Detection of inadequate anastomotic perfusion with handheld vital microscopy in two patients during colorectal surgery

Arthur L.M. Tavy*, Anton F.J. de Bruin, Mat van Iterson, Anke B. Smits, E. Christaan Boerma, Can Ince, Peter G. Noordzij, Djamila Boerma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Introduction: Anastomotic leakage is one of the most feared complications after gastrointestinal surgery. Assessment of anastomotic viability during surgery remains challenging. Sufficient bowel tissue perfusion is a requisite for anastomotic healing. Handheld vital microscopy (HVM) is a non-invasive technique that can directly visualize the intestinal microcirculation during surgery. Presentation of two cases: Two patients underwent elective laparoscopic colorectal surgery. During surgery HVM was used to assess bowel perfusion prior to creation of a primary anastomosis. Although the bowel macroscopically appeared to be well perfused, HVM showed a severely compromised microcirculation. The colon was re-internalized and during the following minutes cyanosis of the bowel occurred which was visually determined by the surgeon. After dissection towards cranially, a new site for the primary anastomosis was chosen. The postoperative period was uncomplicated. Discussion: Sufficient bowel tissue perfusion is often mentioned as key in the pathophysiology of anastomotic leakage. HVM is a technique that could potentially aid surgeons in the assessment of microcirculatory perfusion of the bowel during surgery. Conclusion: We report two cases undergoing colorectal surgery in which HVM showed merit in detecting compromised bowel perfusion before creation of a primary anastomosis.

Original languageEnglish
Pages (from-to)141-145
Number of pages5
JournalClinical Journal of Gastroenterology
Volume14
Issue number1
Early online date21 Sep 2020
DOIs
Publication statusPublished - Feb 2021

Bibliographical note

Publisher Copyright:
© 2020, Japanese Society of Gastroenterology.

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