  3. Johanna M. Louhimo
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  4. Olli Kruuna
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  5. Tom M. Scheinin
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Corresponding author

Correspondence to Johannes M. Salusjärvi.

Ethics declarations

The acquisition of this data was approved by our institutional review board. All of the patients were treated by the local standard of care.

Conflict of interest

The authors declare that they have no conflict of interest.

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Salusjärvi, J.M., Carpelan-Holmström, M.A., Louhimo, J.M. et al. Intraoperative colonic pulse oximetry in left-sided colorectal surgery: can it predict anastomotic leak?. Int J Colorectal Dis 33, 333–336 (2018). https://doi.org/10.1007/s00384-018-2963-4

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  • DOI: https://doi.org/10.1007/s00384-018-2963-4

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