Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak

Andrea Vignali, Luca Gianotti, Marco Braga, Giovanni Radaelli, Leopolde Malvezzi, Valerio Di Carlo

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: The aim of this study was to evaluate the reliability of intraoperative laser-Doppler measurements in predicting the occurrence of anastomotic leak in patients with colorectal cancer undergoing stapled straight anastomosis to the rectum. METHODS: A prospective study was undertaken on 55 patients with rectal cancer or distal sigmoid cancer programmed for elective curative surgery. In all patients transmural colonic blood flow was measured by laser-Doppler flowmetry technique before bowel manipulation (baseline measurement) and after vascular ligation and division. Comorbidities at admission, intraoperative events, associated surgical procedures, and clinical outcome were tested for any association with anastomotic leak. RESULTS: Postoperative mortality was 1.8 percent (1/55 patients), and the overall morbidity was 21.3 percent. Anastomotic leak occurred in eight patients (14.5 percent). After colonic division a blood flow reduction at the rectal stump was observed in 42 patients (76.3 percent) as compared with baseline measurement. The mean rectal stump flow reduction was 6.2 percent in patients without anastomotic leak, whereas in patients who developed anastomosis breakdown it was 16 percent (P <0.001). Mean proximal stump flow reduction was 5.1 percent in the uncomplicated patients, whereas in patients who had an anastomosis breakdown it was 12.9 percent (P <0.01). A positive linear correlation was found between decrease in blood flow and rate of anastomotic leak. CONCLUSION: Blood flow reduction at the rectal stump is associated with an increased risk of anastomotic leak.

Original languageEnglish
Pages (from-to)76-82
Number of pages7
JournalDiseases of the Colon and Rectum
Volume43
Issue number1
Publication statusPublished - Jan 2000

Keywords

  • Anastomotic dehiscence
  • Blood flow
  • Colon surgery
  • Laser Doppler flowmetry
  • Rectal surgery
  • Surgical staplers

ASJC Scopus subject areas

  • Gastroenterology

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